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Obsessive-compulsive disorder

Last reviewed: 23 Jul 2025
Last updated: 20 Aug 2025

Summary

Definition

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
Full details

Other diagnostic factors

  • male sex
Full details

Risk factors

  • family history of obsessive-compulsive disorder (OCD)
  • PANDAS/PANS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection/pediatric acute-onset neuropsychiatric syndrome)
  • 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 obsessive-compulsive disorder (OCD [treatment resistance])
  • schizotypal personality disorder (treatment resistance)
  • tic disorder (treatment resistance)
  • specific or diffuse brain structural abnormalities (treatment resistance)
Full details

Diagnostic tests

1st tests to order

  • no initial test
Full details

Tests to consider

  • Structured Clinical Interview for the DSM (SCID)
  • Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
  • Clinical Global Impression (CGI)
Full details

Treatment algorithm

ACUTE

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

severe symptoms or with comorbid personality disorders or dissociative symptoms

Contributors

Authors

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

OCD and Anxiety Psychiatry of Westchester, P.C.

Hawthorne

NY

Disclosures

PJS declares that he has no competing interests.

Stefano Pallanti, MD, PhD
Stefano Pallanti

Professor of Psychiatry

Institute of Neuroscience

Florence

Italy

Disclosures

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

NY

Disclosures

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

Clinical Assistant Professor of Psychology in Psychiatry

Weill Cornell Medicine

New York

NY

Disclosures

MHF declares that she has no competing interests.

Eric Hollander, MD
Eric Hollander

Clinical Professor of Psychiatry and Behavioral Sciences

Director

Compulsive, Impulsive and Autism Spectrum Disorder Program

Albert Einstein College of Medicine

Montefiore Medical Center

New York

NY

Disclosures

EH has received research grants from Jazz, Roche, and Compass.

Acknowledgements

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

Darin D. Dougherty, MD

Director

Division of Neurotherapeutics

Massachusetts General Hospital

Boston

MA

Disclosures

DDD has received research funding and honoraria from Medtronic. DDD has served as an advisor and received honoraria from Sage, Celenase, and Boehringer-Ingelheim. DDD has served as an advisor and received equity from Neurable, Innercosmos, and Intrinsic Powers.

Robert Hudak, MD

Associate Professor of Psychiatry

University of Pittsburgh School of Medicine

Pittsburgh

Pennsylvania

PA

Disclosures

RH declares that he has no competing interests.

Juliana Belo Diniz, MD

Psychiatrist

Department and Institute of Psychiatry

Clinical Hospital

University of Sao Paulo Medical School

Sao Paulo

Brazil

Disclosures

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

London

UK

Disclosures

AN declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

World Health Organization. International statistical classification of diseases and related health problems. 11th revision. Jan 2022 [internet publication].Full text

American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Jul 2007 [internet publication].Full text

American Psychiatric Association. Guideline watch (March 2013): practice guideline for the treatment of patients with obsessive-compulsive disorder. Mar 2013 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Obsessive-compulsive personality disorder (OCPD)
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    • Somatic symptom disorder
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  • Guidelines

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

    Obsessive-compulsive disorder

    More Patient information
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