Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental health disorder which is characterised by obsessions, compulsions, or both.

• Obsessions are stressful thoughts which recur despite attempts to ignore them.
• Compulsions are rituals performed by the patient, and are often repetitive behaviours. 
  • Often patients perform compulsions to seek relief from their obsessions.

  

Diagnosis of OCD

The ICD-10 criteria for OCD for a diagnosis of OCD are the presence of recurrent, obsessional thoughts or compulsive acts:

• Obsessional thoughts:
  • Ideas, images, impulses which enter someone's mind and are invariably distressing. 
• Compulsive acts or rituals:
  • Repeated, non-useful & stereotyped behaviours, often performed to prevent an unlikely but negative or harmful event. 
  • For example, hand-washing, counting, checking things repeatedly. 

 

Management of obsessive-compulsive disorder

 

Management should be based upon the degree of functional impairment the OCD is causing the patient. 

 

Mild functional impairment

• 1st Line: Low intensity CBT including ERP (exposure and response prevention)
• 2nd line: treat as per moderate impairment 

 

Moderate functional impairment

• 1st Line:  intensive CBT (including ERP) or SSRI (or clomipramine (TCA) as an alternative)

 

Severe functional impairment

• 1st Line:  SSRI  AND  intensive CBT

  

References and Further Reading

  NICE CKS- Obsessive Compulsive Disorder [revised February 2024]