Obsessive-compulsive disorder

Last reviewed: 26 Aug 2023
Last updated: 22 Jul 2022



History and exam

Key diagnostic factors

  • obsessions
  • compulsions
  • sensory phenomena
  • schizotypal personality disorder
  • tic disorder
  • poor motor coordination
  • sensory perceptual difficulties
  • difficulties in sequencing of complex motor tasks
More key diagnostic factors

Other diagnostic factors

  • male sex
Other diagnostic factors

Risk factors

  • family history of OCD
  • PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection)
  • pregnancy
  • male sex (earlier onset, more chronic course, treatment resistance)
  • higher frequency of compulsions (treatment resistance)
  • early age of onset (treatment resistance)
  • previous hospitalizations for OCD (treatment resistance)
  • schizotypal personality disorder (treatment resistance)
  • tic disorder (treatment resistance)
  • specific or diffuse brain structural abnormalities (treatment resistance)
More risk factors

Diagnostic investigations

1st investigations to order

  • no initial test
More 1st investigations to order

Investigations to consider

  • Structured Clinical Interview for the DSM (SCID)
  • Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
  • Clinical Global Impression (CGI)
More investigations to consider

Treatment algorithm


mild to moderate symptoms: without comorbid personality disorders or dissociative symptoms

severe symptoms or with comorbid personality disorders or dissociative symptoms



Phillip J. Seibell, MD, FAPA
Phillip J. Seibell

OCD and Anxiety Psychiatry of Westchester, P.C.




PJS has received honoraria from Slack, Inc., for guest editing an issue on OCD.

Stefano Pallanti, MD, PhD
Stefano Pallanti

Professor of Psychiatry

Institute of Neuroscience




SP declares that he has no competing interests. SP is an author of several references cited in this topic.

Silvia Bernardi, MD
Silvia Bernardi

Project Manager

New York State Psychiatric Institute

Columbia University

New York



SB receives research sponsorship from NYSPI, APA, and the Brain & Behavior Research Foundation. SB is also a board member of the New York council on Problem Gambling. SB is an author of a reference cited in this topic.

Megan Hughes-Feltenberger, PhD
Megan Hughes-Feltenberger

Assistant Professor of Psychology in Psychiatry

Assistant Director of Education for Psychology

Weill Cornell Medical College

Assistant Attending Psychologist

NewYork-Presbyterian Hospital

New York



MHF declares that she has no competing interests.

Eric Hollander, MD
Eric Hollander

Clinical Professor of Psychiatry and Behavioral Sciences


Compulsive, Impulsive and Autism Spectrum Disorder Program

Albert Einstein College of Medicine

Montefiore Medical Center

New York



EH has received research grants from, and has consulted for, Roche, GW Pharmaceuticals, and Bixink.


The authors would like to gratefully acknowledge Dr Ashley Braun, a previous contributor to this topic. AB declares that she has no competing interests.

Peer reviewers

Juliana Belo Diniz, MD


Department and Institute of Psychiatry

Clinical Hospital

University of Sao Paulo Medical School

Sao Paulo



JBD declares that she has no competing interests.

Amit Nigam, MBBS, MRCPsych

Specialist Registrar in Forensic Psychiatry and Honorary Research Worker

National OCD Service

Queen Elizabeth II Hospital

Welwyn Garden City

Forensic Psychiatrist

West London Mental Health NHS Trust




AN declares that he has no competing interests.

  • Differentials

    • Obsessive-compulsive personality disorder (OCPD)
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  • Guidelines

    • Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR)
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    More Guidelines
  • Patient leaflets

    Obsessive-compulsive disorder

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