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Clinical Condition Guide

Obsessive-Compulsive
Disorder (OCD)

A chronic condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce distress.

  • 2-3%
    Prevalence
  • ~19
    Onset Age
  • 1:1
    Ratio
  • 60-70%
    Response Rate

DSM-5-TR Diagnostic Criteria

  • Obsessions

    Intrusive and unwanted thoughts

    • • Recurrent, persistent thoughts, urges, or images experienced as intrusive and unwanted
    • • Person attempts to ignore, suppress, or neutralize with another thought or action

  • Compulsions

    Repetitive behaviors or mental acts

    • • Repetitive behaviors or mental acts performed in response to obsessions
    • • Aimed at preventing or reducing distress, but not connected realistically or clearly excessive

  • Additional Criteria

    Diagnostic requirements:

    • • Obsessions/compulsions are time-consuming (>1 hour/day) or cause significant distress
    • • Not attributable to substance use or medical condition
    • • Not better explained by another mental disorder

Assessment Protocols

Validated tools for screening and severity tracking

  • Y-BOCS

    Yale-Brown Obsessive Compulsive Scale

    Criterion-standard severity measure. 10 items assessing obsessions and compulsions.

    Scoring:

    0-7: Subclinical | 8-15: Mild | 16-23: Moderate | 24-31: Severe | 32-40: Extreme

    Time:15-20 minutes

  • OCI-R

    Obsessive-Compulsive Inventory-Revised

    Brief 18-item self-report covering 6 OCD symptom dimensions.

    Scoring:

    Cut-off score: 21+ suggests clinically significant OCD symptoms

    Time:5-10 minutes

  • DOCS

    Dimensional Obsessive-Compulsive Scale

    Assesses 4 primary OCD dimensions: contamination, responsibility, symmetry, taboo thoughts.

    Scoring:

    Provides subscale scores for different OCD presentations

    Time:10-15 minutes

Causes & Etiology

  • Neurobiological

    • CSTC circuit dysfunction
    • Serotonin dysregulation
    • Elevated activity in orbitofrontal cortex and anterior cingulate
    • Reduced caudate nucleus volume in some studies

  • Genetic

    • Heritability: 45-65%
    • Polygenic inheritance
    • SLC1A1, DLGAP3, BTBD3 genes implicated
    • 10x increased risk with first-degree relative

  • Environmental

    • Childhood trauma
    • PANDAS/PANS
    • Stressful life events
    • Parental accommodation

  • Cognitive

    • Inflated sense of responsibility
    • Thought-action fusion
    • Intolerance of uncertainty
    • Overestimation of threat

Scientific Sources

Evidence-Based

  • Y-BOCS Validation

    Goodman WK, Price LH, et al. The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006-1011.

  • DSM-5-TR Criteria

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.

  • ERP Treatment Efficacy

    Olatunji BO, Davis ML, et al. Cognitive-behavioural therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome. Clin Psychol Rev. 2013;33(8):1206-1217.

  • Neurobiological Model

    Menzies L, Chamberlain SR, et al. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder. Neurosci Biobehav Rev. 2008;32(3):525-549.

  • SSRI Pharmacotherapy

    Soomro GM, Altman D, et al. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev. 2008;(1):CD001765.

  • Comorbidity Patterns

    Ruscio AM, Stein DJ, et al. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(1):53-63.

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