What is Obsessive-Compulsive Disorder (OCD) and how is it treated?

Obsessive-Compulsive Disorder (OCD) is a condition characterized by obsessive thoughts and compulsive behaviors that can significantly impair functioning ¹.

Management includes assessment of severity and risk, including suicide risk, and consideration of comorbidities and safeguarding issues ¹.

For adults with mild functional impairment, psychological interventions such as referral to NHS Talking Therapies for low-intensity cognitive-behavioural therapy (CBT), including exposure and response prevention (ERP), are recommended ¹.

Adults with moderate impairment should be offered either intensive CBT including ERP or a selective serotonin reuptake inhibitor (SSRI), with the choice depending on patient preference and response ¹.

For severe impairment, combined treatment with an SSRI and CBT including ERP is advised ¹.

In children and young people, evidence-based treatments such as CBT involving family or carers are recommended, with guided self-help considered for mild cases, and more intensive CBT for moderate to severe cases ².

Pharmacological treatments include SSRIs (such as fluoxetine, fluvoxamine, paroxetine, sertraline, and escitalopram) and clomipramine, with the latter considered if SSRIs are contraindicated or not effective ¹.

When stopping medication, doses should be tapered gradually over several weeks, and psychological treatment should continue during drug discontinuation to reduce relapse risk ².

In cases of severe, chronic, or treatment-refractory OCD, specialist multidisciplinary teams and inpatient services may be involved, with neurosurgery considered only in exceptional cases after careful assessment ¹.