What are the diagnostic criteria and treatment options for Obsessive-Compulsive Disorder (OCD)?

From the Guidelines

Obsessive-Compulsive Disorder (OCD) is diagnosed when a person experiences recurrent, unwanted obsessions and/or compulsions that cause significant distress and impairment, and treatment typically involves a combination of psychotherapy and medication, with Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) being the first-line treatments.

Diagnostic Criteria

The diagnostic criteria for OCD, as outlined in the DSM-5 1, include the presence of obsessions, compulsions, or both, which are time-consuming, cause clinically significant distress or impairment, and are not attributable to another medical condition or substance use.

• Obsessions are defined as recurrent and persistent thoughts, urges, or impulses that are experienced as intrusive and unwanted, and cause marked anxiety or distress.
• Compulsions are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

Assessment and Treatment

A comprehensive assessment, including a detailed psychiatric history and mental status examination, is essential for diagnosing OCD and determining the appropriate treatment plan 1.

• The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Children’s Y-BOC (CY-BOCS) are widely used to assess OCD symptom severity.
• CBT, particularly Exposure and Response Prevention (ERP), is the first-line psychological treatment for OCD, involving gradual exposure to feared situations while preventing compulsive responses 1.
• Medication options include SSRIs, such as fluoxetine, sertraline, escitalopram, or fluvoxamine, which are typically continued for 12-24 months after symptom improvement.

Treatment Resistance

For treatment-resistant cases, augmentation with antipsychotics like risperidone or aripiprazole may be considered, and combinatorial therapy with CBT and SSRIs can also be effective 1.

• The neurobiological basis of OCD involves dysregulation in cortico-striatal-thalamic-cortical circuits and serotonin/dopamine neurotransmitter systems, explaining why both behavioral interventions and medications targeting these neurotransmitters can be effective.

From the FDA Drug Label

Obsessions are recurrent, persistent ideas, thoughts, images, or impulses that are ego-dystonic. Compulsions are repetitive, purposeful, and intentional behaviors performed in response to an obsession or in a stereotyped fashion, and are recognized by the person as excessive or unreasonable The obsessions or compulsions must cause marked distress, be time-consuming, or significantly interfere with social or occupational functioning, in order to meet the DSM-III-R (circa 1989) diagnosis of OCD

The diagnostic criteria for Obsessive-Compulsive Disorder (OCD) include:

• Recurrent, persistent ideas, thoughts, images, or impulses that are ego-dystonic (obsessions)
• Repetitive, purposeful, and intentional behaviors performed in response to an obsession or in a stereotyped fashion (compulsions)
• The obsessions or compulsions must cause marked distress, be time-consuming, or significantly interfere with social or occupational functioning The diagnosis of OCD is based on the DSM-III-R criteria 2.

Treatment options for OCD include:

• Clomipramine (PO) 2
• Fluoxetine (PO) 3
• Sertraline (PO) 4

From the Research

Diagnostic Criteria for Obsessive-Compulsive Disorder (OCD)

• The diagnosis of OCD is typically made using a combination of clinical interviews and assessment tools, such as the Yale-Brown Obsessive-Compulsive Scale (YBOCS) 5, 6.
• A semi-structured clinician-administered interview, such as the Structured Clinical Interview for Diagnosing Obsessive-Compulsive Spectrum Disorders (SCID-OCSD), can be used to assess for OCD and other related disorders 6.
• The SCID-OCSD assesses disorders drawn from several diagnostic categories that share some core features of obsessive-compulsive phenomenology, including obsessive-compulsive related disorders, impulse-control disorders, and a spectrum of compulsive-impulsive conditions 6.

Treatment Options for OCD

• Established treatments for OCD include cognitive behavior therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication 7, 8.
• Combined treatment with CBT and SSRI may be more effective than monotherapy, especially in the short-term 7.
• SSRIs, such as sertraline and fluoxetine, are effective in reducing symptoms of OCD in adults and children 7, 8, 9.
• CBT, particularly exposure and response prevention (ERP), is also an effective treatment for OCD and can be used alone or in combination with medication 7, 8, 9.

Assessment and Treatment Considerations

• Evidence-based assessments (EBAs) are essential for the accurate diagnosis and treatment of OCD 5.
• The use of structured and semistructured clinician-administered interviews, parent-report and child-report, and self-report measures can help determine the presence and severity of OCD symptoms 5.
• Treatment planning should take into account the individual's specific needs and circumstances, including the presence of comorbid conditions and the potential for treatment resistance 8, 6.