What is Obsessive-Compulsive Disorder (OCD)?

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Last updated: April 16, 2025 • View editorial policy

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From the Guidelines

The most effective treatment for Obsessive-Compulsive Disorder (OCD) is a combination of cognitive-behavioral therapy (CBT), specifically Exposure and Response Prevention (ERP), and medication, with Selective Serotonin Reuptake Inhibitors (SSRIs) being the preferred medications 1.

Treatment Overview

The treatment of OCD involves psychotherapy and pharmacotherapy, with guidelines recommending CBT as the initial treatment for OCD 1. Computer and internet-based treatment is a promising way to overcome barriers to therapy, such as poor help-seeking behavior and inaccessible treatment 1.

Medication

SSRIs, including fluoxetine, sertraline, paroxetine, or escitalopram, are effective in treating OCD, typically requiring 8-12 weeks at adequate doses to show effectiveness 1.

Therapy

ERP therapy involves gradually facing feared situations while preventing compulsive responses, typically requiring 12-20 weekly sessions 1.

Quality of Life

OCD is associated with considerable comorbidity and morbidity, as well as significantly reduced quality of life (QOL), which can be improved with efficacious pharmacotherapy and psychotherapy 1.

  • Key factors associated with decreased QOL in OCD include:
    • Severity of illness
    • Presence of comorbid depression
    • Certain symptom dimensions, such as hoarding
  • Treatment should aim not only for treatment response but also for symptom remission to improve QOL 1.

From the FDA Drug Label

Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of obsessions and compulsions in patients with obsessive-compulsive disorder (OCD), as defined in the DSM-III-R; i.e., the obsessions or compulsions cause marked distress, are time-consuming, or significantly interfere with social or occupational functioning. Obsessive-compulsive disorder is characterized by recurrent and persistent ideas, thoughts, impulses, or images (obsessions) that are ego-dystonic and/or repetitive, purposeful, and intentional behaviors (compulsions) that are recognized by the person as excessive or unreasonable. The efficacy of sertraline was established in 12-week trials with obsessive-compulsive outpatients having diagnoses of obsessive-compulsive disorder as defined according to DSM-III or DSM-III-R criteria

Sertraline is indicated for the treatment of OCD. The efficacy of sertraline in treating OCD was established in 12-week trials with obsessive-compulsive outpatients.

  • Key characteristics of OCD include:
    • Recurrent and persistent ideas, thoughts, impulses, or images (obsessions)
    • Repetitive, purposeful, and intentional behaviors (compulsions)
    • Marked distress, time-consuming, or significant interference with social or occupational functioning 2

PAXIL is indicated for the treatment of obsessions and compulsions in patients with obsessive compulsive disorder (OCD) as defined in the DSM-IV. The obsessions or compulsions cause marked distress, are time-consuming, or significantly interfere with social or occupational functioning. Obsessive compulsive disorder is characterized by recurrent and persistent ideas, thoughts, impulses, or images (obsessions) that are ego-dystonic and/or repetitive, purposeful, and intentional behaviors (compulsions) that are recognized by the person as excessive or unreasonable.

Paroxetine is also indicated for the treatment of OCD. The efficacy of paroxetine in treating OCD was established in 12-week trials with obsessive-compulsive outpatients.

  • Key characteristics of OCD include:
    • Recurrent and persistent ideas, thoughts, impulses, or images (obsessions)
    • Repetitive, purposeful, and intentional behaviors (compulsions)
    • Marked distress, time-consuming, or significant interference with social or occupational functioning 3

From the Research

Treatment Options for OCD

  • First-line treatments for OCD include serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) 4
  • For treatment-resistant OCD, several strategies have been investigated, including:
    • Antipsychotic addition to SRIs, with positive results for haloperidol, pimozide, risperidone, paliperidone, olanzapine, quetiapine, and aripiprazole 4
    • CBT addition to medication, with positive results in two randomized controlled trials (RCTs) 4
    • Switch to intravenous clomipramine (SRI) administration, with positive results in two RCTs 4
    • Switch to paroxetine (SSRI) or venlafaxine (SNRI) when the first trial was negative, with positive results in one RCT 4
    • Addition of medications other than antipsychotics to SRIs, with limited positive results 4

Combination Treatment for OCD

  • Combination treatment with clomipramine and selective serotonin reuptake inhibitors (SSRIs) has been found to be effective in children and adolescents with OCD, with treatment effects persisting through 5 to 22 months of follow-up 5
  • The use of clomipramine and SSRI combination therapy was found to be more effective compared with their monotherapy in all 7 cases studied 5
  • However, combination treatment may increase the risk of side effects, such as cardiovascular side effects, serotonin syndrome, manic switch, insomnia, and possibly headaches, EPS, and sexual dysfunction 5

Guidelines for OCD Treatment

  • NICE guidelines suggest that low-intensity psychological treatments, including exposure and response prevention (ERP), are the first-line treatment for OCD, with combination treatment reserved for adults with severe functional impairment or inadequate response to monotherapy 6
  • US treatment guidelines suggest that there are three first-line treatments for OCD: SSRI, CBT, and SSRI+CBT, with combined treatment recommended for patients with unsatisfactory response to monotherapy or severe OCD 6
  • A systematic review and meta-analysis found that combination treatment was not significantly better than CBT plus placebo, but a recent systematic and meta-analysis found that combination treatment was likely to be more effective than psychotherapeutic interventions alone, at least in severe OCD 6

Efficacy of Selective Serotonin Reuptake Inhibitors

  • Selective serotonin reuptake inhibitors (SSRIs) have been found to be effective in the treatment of OCD, with similar efficacy to clomipramine but a superior side effect profile 7
  • A meta-analysis found that SSRIs had similar efficacy to clomipramine, but with fewer side effects 7
  • A randomized controlled trial found that paroxetine was as effective as clomipramine, but with significantly fewer dropouts due to adverse effects 7

Cognitive Therapy for OCD

  • The addition of cognitive therapy to exposure and response prevention (ERP) has been found to enhance clinical efficacy in the treatment of OCD, with significantly greater symptom and belief reduction compared to ERP alone 8
  • A randomized controlled trial found that ERP+Cognitive Therapy (CT) led to significantly greater symptom and belief reduction as compared to ERP across all main symptom presentations of OCD 8
  • The results of this study suggest that cognitive therapy can be readily integrated with ERP to improve clinical outcomes beyond ERP alone 8

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

6
Research

Optimizing first line treatments for adults with OCD.

Comprehensive psychiatry, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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