Obsessive-Compulsive Disorder (OCD) is a condition characterized by obsessive thoughts and compulsive behaviors that can significantly impair functioning NICE CKS.
Management includes assessment of severity and risk, including suicide risk, and consideration of comorbidities and safeguarding issues NICE CKS.
For adults with mild functional impairment, psychological interventions such as referral to NHS Talking Therapies for low-intensity cognitive-behavioural therapy (CBT), including exposure and response prevention (ERP), are recommended NICE CKS.
Adults with moderate impairment should be offered either intensive CBT including ERP or a selective serotonin reuptake inhibitor (SSRI), with the choice depending on patient preference and response NICE CKS.
For severe impairment, combined treatment with an SSRI and CBT including ERP is advised NICE CKS.
In children and young people, evidence-based treatments such as CBT involving family or carers are recommended, with guided self-help considered for mild cases, and more intensive CBT for moderate to severe cases NICE CG31.
Pharmacological treatments include SSRIs (such as fluoxetine, fluvoxamine, paroxetine, sertraline, and escitalopram) and clomipramine, with the latter considered if SSRIs are contraindicated or not effective NICE CKS.
When stopping medication, doses should be tapered gradually over several weeks, and psychological treatment should continue during drug discontinuation to reduce relapse risk NICE CG31.
In cases of severe, chronic, or treatment-refractory OCD, specialist multidisciplinary teams and inpatient services may be involved, with neurosurgery considered only in exceptional cases after careful assessment NICE CKS.