Clinical Review

Obsessive-compulsive disorder

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2183 (Published 07 April 2014) Cite this as: BMJ 2014;348:g2183
  1. David Veale, consultant psychiatrist1, reader in cognitive behaviour therapy2,
  2. Alison Roberts, clinical psychologist1
  1. 1Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
  2. 2Anxiety Disorders Residential Unit, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London
  1. Correspondence to: D Veale david.veale{at}kcl.ac.uk

Summary points

  • The World Health Organization ranks obsessive-compulsive disorder (OCD) as one of the 10 most handicapping conditions by lost income and decreased quality of life

  • OCD occurs across all ages but most commonly presents in young people

  • Shame often prevents people with OCD seeking help and causes delays in effective treatment

  • Non-specialists should ask screening questions if OCD is suspected

  • OCD is a treatable condition—children and adults should initially be offered cognitive behavioural therapy

  • For moderate to severe OCD in children and adults, selective serotonin reuptake inhibitors may also be offered

Obsessive-compulsive disorder (OCD) is characterised by the presence of obsessions or compulsions, or commonly of both. OCD is the fourth most common mental disorder after depression, alcohol/substance misuse, and social phobia, with a lifetime prevalence in community surveys of 1.6%.1 The severity of OCD differs markedly from one person to another. People are often able to hide their OCD, even from their own family, although it can cause problems in relationships and interfere with the ability to study or work. Health consequences can also occur: fear of contamination can, for example, prevent the accessing of appropriate health services or lead to dermatitis from excessive washing. When the disorder starts in childhood or adolescence, young people may avoid socialising with peers or become unable to live independently. The World Health Organization ranks OCD as one of the 10 most handicapping conditions by lost income and decreased quality of life.2 This clinical review summarises the evidence on how to recognise, assess, and manage people with OCD.

Sources and selection criteria

We referred to published systematic reviews, including the treatment guideline from the National Institute for Health and Care Excellence (2005) and the obsessive compulsive disorder evidence update (2013). We identified reviews by searches for “compulsive behavior”, “obsessive-compulsive disorder”, “obsessive behavior”, “compulsions”, “obsessions”, “obsessive compulsive …

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