A Different Approach to Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a very common and chronic condition that is significantly associated with global disability. OCD is the key example of 'obsessive-compulsive and related disorders', a group of conditions currently classified with the Diagnostic and Statistical Manual of Mental Disorders. It is often underdiagnosed and undertreated. OCD is also an important example of a neuropsychiatric disorder where rigorous research into phenomenology, psychobiology, pharmacotherapy, and psychotherapy has contributed to better recognition, assessment, and outcomes. Although OCD is a relatively homogeneous disorder with similar symptom dimensions globally, individualized assessment of symptoms, degree of insight, and extent of comorbidity are required. Various neurobiological mechanisms underlying OCD have been identified, including the specific brain circuits that support OCD. Additionally, laboratory models have shown how cellular and molecular dysfunction promotes repetitive stereotypes, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioral therapy, and neurosurgery for those with persistent symptoms. The integration of global mental health and translational neuroscience approaches can further advance knowledge about OCD and improve clinical outcomes. Common obsessions and compulsions in OCD patients include concerns about contamination with washing or cleaning, concerns about harming self or others with control, intrusive aggressive or sexual thoughts with mental rituals, and concerns about symmetry with ordering or counting. Not throwing things away is characteristic of hoarding disorder, but hoarding to prevent harm, for example, can also be seen in OCD. These symptom dimensions have been observed worldwide, showing that in some ways OCD is an apparently homogeneous disorder. However, OCD may present with less common symptoms such as fussiness, obsessive jealousy, and musical obsessions. Avoidance is another key feature of OCD; individuals may restrict a range of activities to avoid triggering obsessions.