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Obsessive–compulsive disorder

Nature Reviews Disease Primers volume 5, Article number: 52 (2019) Cite this article

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Abstract

Obsessive–compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the ‘obsessive–compulsive and related disorders’, a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive–behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.

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Fig. 1: Obsessive–compulsive and related disorders.
Fig. 2: OCD symptom dimensions.
Fig. 3: Comorbidities of OCD.
Fig. 4: Circuits involved in OCD.
Fig. 5: Lifespan changes related to disease stage — brain changes as a cause and consequence of OCD.
Fig. 6: OCD treatment algorithm.
Fig. 7: Targets for treatment.

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Authors and Affiliations

  1. Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa

    Dan J. Stein

  2. OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

    Daniel L. C. Costa, Euripedes C. Miguel & Roseli G. Shavitt

  3. Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa

    Christine Lochner

  4. Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India

    Y. C. Janardhan Reddy

  5. Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands

    Odile A. van den Heuvel

  6. Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands

    Odile A. van den Heuvel

  7. Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA

    H. Blair Simpson

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Contributions

Introduction (D.J.S.); Epidemiology (D.J.S.); Mechanisms/pathophysiology (O.A.v.d.H.); Diagnosis, screening and prevention (C.L.); Management (E.C.M., D.L.C.C., R.G.S.); Quality of life (Y.C.J.R.); Outlook (H.B.S.); Overview of Primer (D.J.S.).

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Correspondence to Dan J. Stein.

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Competing interests

D.J.S. has received research grants and/or consultancy honoraria from Lundbeck and Sun, and is also on the scientific advisory board of the TLC Foundation for Body-Focused Repetitive Behaviours, the Anxiety and Depression Association of America (ADAA), and the South African Depression and Anxiety Support Group. D.L.C.C. has received consultancy honoraria from Pfizer and Libbs, and a scholarship from Fundação de Amparo à Pesquisa do Estado de Sao Paulo (Sao Paulo State Foundation for Research Support). E.C.M. has received a productivity grant from the Brazilian National Council for Scientific and Technological Development. Y.C.J.R. has been involved in a study on bipolar disorder, supported by GlaxoSmithKline, and is also lead author on clinical guidelines on OCD produced by the Indian Psychiatric Society. R.G.S. has received consultancy honoraria from Lundbeck, and she receives a productivity grant from the Brazilian National Council for Scientific and Technological Development. H.B.S. has received research grants from Biohaven Pharmaceuticals and royalties from UpToDate, Inc. and Cambridge University Press. She is also on the Board of Directors and the Scientific Advisory Board of ADAA, and is an Associate Editor at JAMA Psychiatry. All other authors declare no competing interests.

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Nature Reviews Disease Primers thanks D. Marazziti, D. Tolin, J. Piacentini, and the other, anonymous, reviewer(s), for their contribution to the peer review of this work.

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South African Depression and Anxiety Group: www.sadag.org

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Stein, D.J., Costa, D.L.C., Lochner, C. et al. Obsessive–compulsive disorder. Nat Rev Dis Primers 5, 52 (2019). https://doi.org/10.1038/s41572-019-0102-3

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