Obsessive–compulsive disorder - Wikipedia

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform ... Obsessive–compulsivedisorder FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Disorderthatinvolvesrepeatedthoughtsthatmakeapersonfeeldriventodosomething "OCD"redirectshere.NottobeconfusedwithObsessive–compulsivepersonalitydisorder.Forotheruses,seeOCD(disambiguation). Thisarticlemayrequirecopyeditingforgrammar.Youcanassistbyeditingit.(November2021)(Learnhowandwhentoremovethistemplatemessage) MedicalconditionObsessive–compulsivedisorderFrequentandexcessivehandwashingoccursinsomepeoplewithOCD.SpecialtyPsychiatrySymptomsFeeltheneedtocheckthingsrepeatedly,performcertainroutinesrepeatedly,havecertainthoughtsrepeatedly[1]ComplicationsTics,anxietydisorder,suicide[2][3]UsualonsetBefore35years[1][2]CausesChangesinlivingsituation,suchasmoving,gettingmarriedordivorced,orstartinganewschoolorjob,deathofalovedoneorotheremotionaltrauma,historyofabuse,lowlevelsofserotonin,anaturalsubstanceinthebrainthatmaintainsmentalbalance,overactivityinareasthebrain,problemsatworkorschool,problemswithanimportantrelationship,lllness(ifyougettheflu,forexample,youmaystartacycleofobsessingaboutgermsandwashingcompulsively).[4]RiskfactorsChildabuse,stress[2]DiagnosticmethodBasedonthesymptoms[2]DifferentialdiagnosisAnxietydisorder,majordepressivedisorder,eatingdisorders,obsessive–compulsivepersonalitydisorder[2]TreatmentCounseling,selectiveserotoninreuptakeinhibitors,clomipramine[5][6]Frequency2.3%[7] Obsessive–compulsivedisorder(OCD)isamentalandbehavioraldisorderinwhichanindividualhasintrusivethoughtsand/orfeelstheneedtoperformcertainroutinesrepeatedlytotheextentwhereitinducesdistressorimpairsgeneralfunction.[8][1][2]Asindicatedbythedisorder'sname,theprimarysymptomsofOCDareobsessionsandcompulsions.Obsessionsarepersistentunwantedthoughts,mentalimages,orurgesthatgeneratefeelingsofanxiety,disgust,ordiscomfort.[9]Commonobsessionsincludefearofcontamination,obsessionwithsymmetry,andintrusivethoughtsaboutreligion,sex,andharm.[1][10]Compulsionsarerepeatedactionsorroutinesthatoccurinresponsetoobsessions.Commoncompulsionsincludeexcessivehandwashing,cleaning,arrangingthings,counting,seekingreassurance,andcheckingthings.[1][10][11]ManyadultswithOCDareawarethattheircompulsionsdonotmakesense,buttheyperformthemanywaytorelievethedistresscausedbyobsessions.[1][9][10][12]Compulsionsoccursooften,typicallytakingupatleastonehourperday,thattheyimpairone'squalityoflife.[1][10] ThecauseofOCDisunknown.[1]Thereappeartobesomegeneticcomponents,anditismorelikelyforbothidenticaltwinstobeaffectedthanbothfraternaltwins.Riskfactorsincludeahistoryofchildabuseorotherstress-inducingevents;somecaseshaveoccurredafterstreptococcalinfections.[1]Diagnosisisbasedonpresentedsymptomsandrequiresrulingoutotherdrug-relatedormedicalcauses;ratingscalessuchastheYale–BrownObsessiveCompulsiveScale(Y-BOCS)assessseverity.[2][13]Otherdisorderswithsimilarsymptomsincludegeneralizedanxietydisorder,majordepressivedisorder,eatingdisorders,ticdisorders,andobsessive–compulsivepersonalitydisorder.[2]Theconditionisalsoassociatedwithageneralincreaseinsuicidality.[3][14] TreatmentforOCDmayinvolvepsychotherapysuchascognitivebehavioraltherapy(CBT),pharmacotherapysuchasantidepressants,orsurgicalproceduressuchasdeepbrainstimulation.[5][6][15][16]CBTincreasesexposuretoobsessionsandpreventscompulsions,whilemetacognitivetherapyencouragesritualbehaviorstoaltertherelationshiptoone'sthoughtsaboutthem.[5][17]Selectiveserotoninreuptakeinhibitors(SSRIs)areacommonantidepressantusedtotreatOCD.SSRIsaremoreeffectivewhenusedinexcessoftherecommendeddepressiondosage;however,higherdosescanincreasesideeffectintensity.[18]CommonlyusedSSRIsincludesertraline,fluoxetine,fluvoxamine,paroxetine,citalopram,andescitalopram.[15]SomepatientsfailtoimproveaftertakingthemaximumtolerateddoseofmultipleSSRIsforatleasttwomonths;thesecasesqualifyastreatment-resistantandrequiresecond-linetreatmentsuchasclomipramineoratypicalantipsychoticaugmentation.[5][6][18][19]Surgerymaybeusedasafinalresortinthemostsevereortreatment-resistantcases,thoughmostproceduresareconsideredexperimentalduetothelimitedliteratureontheirsideeffects.[20]Withouttreatment,OCDoftenlastsdecades.[2] Obsessive–compulsivedisorderaffectsabout2.3%ofpeopleatsomepointintheirlives,whileratesduringanygivenyearareabout1.2%.[2][7]Itisunusualforsymptomstobeginafterage35,andaround50%ofpatientsexperiencedetrimentaleffectstodailylifebeforeage20.[1][2]Malesandfemalesareaffectedequally,andOCDoccursworldwide.[1][2]Thephraseobsessive–compulsiveissometimesusedinaninformalmannerunrelatedtoOCDtodescribesomeoneasexcessivelymeticulous,perfectionistic,absorbed,orotherwisefixated.[21] Contents 1Signsandsymptoms 1.1Obsessions 1.2Compulsions 1.3Insightandovervaluedideation 1.4Cognitiveperformance 1.5Children 1.6Associatedconditions 2Causes 2.1Drug-inducedOCD 2.2Genetics 2.3Brainstructureandfunctioning 2.4Autoimmune 2.5Environment 3Mechanisms 3.1Neuroimaging 3.2Cognitivemodels 3.3Neurobiological 4Diagnosis 4.1Differentialdiagnosis 5Management 5.1Therapy 5.2Medication 5.3Procedures 5.4Children 6Epidemiology 7Prognosis 8History 8.1Notablecases 9Societyandculture 9.1Art,entertainmentandmedia 10Research 11Otheranimals 12References 13Externallinks Signsandsymptoms OCDcanpresentwithawidevarietyofsymptoms.Certaingroupsofsymptomsusuallyoccurtogether;thesegroupsaresometimesviewedasdimensions,orclusters,whichmayreflectanunderlyingprocess.ThestandardassessmenttoolforOCD,theYale–BrownObsessiveCompulsiveScale(Y-BOCS),has13predefinedcategoriesofsymptoms.Thesesymptomsfitintothreetofivegroupings.[22]Ameta-analyticreviewofsymptomstructuresfoundafour-factorgroupingstructuretobemostreliable:asymmetryfactor,aforbiddenthoughtsfactor,acleaningfactor,andahoardingfactor.Thesymmetryfactorcorrelateshighlywithobsessionsrelatedtoordering,counting,andsymmetry,aswellasrepeatingcompulsions.Theforbiddenthoughtsfactorcorrelateshighlywithintrusiveanddistressingthoughtsofaviolent,religious,orsexualnature.Thecleaningfactorcorrelateshighlywithobsessionsaboutcontaminationandcompulsionsrelatedtocleaning.Thehoardingfactoronlyinvolveshoarding-relatedobsessionsandcompulsions,andwasidentifiedasbeingdistinctfromothersymptomgroupings.[23] SomeOCDsubtypeshavebeenassociatedwithimprovementinperformanceoncertaintasks,suchaspatternrecognition(washingsubtype)andspatialworkingmemory(obsessivethoughtsubtype).Subgroupshavealsobeendistinguishedbyneuroimagingfindingsandtreatmentresponse.Neuroimagingstudiesonthishavebeentoofew,andthesubtypesexaminedhavedifferedtoomuchtodrawanyconclusions.Ontheotherhand,subtype-dependenttreatmentresponsehasbeenstudied,andthehoardingsubtypehasconsistentlyrespondedleasttotreatment.[24] WhileOCDisconsideredahomogeneousdisorderfromaneuropsychologicalperspective,manyofthesymptomsmaybetheresultofcomorbiddisorders.Forexample,adultswithOCDhaveexhibitedmoresymptomsofattention–deficit/hyperactivitydisorder(ADHD)andautismspectrumdisorder(ASD)thanadultswithoutOCD.[25] Obsessions Mainarticle:Intrusivethought Seealso:Primarilyobsessionalobsessivecompulsivedisorder PeoplewithOCDmayfaceintrusivethoughts,suchasthoughtsaboutthedevil(shownisapaintedinterpretationofHell). Obsessionsarestress-inducingthoughtsthatrecurandpersist,despiteeffortstoignoreorconfrontthem.[26]PeoplewithOCDfrequentlyperformtasks,orcompulsions,toseekrelieffromobsession-relatedanxiety.Withinandamongindividuals,initialobsessionsvaryinclarityandvividness.Arelativelyvagueobsessioncouldinvolveageneralsenseofdisarrayortension,accompaniedbyabeliefthatlifecannotproceedasnormalwhiletheimbalanceremains.Amoreintenseobsessioncouldbeapreoccupationwiththethoughtorimageofaclosefamilymemberorfrienddying,orintrusionsrelatedtorelationshiprightness.[27][28]Otherobsessionsconcernthepossibilitythatsomeoneorsomethingotherthanoneself—suchasGod,thedevil,ordisease—willharmeitherthepatientorthepeopleorthingsthepatientcaresabout.OtherswithOCDmayexperiencethesensationofinvisibleprotrusionsemanatingfromtheirbodies,orfeelthatinanimateobjectsareensouled.[29] SomepeoplewithOCDexperiencesexualobsessionsthatmayinvolveintrusivethoughtsorimagesof"kissing,touching,fondling,oralsex,analsex,intercourse,incest,andrape"with"strangers,acquaintances,parents,children,familymembers,friends,coworkers,animals,andreligiousfigures,"andcanincludeheterosexualorhomosexualcontactwithpeopleofanyage.[30]Similartootherintrusivethoughtsorimages,somedisquietingsexualthoughtsarenormalattimes,butpeoplewithOCDmayattachextraordinarysignificancetosuchthoughts.Forexample,obsessivefearsaboutsexualorientationcanappeartotheaffectedindividual,andeventothosearoundthem,asacrisisofsexualidentity.[31][32]Furthermore,thedoubtthataccompaniesOCDleadstouncertaintyregardingwhetheronemightactonthetroublingthoughts,resultinginself-criticismorself-loathing.[30] MostpeoplewithOCDunderstandthattheirthoughtsdonotcorrespondwithreality;however,theyfeelthattheymustactasthoughtheseideasarecorrectorrealistic.Forexample,someonewhoengagesincompulsivehoardingmightbeinclinedtotreatinorganicmatterasifithadthesentienceorrightsoflivingorganisms,despiteacceptingthatsuchbehaviorisirrationalonanintellectuallevel.ThereisadebateastowhetherhoardingshouldbeconsideredwithotherOCDsymptoms.[33] Compulsions Mainarticle:Compulsivebehavior Skin-pickingdisorder SomepeoplewithOCDperformcompulsiveritualsbecausetheyinexplicablyfeelthattheymustdoso,whileothersactcompulsivelytomitigatetheanxietythatstemsfromobsessivethoughts.Theaffectedindividualmightfeelthattheseactionswilleitherpreventadreadedeventfromoccurring,orpushtheeventfromtheirthoughts.Inanycase,theirreasoningissoidiosyncraticordistortedthatitresultsinsignificantdistress,eitherpersonally,orforthosearoundtheaffectedindividual.Excessiveskinpicking,hairpulling,nailbiting,andotherbody-focusedrepetitivebehaviordisordersareallontheobsessive–compulsivespectrum.[2]SomeindividualswithOCDareawarethattheirbehaviorsarenotrational,buttheyfeelcompelledtofollowthroughwiththemtofendofffeelingsofpanicordread.[34]Furthermore,compulsionsoftenstemfrommemorydistrust,asymptomofOCDcharacterizedbyinsecurityinone'sskillsinperception,attention,andmemory,evenincaseswherethereisnoclearevidenceofadeficit.[35] Commoncompulsionsmayincludehandwashing,cleaning,checkingthings(suchaslocksondoors),repeatingactions(suchasrepeatedlyturningonandoffswitches),orderingitemsinacertainway,andrequestingreassurance.[36]Althoughsomeindividualsperformactionsrepeatedly,theydonotnecessarilyperformtheseactionscompulsively;forexample,morningornighttimeroutinesandreligiouspracticesarenotusuallycompulsions.Whetherbehaviorsqualifyascompulsionsormerehabitdependsonthecontextinwhichtheyareperformed.Forinstance,arrangingandorderingbooksforeighthoursadaywouldbeexpectedofsomeonewhoworksinalibrary,butthisroutinewouldseemabnormalinothersituations.Inotherwords,habitstendtobringefficiencytoone'slife,whilecompulsionstendtodisruptit.[37]Furthermore,compulsionsaredifferentfromtics(suchastouching,tapping,rubbing,orblinking)andstereotypedmovements(suchasheadbanging,bodyrocking,orself-biting),whichareusuallynotascomplexandnotprecipitatedbyobsessions.[38]Itcansometimesbedifficulttotellthedifferencebetweencompulsionsandcomplextics,andabout10–40%ofpeoplewithOCDalsohavealifetimeticdisorder.[2][39] PeoplewithOCDrelyoncompulsionsasanescapefromtheirobsessivethoughts;however,theyareawarethatreliefisonlytemporary,andthatintrusivethoughtswillreturn.Someaffectedindividualsusecompulsionstoavoidsituationsthatmaytriggerobsessions.Compulsionsmaybeactionsdirectlyrelatedtotheobsession,suchassomeoneobsessedwithcontaminationcompulsivelywashingtheirhands,buttheycanbeunrelatedaswell.[10]InadditiontoexperiencingtheanxietyandfearthattypicallyaccompaniesOCD,affectedindividualsmayspendhoursperformingcompulsionseveryday.Insuchsituations,itcanbecomedifficultforthepersontofulfilltheirwork,familial,orsocialroles.Thesebehaviorscanalsocauseadversephysicalsymptoms;forexample,peoplewhoobsessivelywashtheirhandswithantibacterialsoapandhotwatercanmaketheirskinredandrawwithdermatitis.[40] IndividualswithOCDoftenuserationalizationstoexplaintheirbehavior;however,theserationalizationsdonotapplytothebehavioralpattern,buttoeachindividualoccurrence.Forexample,someonecompulsivelycheckingthefrontdoormayarguethatthetimeandstressassociatedwithonecheckislessthanthetimeandstressassociatedwithbeingrobbed,andcheckingisconsequentlythebetteroption.Thisreasoningoftenoccursinacyclicalmanner,andcancontinueforaslongastheaffectedpersonneedsittoinordertofeelsafe.[41] Incognitivebehavioraltherapy,OCDpatientsareaskedtoovercomeintrusivethoughtsbynotindulginginanycompulsions.TheyaretaughtthatritualskeepOCDstrong,whilenotperformingthemcausesOCDtobecomeweaker.[42]Thispositionissupportedbythepatternofmemorydistrust;themoreoftencompulsionsarerepeated,themoreweakenedmemorytrustbecomes,andthiscyclecontinuesasmemorydistrustincreasescompulsionfrequency.[43]Forbody-focusedrepetitivebehaviors(BFRB)suchastrichotillomania(hairpulling),skinpicking,andonychophagia(nailbiting),behavioralinterventionssuchashabitreversaltraininganddecouplingarerecommendedforthetreatmentofcompulsivebehaviors.[44][45] OCDsometimesmanifestswithoutovertcompulsions,whichmaybetermed"primarilyobsessionalOCD."OCDwithoutovertcompulsionscould,byoneestimate,characterizeasmanyas50–60%ofOCDcases.[46] Insightandovervaluedideation TheDSM-5identifiesacontinuumforthelevelofinsightinOCD,rangingfromgoodinsight(theleastsevere)tonoinsight(themostsevere).Goodorfairinsightischaracterizedbytheacknowledgmentthatobsessive–compulsivebeliefsareormaynotbetrue,whilepoorinsight,inthemiddleofthecontinuum,ischaracterizedbythebeliefthatobsessive–compulsivebeliefsareprobablytrue.Theabsenceofinsightaltogether,inwhichtheindividualiscompletelyconvincedthattheirbeliefsaretrue,isalsoidentifiedasadelusionalthoughtpattern,andoccursinabout4%ofpeoplewithOCD.[47][48]WhencasesofOCDwithnoinsightbecomesevere,affectedindividualshaveanunshakablebeliefintherealityoftheirdelusions,whichcanmaketheircasesdifficulttodifferentiatefrompsychoticdisorders.[49] SomepeoplewithOCDexhibitwhatisknownasovervaluedideas,ideasthatareabnormalcomparedtoaffectedindividuals'respectivecultures,andmoretreatment-resistantthanmostnegativethoughtsandobsessions.[50]Aftersomediscussion,itispossibletoconvincetheindividualthattheirfearsareunfounded.ItmaybemoredifficulttopracticeERPtherapyonsuchpeople,astheymaybeunwillingtocooperate,atleastinitially.[citationneeded]Similartohowinsightisidentifiedonacontinuum,obsessive-compulsivebeliefsarecharacterizedonaspectrum,rangingfromobsessivedoubttodelusionalconviction.IntheUnitedStates,overvaluedideation(OVI)isconsideredmostakintopoorinsight—especiallywhenconsideringbeliefstrengthasoneofanidea'skeyidentifiers—butEuropeanqualificationshavehistoricallybeenbroader.Furthermore,severeandfrequentovervaluedideasareconsideredsimilartoidealizedvalues,whicharesorigidlyheldby,andsoimportanttoaffectedindividuals,thattheyendupbecomingadefiningidentity.[50]InadolescentOCDpatients,OVIisconsideredaseveresymptom.[51] Historically,OVIhasbeenthoughttobelinkedtopoorertreatmentoutcomeinpatientswithOCD,butitiscurrentlyconsideredapoorindicatorofprognosis.[51][52]TheOvervaluedIdeasScale(OVIS)hasbeendevelopedasareliablequantitativemethodofmeasuringlevelsofOVIinpatientswithOCD,andresearchhassuggestedthatovervaluedideasaremorestableforthosewithmoreextremeOVISscores.[53] Cognitiveperformance ThoughOCDwasoncebelievedtobeassociatedwithabove-averageintelligence,thisdoesnotappeartonecessarilybethecase.[54]A2013reviewreportedthatpeoplewithOCDmaysometimeshavemildbutwide-rangingcognitivedeficits,mostsignificantlythoseaffectingspatialmemoryandtoalesserextentwithverbalmemory,fluency,executivefunction,andprocessingspeed,whileauditoryattentionwasnotsignificantlyaffected.[55]PeoplewithOCDshowimpairmentinformulatinganorganizationalstrategyforcodinginformation,set-shifting,andmotorandcognitiveinhibition.[56] SpecificsubtypesofsymptomdimensionsinOCDhavebeenassociatedwithspecificcognitivedeficits.[57]Forexample,theresultsofonemeta-analysiscomparingwashingandcheckingsymptomsreportedthatwashersoutperformedcheckersoneightoutoftencognitivetests.[58]Thesymptomdimensionofcontaminationandcleaningmaybeassociatedwithhigherscoresontestsofinhibitionandverbalmemory.[59] Children Approximately1–2%ofchildrenareaffectedbyOCD.[60]Obsessive–compulsivedisordersymptomstendtodevelopmorefrequentlyinchildren10–14yearsofage,withmalesdisplayingsymptomsatanearlierage,andatamoreseverelevelthanfemales.[61]Inchildren,symptomscanbegroupedintoatleastfourtypes,includingsporadicandtic-relatedOCD.[22] Associatedconditions PeoplewithOCDmaybediagnosedwithotherconditionsaswellasOCD,suchasobsessive–compulsivepersonalitydisorder,majordepressivedisorder,bipolardisorder,generalizedanxietydisorder,anorexianervosa,socialanxietydisorder,bulimianervosa,Tourettesyndrome,transformationobsession,ASD,ADHD,dermatillomania,bodydysmorphicdisorder,andtrichotillomania.[62]Morethan50%ofpeoplewithOCDexperiencesuicidaltendencies,and15%haveattemptedsuicide.[13]Depression,anxiety,andpriorsuicideattemptsincreasetheriskoffuturesuicideattempts.[63] IndividualswithOCDhavealsobeenfoundtobeaffectedbydelayedsleepphasedisorderatasubstantiallyhigherratethanthegeneralpublic.[64]Moreover,severeOCDsymptomsareconsistentlyassociatedwithgreatersleepdisturbance.ReducedtotalsleeptimeandsleepefficiencyhavebeenobservedinpeoplewithOCD,withdelayedsleeponsetandoffset,andanincreasedprevalenceofdelayedsleepphasedisorder.[65] SomeresearchhasdemonstratedalinkbetweendrugaddictionandOCD.Forexample,thereisahigherriskofdrugaddictionamongthosewithanyanxietydisorder,likelyasawayofcopingwiththeheightenedlevelsofanxiety.However,drugaddictionamongpeoplewithOCDmayserveasatypeofcompulsivebehavior,andnotjustasacopingmechanism.DepressionisalsoextremelyprevalentamongpeoplewithOCD.OneexplanationforthehighdepressionrateamongOCDpopulationswaspositedbyMineka,Watson,andClark(1998),whoexplainedthatpeoplewithOCD,oranyotheranxietydisorder,mayfeeldepressedbecauseofan"outofcontrol"typeoffeeling.[66] SomeoneexhibitingOCDsignsdoesnotnecessarilyhaveOCD.Behaviorsthatpresentasobsessive–compulsivecanalsobefoundinanumberofotherconditions,includingobsessive–compulsivepersonalitydisorder(OCPD),autismspectrumdisorder(ASD),ordisordersinwhichperseverationisapossiblefeature(ADHD,PTSD,bodilydisorders,orstereotypedbehaviors).[67]SomecasesofOCDpresentsymptomstypicallyassociatedwithTourettesyndrome,suchascompulsionsthatmayappeartoresemblemotortics;thishasbeentermedtic-relatedOCDorTouretticOCD.[68][69] OCDfrequentlyoccurscomorbidlywithbothbipolardisorderandmajordepressivedisorder.Between60and80%ofthosewithOCDexperienceamajordepressiveepisodeintheirlifetime.Comorbidityrateshavebeenreportedatbetween19and90%,asaresultofmethodologicaldifferences.Between9–35%ofthosewithbipolardisorderalsohaveOCD,comparedto1–2%inthegeneralpopulation.About50%ofthosewithOCDexperiencecyclothymictraitsorhypomanicepisodes.OCDisalsoassociatedwithanxietydisorders.LifetimecomorbidityforOCDhasbeenreportedat22%forspecificphobia,18%forsocialanxietydisorder,12%forpanicdisorder,and30%forgeneralizedanxietydisorder.ThecomorbidityrateforOCDandADHDhasbeenreportedtobeashighas51%.[70] Causes Mainarticle:Causeofobsessive-compulsivedisorder ThecauseofOCDisunknown.[1]Bothenvironmentalandgeneticfactorsarebelievedtoplayarole.Riskfactorsincludeahistoryofchildabuseorotherstress-inducingevents.[2] Drug-inducedOCD Somemedicationsandotherdrugs,suchasmethamphetamineorcocaine,caninduceobsessive-compulsivedisorder(OCD)inpeoplewithoutprevioussymptoms.[71] Someatypicalantipsychotics(second-generationantipsychotics)suchasolanzapine(Zyprexa)andclozapine(Clozaril)caninduceOCDinpeople,particularlyindividualswithschizophrenia.[72][73][74][75] Genetics ThereappeartobesomegeneticcomponentsofOCDcausation,withidenticaltwinsmoreoftenaffectedthanfraternaltwins.[2]Furthermore,individualswithOCDaremorelikelytohavefirst-degreefamilymembersexhibitingthesamedisordersthanmatchedcontrols.IncasesinwhichOCDdevelopsduringchildhood,thereisamuchstrongerfamiliallinkinthedisorderthanwithcasesinwhichOCDdevelopslaterinadulthood.Ingeneral,geneticfactorsaccountfor45–65%ofthevariabilityinOCDsymptomsinchildrendiagnosedwiththedisorder.[76]A2007studyfoundevidencesupportingthepossibilityofaheritableriskforOCD.[77] AmutationhasbeenfoundinthehumanserotonintransportergenehSERTinunrelatedfamilieswithOCD.[78] AsystematicreviewfoundthatwhileneitherallelewasassociatedwithOCDoverall,inCaucasians,theLallelewasassociatedwithOCD.[79]Anothermeta-analysisobservedanincreasedriskinthosewiththehomozygousSallele,butfoundtheLSgenotypetobeinverselyassociatedwithOCD.[80] Agenome-wideassociationstudyfoundOCDtobelinkedwithSNPsnearBTBD3,andtwoSNPsinDLGAP1inatrio-basedanalysis,butnoSNPreachedsignificancewhenanalyzedwithcase-controldata.[81] Onemeta-analysisfoundasmallbutsignificantassociationbetweenapolymorphisminSLC1A1andOCD.[82] TherelationshipbetweenOCDandCOMThasbeeninconsistent,withonemeta-analysisreportingasignificantassociation,albeitonlyinmen,andanothermetaanalysisreportingnoassociation.[83][84] Ithasbeenpostulatedbyevolutionarypsychologiststhatmoderateversionsofcompulsivebehaviormayhavehadevolutionaryadvantages.Exampleswouldbemoderateconstantcheckingofhygiene,thehearth,ortheenvironmentforenemies.Similarly,hoardingmayhavehadevolutionaryadvantages.Inthisview,OCDmaybetheextremestatisticaltailofsuchbehaviors,possiblytheresultofahighnumberofpredisposinggenes.[85] Brainstructureandfunctioning ImagingstudieshaveshowndifferencesinthefrontalcortexandsubcorticalstructuresofthebraininpatientswithOCD.ThereappearstobeaconnectionbetweentheOCDsymptomsandabnormalitiesincertainareasofthebrain,butthatconnectionisnotclear.[86]SomepeoplewithOCDhaveareasofunusuallyhighactivityintheirbrain,orlowlevelsofthechemicalserotonin,[87]whichisaneurotransmitterthatsomenervecellsusetocommunicatewitheachother,[88]andisthoughttobeinvolvedinregulatingmanyfunctions,influencingemotions,mood,memory,andsleep.[89] Autoimmune AcontroversialhypothesisisthatsomecasesofrapidonsetofOCDinchildrenandadolescentsmaybecausedbyasyndromeconnectedtoGroupAstreptococcalinfections(GABHS),knownaspediatricautoimmuneneuropsychiatricdisordersassociatedwithstreptococcalinfections(PANDAS).[90][91][92]OCDandticdisordersarehypothesizedtoariseinasubsetofchildrenasaresultofapost-streptococcalautoimmuneprocess.[93][94][95]ThePANDAShypothesisisunconfirmedandunsupportedbydata,andtwonewcategorieshavebeenproposed:PANS(pediatricacute-onsetneuropsychiatricsyndrome)andCANS(childhoodacuteneuropsychiatricsyndrome).[94][95]TheCANS/PANShypothesesincludedifferentpossiblemechanismsunderlyingacute-onsetneuropsychiatricconditions,butdonotexcludeGABHSinfectionsasacauseinasubsetofindividuals.[94][95]PANDAS,PANS,andCANSarethefocusofclinicalandlaboratoryresearch,butremainunproven.[93][94][95]WhetherPANDASisadistinctentitydifferingfromothercasesofticdisordersorOCDisdebated.[96][97][98][99] Areviewofstudiesexamininganti-basalgangliaantibodiesinOCDfoundanincreasedriskofhavinganti-basalgangliaantibodiesinthosewithOCDversusthegeneralpopulation.[100] Environment OCDmaybemorecommoninpeoplewhohavebeenbullied,abused,orneglected,anditsometimesstartsafterasignificantlifeevent,suchaschildbirthorbereavement.[87]Ithasbeenreportedinsomestudiesthatthereisaconnectionbetweenchildhoodtraumaandobsessive-compulsivesymptoms.Moreresearchisneededtounderstandthisrelationshipbetter.[86] Mechanisms Mainarticle:Biologyofobsessive–compulsivedisorder Neuroimaging SomepartsofthebrainshowingabnormalactivityinOCD Functionalneuroimagingduringsymptomprovocationhasobservedabnormalactivityintheorbitofrontalcortex(OFC),leftdorsolateralprefrontalcortex(dlPFC),rightpremotorcortex,leftsuperiortemporalgyrus,globuspallidusexternus,hippocampus,andrightuncus.Weakerfociofabnormalactivitywerefoundintheleftcaudate,posteriorcingulatecortex,andsuperiorparietallobule.[101]However,anoldermeta-analysisoffunctionalneuroimaginginOCDreportedthattheonlyconsistentfunctionalneuroimagingfindingwasincreasedactivityintheorbitalgyrusandheadofthecaudatenucleus,whileanteriorcingulatecortex(ACC)activationabnormalitiesweretooinconsistent.[102]Ameta-analysiscomparingaffectiveandnonaffectivetasksobserveddifferenceswithcontrolsinregionsimplicatedinsalience,habit,goal-directedbehavior,self-referentialthinking,andcognitivecontrol.Fornonaffectivetasks,hyperactivitywasobservedintheinsula,ACC,andheadofthecaudate/putamen,whilehypoactivitywasobservedinthemedialprefrontalcortex(mPFC)andposteriorcaudate.Affectivetaskswereobservedtorelatetoincreasedactivationintheprecuneusandposteriorcingulatecortex,whiledecreasedactivationwasfoundinthepallidum,ventralanteriorthalamus,andposteriorcaudate.[103]Theinvolvementofthecortico-striato-thalamo-corticalloopinOCD,aswellasthehighratesofcomorbiditybetweenOCDandADHD,haveledsometodrawalinkintheirmechanism.Observedsimilaritiesincludedysfunctionoftheanteriorcingulatecortexandprefrontalcortex,aswellasshareddeficitsinexecutivefunctions.[104]TheinvolvementoftheorbitofrontalcortexanddorsolateralprefrontalcortexinOCDissharedwithbipolardisorder,andmayexplainthehighdegreeofcomorbidity.[105]DecreasedvolumesofthedorsolateralprefrontalcortexrelatedtoexecutivefunctionhasalsobeenobservedinOCD.[106] PeoplewithOCDevinceincreasedgreymattervolumesinbilaterallenticularnuclei,extendingtothecaudatenuclei,withdecreasedgreymattervolumesinbilateraldorsalmedialfrontal/anteriorcingulategyri.[107][105]Thesefindingscontrastwiththoseinpeoplewithotheranxietydisorders,whoevincedecreased(ratherthanincreased)greymattervolumesinbilaterallenticular/caudatenuclei,aswellasdecreasedgreymattervolumesinbilateraldorsalmedialfrontal/anteriorcingulategyri.[105]IncreasedwhitemattervolumeanddecreasedfractionalanisotropyinanteriormidlinetractshasbeenobservedinOCD,possiblyindicatingincreasedfibercrossings.[108] Cognitivemodels Generally,twocategoriesofmodelsforOCDhavebeenpostulated,thefirstinvolvingdeficitsinexecutivefunction,andthesecondinvolvingdeficitsinmodulatorycontrol.ThefirstcategoryofexecutivedysfunctionisbasedontheobservedstructuralandfunctionalabnormalitiesinthedlPFC,striatumandthalamus.ThesecondcategoryinvolvingdysfunctionalmodulatorycontrolprimarilyreliesonobservedfunctionalandstructuraldifferencesintheACC,mPFC,andOFC.[109][110] OneproposedmodelsuggeststhatdysfunctionintheOFCleadstoimpropervaluationofbehaviorsanddecreasedbehavioralcontrol,whiletheobservedalterationsinamygdalaactivationsleadstoexaggeratedfearsandrepresentationsofnegativestimuli.[111] DuetotheheterogeneityofOCDsymptoms,studiesdifferentiatingvarioussymptomshavebeenperformed.Symptom-specificneuroimagingabnormalitiesincludethehyperactivityofcaudateandACCincheckingrituals,whilefindingincreasedactivityofcorticalandcerebellarregionsincontamination-relatedsymptoms.Neuroimagingdifferentiatingcontentofintrusivethoughtshasfounddifferencesbetweenaggressiveasopposedtotaboothoughts,findingincreasedconnectivityoftheamygdala,ventralstriatum,andventromedialprefrontalcortexinaggressivesymptoms,whileobservingincreasedconnectivitybetweentheventralstriatumandinsulainsexualorreligiousintrusivethoughts.[112] Anothermodelproposesthataffectivedysregulationlinksexcessiverelianceonhabit-basedactionselection[113]withcompulsions.ThisissupportedbytheobservationthatthosewithOCDdemonstratedecreasedactivationoftheventralstriatumwhenanticipatingmonetaryreward,aswellasincreasedfunctionalconnectivitybetweentheVSandtheOFC.Furthermore,thosewithOCDdemonstratereducedperformanceinPavlovianfear-extinctiontasks,hyperresponsivenessintheamygdalatofearfulstimuli,andhyporesponsivenessintheamygdalawhenexposedtopositivelyvalancedstimuli.Stimulationofthenucleusaccumbenshasalsobeenobservedtoeffectivelyalleviatebothobsessionsandcompulsions,supportingtheroleofaffectivedysregulationingeneratingboth.[111] Neurobiological FromtheobservationoftheefficacyofantidepressantsinOCD,aserotoninhypothesisofOCDhasbeenformulated.Studiesofperipheralmarkersofserotonin,aswellaschallengeswithproserotonergiccompoundshaveyieldedinconsistentresults,includingevidencepointingtowardsbasalhyperactivityofserotonergicsystems.[114]Serotoninreceptorandtransporterbindingstudieshaveyieldedconflictingresults,includinghigherandlowerserotoninreceptor5-HT2AandserotonintransporterbindingpotentialsthatwerenormalizedbytreatmentwithSSRIs.Despiteinconsistenciesinthetypesofabnormalitiesfound,evidencepointstowardsdysfunctionofserotonergicsystemsinOCD.[115]OrbitofrontalcortexoveractivityisattenuatedinpeoplewhohavesuccessfullyrespondedtoSSRImedication,aresultbelievedtobecausedbyincreasedstimulationofserotoninreceptors5-HT2Aand5-HT2C.[116] AcomplexrelationshipbetweendopamineandOCDhasbeenobserved.Althoughantipsychotics,whichactbyantagonizingdopaminereceptorsmayimprovesomecasesofOCD,theyfrequentlyexacerbateothers.Antipsychotics,inthelowdosesusedtotreatOCD,mayactuallyincreasethereleaseofdopamineintheprefrontalcortex,throughinhibitingautoreceptors.Furthercomplicatingthingsistheefficacyofamphetamines,decreaseddopaminetransporteractivityobservedinOCD,[117]andlowlevelsofD2bindinginthestriatum.[118]Furthermore,increaseddopaminereleaseinthenucleusaccumbensafterdeepbrainstimulationcorrelateswithimprovementinsymptoms,pointingtoreduceddopaminereleaseinthestriatumplayingaroleingeneratingsymptoms.[119] AbnormalitiesinglutamatergicneurotransmissionhaveimplicatedinOCD.Findingssuchasincreasedcerebrospinalglutamate,lessconsistentabnormalitiesobservedinneuroimagingstudies,andtheefficacyofsomeglutamatergicdrugs,suchastheglutamate-inhibitingriluzole,haveimplicatedglutamateinOCD.[118]OCDhasbeenassociatedwithreducedN-AcetylasparticacidinthemPFC,whichisthoughttoreflectneurondensityorfunctionality,althoughtheexactinterpretationhasnotbeenestablished.[120] Diagnosis Formaldiagnosismaybeperformedbyapsychologist,psychiatrist,clinicalsocialworker,orotherlicensedmentalhealthprofessional.TobediagnosedwithOCD,apersonmusthaveobsessions,compulsions,orboth,accordingtotheDiagnosticandStatisticalManualofMentalDisorders(DSM).TheQuickReferencetothe2000editionoftheDSMstatesthatseveralfeaturescharacterizeclinicallysignificantobsessionsandcompulsions,andthatsuchobsessionsarerecurrentandpersistentthoughts,impulses,orimagesthatareexperiencedasintrusive,andthatcausemarkedanxietyordistress.Thesethoughts,impulses,orimagesareofadegreeortypethatliesoutsidethenormalrangeofworriesaboutconventionalproblems.[121]Apersonmayattempttoignoreorsuppresssuchobsessions,ortoneutralizethemwithsomeotherthoughtoraction,andwilltendtorecognizetheobsessionsasidiosyncraticorirrational. Compulsionsbecomeclinicallysignificantwhenapersonfeelsdriventoperformtheminresponsetoanobsession,oraccordingtorulesthatmustbeappliedrigidly,andwhenthepersonconsequentlyfeelsorcausessignificantdistress.Therefore,whilemanypeoplewhodonothaveOCDmayperformactionsoftenassociatedwithOCD(suchasorderingitemsinapantrybyheight),thedistinctionwithclinicallysignificantOCDliesinthefactthatthepersonwithOCDmustperformtheseactionstoavoidsignificantpsychologicaldistress.Thesebehaviorsormentalactsareaimedatpreventingorreducingdistressorpreventingsomedreadedeventorsituation;however,theseactivitiesarenotlogicallyorpracticallyconnectedtotheissue,or,theyareexcessive.Inaddition,atsomepointduringthecourseofthedisorder,theindividualmustrealizethathisorherobsessionsorcompulsionsareunreasonableorexcessive.[citationneeded] Moreover,theobsessionsorcompulsionsmustbetime-consuming,oftentakingupmorethanonehourperday,orcauseimpairmentinsocial,occupational,orscholasticfunctioning.[121]ItishelpfultoquantifytheseverityofsymptomsandimpairmentbeforeandduringtreatmentforOCD.Inadditiontotheperson'sestimateofthetimespenteachdayharboringobsessive-compulsivethoughtsorbehaviors,concretetoolscanbeusedtogaugetheperson'scondition.Thismaybedonewithratingscales,suchastheYale–BrownObsessiveCompulsiveScale(Y-BOCS;expertrating)[122]ortheobsessive-compulsiveinventory(OCI-R;self-rating).[123]Withmeasurementssuchasthese,psychiatricconsultationcanbemoreappropriatelydetermined,asithasbeenstandardized.[13] OCDissometimesplacedinagroupofdisorderscalledtheobsessive–compulsivespectrum.[124] Differentialdiagnosis OCDisoftenconfusedwiththeseparateconditionobsessive–compulsivepersonalitydisorder(OCPD).OCDisegodystonic,meaningthatthedisorderisincompatiblewiththeindividual'sself-concept.[125][126]Asegodystonicdisordersgoagainstaperson'sself-concept,theytendtocausemuchdistress.OCPD,ontheotherhand,isegosyntonic,markedbytheperson'sacceptancethatthecharacteristicsandbehaviorsdisplayedasaresultarecompatiblewiththeirself-image,orareotherwiseappropriate,correct,orreasonable. Asaresult,peoplewithOCDareoftenawarethattheirbehaviorisnotrational,andareunhappyabouttheirobsessions,butneverthelessfeelcompelledbythem.[127]Bycontrast,peoplewithOCPDarenotawareofanythingabnormal;theywillreadilyexplainwhytheiractionsarerational.Itisusuallyimpossibletoconvincethemotherwise,andtheytendtoderivepleasurefromtheirobsessionsorcompulsions.[127] Management Cognitivebehavioraltherapy(CBT)andpsychotropicmedicationsarethefirst-linetreatmentsforOCD.[1][128] Therapy Oneexposureandritualpreventionactivitywouldbetocheckthelockonlyonceandthenleave. Thespecifictechniqueusedincognitivebehavioraltherapy(CBT)iscalledexposureandresponseprevention(ERP),whichinvolvesteachingthepersontodeliberatelycomeintocontactwithsituationsthattriggerobsessivethoughtsandfears(exposure),withoutcarryingouttheusualcompulsiveactsassociatedwiththeobsession(responseprevention).Thistechniquecausespatientstograduallylearntotoleratethediscomfortandanxietyassociatedwithnotperformingtheircompulsions.Formanypatients,ERPistheadd-ontreatmentofchoicewhenselectiveserotoninreuptakeinhibitors(SSRIs)orserotonin-norepinephrinereuptakeinhibitors(SNRIs)medicationdoesnoteffectivelytreatOCDsymptoms,orviceversa,forindividualswhobegintreatmentwithpsychotherapy.[86] Forexample,apatientmightbeaskedtotouchsomethingverymildlycontaminated(exposure),andwashtheirhandsonlyonceafterward(responseprevention).Anotherexamplemightentailaskingthepatienttoleavethehouseandcheckthelockonlyonce(exposure),withoutgoingbacktocheckagain(responseprevention).Aftersucceedingatonestageoftreatment,thepatient'slevelofdiscomfortintheexposurephasecanbeincreased.Whenthistherapyissuccessful,thepatientwillquicklyhabituatetoananxiety-producingsituation,discoveringaconsiderabledropinanxietylevel.[129] ERPhasastrongevidencebase,andisconsideredthemosteffectivetreatmentforOCD.[129]However,thisclaimwasdoubtedbysomeresearchersin2000,whocriticizedthequalityofmanystudies.[130] Acceptanceandcommitmenttherapy(ACT),anewertherapyalsousedtotreatanxietyanddepression,hasalsobeenfoundtobeeffectiveintreatmentofOCD.[131][132]ACTusesacceptanceandmindfulnessstrategiestoteachpatientsnottooverreacttooravoidunpleasantthoughtsandfeelingsbutrather"movetowardvaluedbehavior."[133][134] A2007CochranereviewalsofoundthatpsychologicalinterventionsderivedfromCBTmodels,suchasERPandACT,weremoreeffectivethantreatmentasusual,consistingofnotreatment,awaitinglist,ornon-CBTinterventions.[135]Otherformsofpsychotherapy,suchaspsychodynamicsandpsychoanalysis,mayhelpinmanagingsomeaspectsofthedisorder.However,in2007,theAmericanPsychiatricAssociation(APA)notedalackofcontrolledstudiesshowingtheirefficacy,"indealingwiththecoresymptomsofOCD."[136]Forbody-focusedrepetitivebehaviors(BFRB),behavioralinterventionssuchashabit-reversaltraininganddecouplingarerecommended.[44][45] PsychotherapyincombinationwithpsychiatricmedicationmaybemoreeffectivethaneitheroptionaloneforindividualswithsevereOCD.[137][138][139] Medication AblisterpackofclomipramineunderthebrandnameAnafranil ThemedicationsmostfrequentlyusedtotreatOCDareantidepressants,includingselectiveserotoninreuptakeinhibitors(SSRIs)andserotonin-norepinephrinereuptakeinhibitors(SNRIs).Clomipramine,amedicationbelongingtotheclassoftricyclicantidepressants,appearstoworkaswellasSSRIs,buthasahigherrateofsideeffects.[5] SSRIshelppeoplewithOCDbyinhibitingthereabsorptionofserotoninbythenervecellsaftertheycarrymessagesfromneuronstosynapse;thus,moreserotoninisavailabletopassfurthermessagesbetweennearbynervecells.[89] SSRIsareasecond-linetreatmentofadultOCDwithmildfunctionalimpairment,andasfirst-linetreatmentforthosewithmoderateorsevereimpairment.Inchildren,SSRIscanbeconsideredasasecond-linetherapyinthosewithmoderatetosevereimpairment,withclosemonitoringforpsychiatricadverseeffects.[128]PatientstreatedwithSSRIsareabouttwiceaslikelytorespondtotreatmentasarethosetreatedwithplacebo,sothistreatmentisqualifiedasefficacious.[140][141]Efficacyhasbeendemonstratedbothinshort-term(6–24weeks)treatmenttrials,andindiscontinuationtrialswithdurationsof28–52weeks.[142][143][144] In2006,theNationalInstituteofClinicalandHealthExcellence(NICE)guidelinesrecommendedaugmentativesecond-generation(atypical)antipsychoticsfortreatment-resistantOCD.[6]Atypicalantipsychoticsarenotusefulwhenusedalone,andnoevidencesupportstheuseoffirst-generationantipsychotics.[19][145]ForOCDtreatmentspecifically,thereistentativeevidenceforrisperidone,andinsufficientevidenceforolanzapine.Quetiapineisnobetterthanplacebowithregardtoprimaryoutcomes,butsmalleffectswerefoundintermsofYBOCSscore.Theefficacyofquetiapineandolanzapinearelimitedbyaninsufficientnumberofstudies.[146]A2014reviewarticlefoundtwostudiesthatindicatedthataripiprazolewas"effectiveintheshort-term",andfoundthat"[t]herewasasmalleffect-sizeforrisperidoneoranti-psychoticsingeneralintheshort-term";however,thestudyauthorsfound"noevidencefortheeffectivenessofquetiapineorolanzapineincomparisontoplacebo."[6]WhilequetiapinemaybeusefulwhenusedinadditiontoanSSRI/SNRIintreatment-resistantOCD,thesedrugsareoftenpoorlytolerated,andhavemetabolicsideeffectsthatlimittheiruse.AguidelinebytheAmericanPsychologicalAssociationsuggestedthatdextroamphetaminemaybeconsideredbyitselfaftermorewell-supportedtreatmentshavebeenattempted.[147] Procedures Electroconvulsivetherapy(ECT)hasbeenfoundtohaveeffectivenessinsomesevereandrefractorycases.[148] Surgerymaybeusedasalastresortinpeoplewhodonotimprovewithothertreatments.Inthisprocedure,asurgicallesionismadeinanareaofthebrain(thecingulatecortex).Inonestudy,30%ofparticipantsbenefittedsignificantlyfromthisprocedure.[149]Deepbrainstimulationandvagusnervestimulationarepossiblesurgicaloptionsthatdonotrequiredestructionofbraintissue.IntheUnitedStates,theFoodandDrugAdministrationapproveddeep-brainstimulationforthetreatmentofOCDunderahumanitariandeviceexemption,requiringthattheprocedurebeperformedonlyinahospitalwithspecialqualificationstodoso.[150] IntheUnitedStates,psychosurgeryforOCDisatreatmentoflastresort,andwillnotbeperformeduntilthepersonhasfailedseveralattemptsatmedication(atthefulldosage)withaugmentation,andmanymonthsofintensivecognitive–behavioraltherapywithexposureandritual/responseprevention.[151]Likewise,intheUnitedKingdom,psychosurgerycannotbeperformedunlessacourseoftreatmentfromasuitablyqualifiedcognitive–behavioraltherapisthasbeencarriedout. Children TherapeutictreatmentmaybeeffectiveinreducingritualbehaviorsofOCDforchildrenandadolescents.[152]SimilartothetreatmentofadultswithOCD,cognitivebehavioraltherapystandsasaneffectiveandvalidatedfirstlineoftreatmentofOCDinchildren.[153]Familyinvolvement,intheformofbehavioralobservationsandreports,isakeycomponenttothesuccessofsuchtreatments.[154]Parentalinterventionsalsoprovidepositivereinforcementforachildwhoexhibitsappropriatebehaviorsasalternativestocompulsiveresponses.Inarecentmeta-analysisofevidenced-basedtreatmentofOCDinchildren,family-focusedindividualCBTwaslabeledas"probablyefficacious,"establishingitasoneoftheleadingpsychosocialtreatmentsforyouthwithOCD.[153]Afteroneortwoyearsoftherapy,inwhichachildlearnsthenatureoftheirobsessionandacquiresstrategiesforcoping,theymayacquirealargercircleoffriends,exhibitlessshyness,andbecomelessself-critical.[155] AlthoughtheknowncausesofOCDinyoungeragegroupsrangefrombrainabnormalitiestopsychologicalpreoccupations,lifestresssuchasbullyingandtraumaticfamilialdeathsmayalsocontributetochildhoodcasesofOCD,andacknowledgingthesestressorscanplayaroleintreatingthedisorder.[156] Epidemiology Age-standardizeddisability-adjustedlifeyearestimatedratesforobsessive-compulsivedisorderper100,000 inhabitantsin2004.  nodata  <45  45–52.5  52.5–60  60–67.5  67.5–75  75–82.5  82.5–90  90–97.5  97.5–105  105–112.5  112.5–120  >120 Obsessive–compulsivedisorderaffectsabout2.3%ofpeopleatsomepointintheirlife,withtheyearlyrateabout1.2%.[7]OCDoccursworldwide.[2]Itisunusualforsymptomstobeginaftertheageof35andhalfofpeopledevelopproblemsbefore20.[1][2]Malesandfemalesareaffectedaboutequally.[1] Prognosis QualityoflifeisreducedacrossalldomainsinOCD.WhilepsychologicalorpharmacologicaltreatmentcanleadtoareductionofOCDsymptomsandanincreaseinreportedqualityoflife,symptomsmaypersistatmoderatelevelsevenfollowingadequatetreatmentcourses,andcompletelysymptom-freeperiodsareuncommon.[157][158]InpediatricOCD,around40%stillhavethedisorderinadulthood,andaround40%qualifyforremission.[159] History Plutarch,anancientGreekphilosopherandhistorian,describesanancientRomanmanwhopossiblyhadscrupulosity,whichcouldbeasymptomofOCDorOCPD.Thismanisdescribedas"turningpaleunderhiscrownofflowers,"prayingwitha"falteringvoice,"andscattering"incensewithtremblinghands."[160][161][162] Inthe7thcenturyAD,JohnClimacusrecordsaninstanceofayoungmonkplaguedbyconstantandoverwhelming"temptationstoblasphemy"consultinganoldermonk,whotoldhim:"Myson,Itakeuponmyselfallthesinswhichthesetemptationshaveledyou,ormayleadyou,tocommit.AllIrequireofyouisthatforthefutureyoupaynoattentiontothemwhatsoever."[163]: 212 TheCloudofUnknowing,aChristianmysticaltextfromthelate14thcentury,recommendsdealingwithrecurringobsessionsbyattemptingtoignorethem,and,ifthatfails,to"cowerunderthemlikeapoorwretchandacowardovercomeinbattle,andreckonittobeawasteofyourtimeforyoutostriveanylongeragainstthem",atechniquenowknownasemotionalflooding.[163]: 213  Fromthe14thtothe16thcenturyinEurope,itwasbelievedthatpeoplewhoexperiencedblasphemous,sexualorotherobsessivethoughtswerepossessedbythedevil.[125][163]: 213 Basedonthisreasoning,treatmentinvolvedbanishingthe"evil"fromthe"possessed"personthroughexorcism.[164][165]Thevastmajorityofpeoplewhothoughtthattheywerepossessedbythedevildidnothavehallucinationsorother"spectacularsymptoms"but"complainedofanxiety,religiousfears,andevilthoughts."[163]: 213 In1584,awomanfromKent,England,namedMrs.Davie,describedbyajusticeofthepeaceas"agoodwife,"wasnearlyburnedatthestakeaftersheconfessedthatsheexperiencedconstant,unwantedurgestomurderherfamily.[163]: 213  TheEnglishtermobsessive–compulsivearoseasatranslationofGermanZwangsvorstellung(obsession)usedinthefirstconceptionsofOCDbyCarlWestphal.Westphal'sdescriptionwentontoinfluencePierreJanet,whofurtherdocumentedfeaturesofOCD.[48]Intheearly1910s,SigmundFreudattributedobsessive–compulsivebehaviortounconsciousconflictsthatmanifestassymptoms.[164]Freuddescribestheclinicalhistoryofatypicalcaseof"touchingphobia"asstartinginearlychildhood,whenthepersonhasastrongdesiretotouchanitem.Inresponse,thepersondevelopsan"externalprohibition"againstthistypeoftouching.However,this"prohibitiondoesnotsucceedinabolishing"thedesiretotouch;allitcandoisrepressthedesireand"forceitintotheunconscious."[166]FreudianpsychoanalysisremainedthedominanttreatmentforOCDuntilthemid-1980s,eventhoughmedicinalandtherapeutictreatmentswereknownandavailable,becauseitwaswidelythoughtthatthesetreatmentswouldbedetrimentaltotheeffectivenessofthepsychotherapy.[163]: 210–211 Inthemid-1980s,thisapproachchanged,andpractitionersbegantreatingOCDprimarilywithmedicineandpracticaltherapyratherthanthroughpsychoanalysis.[163]: 210  Notablecases JohnBunyan(1628–1688),theauthorofThePilgrim'sProgress,displayedsymptomsofOCD(whichhadnotyetbeennamed).Duringthemostsevereperiodofhiscondition,hewouldmutterthesamephraseoverandoveragaintohimselfwhilerockingbackandforth.[163]: 53–54 HelaterdescribedhisobsessionsinhisautobiographyGraceAboundingtotheChiefofSinners,stating,"Thesethingsmayseemridiculoustoothers,evenasridiculousastheywereinthemselves,buttometheywerethemosttormentingcogitations."[163]: 53–54 Hewrotetwopamphletsadvisingthosewithsimilaranxieties.[163]: 217–218 Inoneofthem,hewarnsagainstindulgingincompulsions:"Havecareofputtingoffyourtroubleofspiritinthewrongway:bypromisingtoreformyourselfandleadanewlife,byyourperformancesorduties".[163]: 217–218  Britishpoet,essayistandlexicographerSamuelJohnson(1709–1784)alsohadOCD.Hehadelaborateritualsforcrossingthethresholdsofdoorways,andrepeatedlywalkedupanddownstaircasescountingthesteps.[167][163]: 54–55 Hewouldtoucheverypostonthestreetashewalkedpast,onlystepinthemiddlesofpavingstones,andrepeatedlyperformtasksasthoughtheyhadnotbeendoneproperlythefirsttime.[163]: 55  TheAmericanaviatorandfilmmakerHowardHughesisknowntohavehadOCD.[168]FriendsofHugheshavealsomentionedhisobsessionwithminorflawsinclothing.[169]ThiswasconveyedinTheAviator(2004),afilmbiographyofHughes.[170] Englishsinger-songwriterGeorgeEzrahasopenlyspokenabouthislife-longstrugglewithOCD,particularly"PureOCD."[171] WorldrenownedSwedishclimateactivistGretaThunbergisalsoknowntohaveOCD,amongothermentalhealthconditions.[172] AmericanactorJamesSpaderisalsoknowntohaveOCD.[173] Societyandculture Thisribbonrepresentstrichotillomaniaandotherbody-focusedrepetitivebehaviors.ConceptfortheribbonwasstartedbyJenneSchrader.ColorswerevotedonbyaTrichotillomaniaFacebookcommunity,andmadeofficialbytheTrichotillomaniaLearningCenterinAugust2013. Art,entertainmentandmedia MoviesandtelevisionshowsmayportrayidealizedorincompleterepresentationsofdisorderssuchasOCD.Compassionateandaccurateliteraryandon-screendepictionsmayhelpcounteractthepotentialstigmaassociatedwithanOCDdiagnosis,andleadtoincreasedpublicawareness,understandingandsympathyforsuchdisorders.[174][175] InthefilmAsGoodasItGets(1997),actorJackNicholsonportraysamanwithOCDwhoperformsritualisticbehaviorsthatdisrupthislife.[176] ThefilmMatchstickMen(2003),directedbyRidleyScott,portraysaconmannamedRoy(NicolasCage)withOCDwhoopensandclosesdoorsthreetimeswhilecountingaloudbeforehecanwalkthroughthem.[177] InthetelevisionseriesMonk(2002–2009),thetitularcharacterAdrianMonkfearsbothhumancontactanddirt.[178][179] InTurtlesAlltheWayDown(2017),ayoungadultnovelbyauthorJohnGreen,teenagemaincharacterAzaHolmesstruggleswithOCDthatmanifestsasafearofthehumanmicrobiome.Throughoutthestory,Azarepeatedlyopensanunhealedcallusonherfingertodrainoutwhatshebelievesarepathogens.ThenovelisbasedonGreen'sownexperienceswithOCD.HeexplainedthatTurtlesAlltheWayDownisintendedtoshowhow"mostpeoplewithchronicmentalillnessesalsolivelong,fulfillinglives".[180] TheBritishTVseriesPure(2019)starsCharlyCliveasa24-year-oldMarniewhoisplaguedbydisturbingsexualthoughts,asakindofprimarilyobsessionalobsessivecompulsivedisorder.[181]TheseriesisbasedonabookofthesamenamebyRoseCartwright. Research ThenaturallyoccurringsugarinositolhasbeensuggestedasatreatmentforOCD.[182] μ-Opioids,suchashydrocodoneandtramadol,mayimproveOCDsymptoms.[183]AdministrationofopiatetreatmentmaybecontraindicatedinindividualsconcurrentlytakingCYP2D6inhibitorssuchasfluoxetineandparoxetine.[184] Muchcurrentresearchisdevotedtothetherapeuticpotentialoftheagentsthataffectthereleaseoftheneurotransmitterglutamateorthebindingtoitsreceptors.Theseincluderiluzole,memantine,gabapentin,N-acetylcysteine,topiramateandlamotrigine.[185] Otheranimals Seealso:Animalpsychopathology§ Obsessivecompulsivedisorder(OCD) References ^abcdefghijklmnoTheNationalInstituteofMentalHealth(NIMH)(January2016)."WhatisObsessive-CompulsiveDisorder(OCD)?".U.S.NationalInstitutesofHealth(NIH).Archivedfromtheoriginalon23July2016.Retrieved24July2016. ^abcdefghijklmnopqrDiagnosticandstatisticalmanualofmentaldisorders :DSM-5(5 ed.).Washington:AmericanPsychiatricPublishing.2013.pp. 237–242.ISBN 978-0-89042-555-8. ^abAngelakis,I;Gooding,P;Tarrier,N;Panagioti,M(25March2015)."Suicidalityinobsessivecompulsivedisorder(OCD):Asystematicreviewandmeta-analysis".ClinicalPsychologyReview.Oxford,England:PergamonPress.39:1–15.doi:10.1016/j.cpr.2015.03.002.PMID 25875222. ^Clinic,Clevelandclinic."ObsessiveCompulsiveDisorder".https://my.clevelandclinic,org.Clevelandclinic.Retrieved9June2022. ^abcdeGrantJE(14August2014)."Clinicalpractice:Obsessive-compulsivedisorder".TheNewEnglandJournalofMedicine.371(7):646–53.doi:10.1056/NEJMcp1402176.PMID 25119610. ^abcdeVeale,D;Miles,S;Smallcombe,N;Ghezai,H;Goldacre,B;Hodsoll,J(29November2014)."AtypicalantipsychoticaugmentationinSSRItreatmentrefractoryobsessive-compulsivedisorder:asystematicreviewandmeta-analysis".BMCPsychiatry.14:317.doi:10.1186/s12888-014-0317-5.PMC 4262998.PMID 25432131. ^abcGoodman,WK;Grice,DE;Lapidus,KA;Coffey,BJ(September2014)."Obsessive-compulsivedisorder".ThePsychiatricClinicsofNorthAmerica.37(3):257–67.doi:10.1016/j.psc.2014.06.004.PMID 25150561. ^Drs;Sartorius,Norman;Henderson,A.S.;Strotzka,H.;Lipowski,Z.;Yu-cun,Shen;You-xin,Xu;Strömgren,E.;Glatzel,J.;Kühne,G.-E.;Misès,R.;Soldatos,C.R.;Pull,C.B.;Giel,R.;Jegede,R.;Malt,U.;Nadzharov,R.A.;Smulevitch,A.B.;Hagberg,B.;Perris,C.;Scharfetter,C.;Clare,A.;Cooper,J.E.;Corbett,J.A.;GriffithEdwards,J.;Gelder,M.;Goldberg,D.;Gossop,M.;Graham,P.;Kendell,R.E.;Marks,I.;Russell,G.;Rutter,M.;Shepherd,M.;West,D.J.;Wing,J.;Wing,L.;Neki,J.S.;Benson,F.;Cantwell,D.;Guze,S.;Helzer,J.;Holzman,P.;Kleinman,A.;Kupfer,D.J.;Mezzich,J.;Spitzer,R.;Lokar,J."TheICD-10ClassificationofMentalandBehaviouralDisordersClinicaldescriptionsanddiagnosticguidelines"(PDF).www.who.intWorldHealthOrganization.MicrosoftWord.bluebook.doc.p. 116(foot).Retrieved23June2021–viaMicrosoftBing.{{citeweb}}:CS1maint:url-status(link) ^ab"Overview-Obsessivecompulsivedisorder(OCD)".nhs.uk.16February2021.Retrieved6November2021. ^abcde"WhatIsObsessive-CompulsiveDisorder?".www.psychiatry.org.Retrieved6November2021. ^CDC(2December2020)."Obsessive-CompulsiveDisorderinChildren|CDC".CentersforDiseaseControlandPrevention.Retrieved6November2021. ^"Whatarecompulsions?|OCD-UK".Retrieved5November2021. ^abcFenskeJN,SchwenkTL(August2009)."Obsessivecompulsivedisorder:diagnosisandmanagement".AmericanFamilyPhysician.80(3):239–45.PMID 19621834.Archivedfromtheoriginalon12May2014. ^Alonso,P.;Segalàs,C.;Real,E.;Pertusa,A.;Labad,J.;Jiménez-Murcia,S.;Jaurrieta,N.;Bueno,B.;Vallejo,J.;Menchón,J.M.(13January2010)."Suicideinpatientstreatedforobsessive-compulsivedisorder:aprospectivefollow-upstudy".JournalofAffectiveDisorders.124(3):300–308.doi:10.1016/j.jad.2009.12.001.PMID 20060171–viaElsevierScienceDirect. ^ab"MedicationsApprovedforTreatmentofOCD".BeyondOCD:OCDInformationandResources.Retrieved11December2021.{{citeweb}}:CS1maint:url-status(link) ^Pittenger,Christopher;Bloch,MichaelH.(September2014)."Pharmacologicaltreatmentofobsessive-compulsivedisorder".PsychiatricClinicsofNorthAmerica.37(3):375–391.doi:10.1016/j.psc.2014.05.006.PMC 4143776.PMID 25150568. ^Wells,Adrian.(2011)[2009].Metacognitivetherapyforanxietyanddepression(Pbk. ed.).NewYork,NY:GuilfordPress.ISBN 978-1-60918-496-4.OCLC 699763619. ^abBloch,MichaelH.;McGuire,Joseph;Landeros-Weisenberger,Angeli;Leckman,JamesF.;Pittenger,Christopher(August2010)."Meta-AnalysisoftheDose-ResponseRelationshipofSSRIinObsessive-CompulsiveDisorder".MolecularPsychiatry.15(8):850–855.doi:10.1038/mp.2009.50.PMC 2888928.PMID 19468281. ^abDecloedtEH,SteinDJ(2010)."Currenttrendsindrugtreatmentofobsessive-compulsivedisorder".NeuropsychiatrDisTreat.6:233–42.doi:10.2147/NDT.S3149.PMC 2877605.PMID 20520787. ^Blomstedt,Patric;Sjöberg,RickardL.;Hansson,Maja;Bodlund,Owe;Hariz,MarwinI.(December2013)."DeepBrainStimulationintheTreatmentofObsessive-CompulsiveDisorder".WorldNeurosurgery.80(6):E245–E253.doi:10.1016/j.wneu.2012.10.006.PMID 23044000–viaElsevierScienceDirect. ^Bynum,W.F.;Porter,Roy;Shepherd,Michael(1985)."ObsessionalDisorders:AConceptualHistory.TerminologicalandClassificatoryIssues.".Theanatomyofmadness:essaysinthehistoryofpsychiatry.London:Routledge.pp. 166–187.ISBN 978-0-415-32382-6. ^abLeckman,JF;Bloch,MH;King,RA(2009)."Symptomdimensionsandsubtypesofobsessive-compulsivedisorder:adevelopmentalperspective".DialoguesinClinicalNeuroscience.11(1):21–33.doi:10.31887/DCNS.2009.11.1/jfleckman.PMC 3181902.PMID 19432385. ^Bloch,MH;Landeros-Weisenberger,A;Rosario,MC;Pittenger,C;Leckman,JF(December2008)."Meta-analysisofthesymptomstructureofobsessive-compulsivedisorder".TheAmericanJournalofPsychiatry.165(12):1532–42.doi:10.1176/appi.ajp.2008.08020320.PMC 3972003.PMID 18923068. ^McKay,D;Abramowitz,JS;Calamari,JE;Kyrios,M;Radomsky,A;Sookman,D;Taylor,S;Wilhelm,S(July2004)."Acriticalevaluationofobsessive-compulsivedisordersubtypes:symptomsversusmechanisms".ClinicalPsychologyReview.24(3):283–313.doi:10.1016/j.cpr.2004.04.003.PMID 15245833. ^Anholt,GideonE.;Cath,DanielleC.;vanOppen,Patricia;Eikelenboom,Merijn;Smit,JohannesH.;vanMegen,Harold;vanBalkom,AntonJ.L.M.(2010)."AutismandADHDSymptomsinPatientswithOCD:AreTheyAssociatedwithSpecificOCSymptomDimensionsorOCSymptomSeverity?".JournalofAutismandDevelopmentalDisorders.40(5):580–589.doi:10.1007/s10803-009-0922-1.PMC 2855859.PMID 20039111. ^Markarian,Y;Larson,MJ;Aldea,MA;Baldwin,SA;Good,D;Berkeljon,A;Murphy,TK;Storch,EA;McKay,D(February2010)."Multiplepathwaystofunctionalimpairmentinobsessive-compulsivedisorder".ClinicalPsychologyReview.30(1):78–88.doi:10.1016/j.cpr.2009.09.005.PMID 19853982. ^Doron,G;Szepsenwol,O;Karp,E;Gal,N(2013)."ObsessingAboutIntimate-Relationships:TestingtheDoubleRelationship-VulnerabilityHypothesis".JournalofBehaviorTherapyandExperimentalPsychiatry.44(4):433–440.doi:10.1016/j.jbtep.2013.05.003.PMID 23792752. ^Baer2001,p. xiv.sfnerror:notarget:CITEREFBaer2001(help) ^Mash,EricJ.;Wolfe,DavidA.(2005).Abnormalchildpsychology(3 ed.).Belmont,California:ThomsonWadsworth.p. 197.ISBN 978-1305105423. ^abOsgood-Hynes,Deborah."ThinkingBadThoughts"(PDF).Belmont,Massachusetts:MGH/McLeanOCDInstitute.Archivedfromtheoriginal(PDF)on15November2011.Retrieved30December2006. ^Williams,Monnica."SexualOrientationWorriesinObsessive-CompulsiveDisorder".OCDTypes.Retrieved4February2021. ^Williams,Monnica;Farris,Samantha(15May2011)."SexualOrientationObsessionsinObsessive-CompulsiveDisorder:PrevalenceandCorrelates".JournalofPsychiatricResearch.Amsterdam,Netherlands:Elsevier.187(1–2):156–159.doi:10.1016/j.psychres.2010.10.019.PMC 3070770.PMID 21094531. ^Murphy,DennisL.;Timpano,KiaraR.;Wheaton,MichaelG.;Greenberg,BenjaminD.;Miguel,EuripidesC.(2010)."Obsessive-compulsivedisorderanditsrelateddisorders:areappraisalofobsessive-compulsivespectrumconcepts".DialoguesinClinicalNeuroscience.Abingdon,England:Taylor&Francis.12(2):131–48.doi:10.31887/DCNS.2010.12.2/dmurphy.PMC 3181955.PMID 20623919. ^HighlightsofChangesfromDSM-IV-TRtoDSM-5(PDF),AmericanPsychiatricAssociation,2013,p. 7,archived(PDF)fromtheoriginalon19October2013,retrieved12April2016 ^Hermans,Dirk;Engelen,Ute;Grouwels,Luc;Joos,Els;Lemmens,Jos;Pieters,Guido(January2008)."Cognitiveconfidenceinobsessive-compulsivedisorder:distrustingperception,attentionandmemory".BehaviourResearchandTherapy.Amsterdam,Netherlands:Elsevier.46(1):98–113.doi:10.1016/j.brat.2007.11.001.PMID 18076865. ^BoydMA(2007).PsychiatricNursing.IssuesinMentalHealthNursing.Vol. 15.Baltimore,Maryland:LippincottWilliams&Wilkins.pp. 13–26.doi:10.3109/01612849409074930.ISBN 978-0-397-55178-1.PMID 8119793. ^"Obsessive-CompulsiveDisorder,(2005)".Retrieved15December2009. ^Storch;et al.(2008)."Obsessive-compulsivedisorderinyouthwithandwithoutachronicticdisorder".DepressionandAnxiety.25(9):761–767.doi:10.1002/da.20304.PMID 17345600.S2CID 30858531. ^Conelea;et al.(2014)."Tic-relatedobsessive-compulsivedisorder(OCD):phenomenologyandtreatmentoutcomeinthePediatricOCDTreatmentStudyII".JournaloftheAmericanAcademyofChild&AdolescentPsychiatry.53(12):1308–16.doi:10.1016/j.jaac.2014.09.014.PMC 4254546.PMID 25457929. ^"HygieneoftheSkin:WhenIsCleanTooClean?Subtopic:"SkinBarrierPropertiesandEffectofHandHygienePractices",Paragraph5".Archivedfromtheoriginalon21April2009.Retrieved26March2009. ^Pélissier,Marie-Claude;O'Connor,KieronP.(March2002)."Deductiveandinductivereasoninginobsessive-compulsivedisorder".BritishJournalofClinicalPsychology.Leicester,England:Wiley-Blackwell(41):15–27.doi:10.1348/014466502163769.PMID 11931675. ^"UnderstandingCBTforOCD".PerelmanSchoolofMedicineUniversityofPennsylvania.Retrieved31August2021.{{citeweb}}:CS1maint:url-status(link) ^vandenHout,Marcel;Kindt,Merel(June2004)."Obsessive-compulsivedisorderandtheparadoxicaleffectsofperseverativebehaviouronexperienceduncertainty".JournalofBehaviorTherapyandExperimentalPsychiatry.35(2):165–181.doi:10.1016/j.jbtep.2004.04.007.hdl:1874/11267.PMID 15210377. ^abHimle,MichaelB.;Flessner,ChristopherA.;Woods,DouglasW.(2004)."AdvancesinthebehavioranalytictreatmentoftrichotillomaniaandTourette'sSyndrome".JournalofEarlyandIntensiveBehaviorIntervention.1(1):57–64.doi:10.1037/h0100282.ISSN 1554-4893. ^abSarris,Jerome;Camfield,David;Berk,Michael(2012)."Complementarymedicine,self-help,andlifestyleinterventionsforObsessiveCompulsiveDisorder(OCD)andtheOCDspectrum:Asystematicreview".JournalofAffectiveDisorders.138(3):213–221.doi:10.1016/j.jad.2011.04.051.PMID 21620478. ^Weisman,MyrnaM.(May1998)."Thecrossnationalepidemiologyofobsessive–compulsivedisorder".NewDevelopmentsinObsessive-CompulsiveandSpectrumDisorders.3(1):6–9. ^SubstanceAbuseandMentalHealthServicesAdministration(June2016)."Table3.13,DSM-IVtoDSM-5Obsessive-CompulsiveDisorderComparison".ImpactoftheDSM-IVtoDSM-5ChangesontheNationalSurveyonDrugUseandHealth[Internet].Retrieved11December2021.{{citeweb}}:CS1maint:url-status(link) ^abRuiz,P;Sadock,B;Sadock,V(2017).KaplanandSadock'sComprehensiveTextbookofPsychiatry(10th ed.).LWW.ISBN 978-1-4511-0047-1. ^O'Dwyer,Anne-MarieCarter,Obsessive–compulsivedisorderanddelusionsrevisited,TheBritishJournalofPsychiatry(2000)176:281–284 ^abVeale,D.(2002)."Over-valuedideas:aconceptualanalysis"(PDF).BehaviourResearchandTherapy.40(4):383–400.doi:10.1016/S0005-7967(01)00016-X.PMID 12002896. ^abBorda,Tania;Neziroglu,Fugen;Taboas,William;McKay,Dean;Frenkiel,Leah(September2017)."Overvaluedideationinadolescentswithobsessive-compulsivedisorder".PsychiatryResearch.255:66–71.doi:10.1016/j.psychres.2017.05.001.PMID 28528243.S2CID 4627755–viaElsevierScienceDirect. ^Kozak,M.J.;Foa,E.B.(March1994)."Obsessions,overvaluedideas,anddelusionsinobsessive-compulsivedisorder".BehaviourResearchandTherapy.32(3):343–353.doi:10.1016/0005-7967(94)90132-5.PMID 8192634. ^Neziroglu,Fugen;McKay,Dean;Yaryura-Tobias,JoseA.;Stevens,KevinP.;Todaro,John(1999)."Theovervaluedideasscale:development,reliabilityandvalidityinobsessive–compulsivedisorder".BehaviourResearchandTherapy.37(9):881–902.doi:10.1016/S0005-7967(98)00191-0.PMID 10458051–viaElsevierScienceDirect. ^AbramovitchAmitai;AnholtGideon;Raveh-GottfriedSagi;HamoNaama;AbramowitzJonathanS(2017)."Meta-AnalysisofIntelligenceQuotient(IQ)inObsessive-CompulsiveDisorder".NeuropsychologyReview.28(1):111–120.doi:10.1007/s11065-017-9358-0.PMID 28864868.S2CID 4012128. ^ShinNY,LeeTY,KimE,KwonJS(19July2013)."Cognitivefunctioninginobsessive-compulsivedisorder:ameta-analysis".PsychologicalMedicine.44(6):1121–1130.doi:10.1017/S0033291713001803.PMID 23866289.S2CID 28181106. ^ÇetinayAydınP,GüleçÖyekçinD(2013)."Cognitivefunctionsinpatientswithobsessivecompulsivedisorder".TurkPsikiyatriDergisi(TurkishJournalofPsychiatry).24(4):266–74.doi:10.5080/u7172.PMID 24310094. ^Pauls,DL;Abramovitch,A;Rauch,SL;Geller,DA(June2014)."Obsessive-compulsivedisorder:anintegrativegeneticandneurobiologicalperspective".NatureReviews.Neuroscience.15(6):410–24.doi:10.1038/nrn3746.PMID 24840803.S2CID 17781028. ^Leopold,R;Backenstrass,M(March2015)."Neuropsychologicaldifferencesbetweenobsessive-compulsivewashersandcheckers:asystematicreviewandmeta-analysis".JournalofAnxietyDisorders.30:48–58.doi:10.1016/j.janxdis.2014.12.016.PMID 25601381. ^Abramovitch,Amitai;Cooperman,Allison(April2015)."Thecognitiveneuropsychologyofobsessive-compulsivedisorder:Acriticalreview".JournalofObsessive-CompulsiveandRelatedDisorders.5:24–36.doi:10.1016/j.jocrd.2015.01.002. ^Jones,AnnaM.;Nadai,AlessandroS.De;Arnold,ElysseB.;McGuire,JosephF.;Lewin,AdamB.;Murphy,TanyaK.;Storch,EricA.(1February2013)."PsychometricPropertiesoftheObsessiveCompulsiveInventory:ChildVersioninChildrenandAdolescentswithObsessive–CompulsiveDisorder".ChildPsychiatry&HumanDevelopment.44(1):137–151.doi:10.1007/s10578-012-0315-0.ISSN 0009-398X.PMID 22711294.S2CID 27470036. ^Last,CynthiaG.;Strauss,CydC.(1989)."Obsessive—compulsivedisorderinchildhood".JournalofAnxietyDisorders.3(4):295–302.doi:10.1016/0887-6185(89)90020-0. ^ChenYW,DilsaverSC(1995)."Comorbidityforobsessive-compulsivedisorderinbipolarandunipolardisorders".PsychiatryResearch.59(1–2):57–64.doi:10.1016/0165-1781(95)02752-1.PMID 8771221.S2CID 2782199. ^Angelakis,I;Gooding,P;Tarrier,N;Panagioti,M(July2015)."Suicidalityinobsessivecompulsivedisorder(OCD):asystematicreviewandmeta-analysis".ClinicalPsychologyReview.39:1–15.doi:10.1016/j.cpr.2015.03.002.PMID 25875222. ^TurnerJ,DrummondLM,MukhopadhyayS,GhodseH,WhiteS,PillayA,FinebergNA(June2007)."Aprospectivestudyofdelayedsleepphasesyndromeinpatientswithsevereresistantobsessive–compulsivedisorder".WorldPsychiatry.6(2):108–111.PMC 2219909.PMID 18235868. ^PatersonJL,ReynoldsAC,FergusonSA,DawsonD(2013)."Sleepandobsessive-compulsivedisorder(OCD)".SleepMedicineReviews.17(6):465–74.doi:10.1016/j.smrv.2012.12.002.PMID 23499210. ^MinekaS,WatsonD,ClarkLA(1998)."Comorbidityofanxietyandunipolarmooddisorders".AnnualReviewofPsychology.49:377–412.doi:10.1146/annurev.psych.49.1.377.PMID 9496627.S2CID 14546782. ^PediatricObsessive-CompulsiveDisorderDifferentialDiagnosesArchived17September2012attheWaybackMachine–2012 ^MansuetoCS,KeulerDJ(2005)."Ticorcompulsion?:it'sTouretticOCD".BehaviorModification.29(5):784–99.doi:10.1177/0145445505279261.PMID 16046664.S2CID 146592937. ^"OCDandTouretteSyndrome:Re-examiningtheRelationship".InternationalOCDFoundation.Archivedfromtheoriginalon1November2013.Retrieved30October2013. ^Pallanti,S;Grassi,G;Sarrecchia,ED;Cantisani,A;Pellegrini,M(2011)."Obsessive-compulsivedisordercomorbidity:clinicalassessmentandtherapeuticimplications".FrontiersinPsychiatry.2:70.doi:10.3389/fpsyt.2011.00070.PMC 3243905.PMID 22203806. ^Diagnosticandstatisticalmanualofmentaldisorders :DSM-5(5th ed.).Arlington,VA:AmericanPsychiatricAssociation.2013.ISBN 978-0-89042-554-1.OCLC 830807378. ^Alevizos,Basil;Papageorgiou,Charalambos;Christodoulou,GeorgeN.(1September2004)."Obsessive-compulsivesymptomswitholanzapine".TheInternationalJournalofNeuropsychopharmacology.7(3):375–377.doi:10.1017/S1461145704004456.ISSN 1461-1457.PMID 15231024. ^Kulkarni,Gajanan;Narayanaswamy,JanardhananC.;Math,SureshBada(1January2012)."Olanzapineinducedde-novoobsessivecompulsivedisorderinapatientwithschizophrenia".IndianJournalofPharmacology.44(5):649–650.doi:10.4103/0253-7613.100406.ISSN 0253-7613.PMC 3480803.PMID 23112432. ^Lykouras,L.;Zervas,I.M.;Gournellis,R.;Malliori,M.;Rabavilas,A.(1September2000)."Olanzapineandobsessive-compulsivesymptoms".EuropeanNeuropsychopharmacology.10(5):385–387.doi:10.1016/s0924-977x(00)00096-1.ISSN 0924-977X.PMID 10974610.S2CID 276209. ^Schirmbeck,Frederike;Zink,Mathias(1March2012)."Clozapine-InducedObsessive-CompulsiveSymptomsinSchizophrenia:ACriticalReview".CurrentNeuropharmacology.10(1):88–95.doi:10.2174/157015912799362724.ISSN 1570-159X.PMC 3286851.PMID 22942882. ^AbramowitzJS,TaylorS,McKayD(2009)."Obsessive-compulsivedisorder".Lancet.374(9688):491–9.doi:10.1016/S0140-6736(09)60240-3.PMID 19665647.S2CID 203833429. ^MenziesL,AchardS,ChamberlainSR,FinebergN,ChenCH,delCampoN,SahakianBJ,RobbinsTW,BullmoreE(2007)."Neurocognitiveendophenotypesofobsessive-compulsivedisorder".Brain.130(Pt12):3223–36.doi:10.1093/brain/awm205.PMID 17855376. ^OzakiN,GoldmanD,KayeWH,PlotnicovK,GreenbergBD,LappalainenJ,RudnickG,MurphyDL(2003)."Serotonintransportermissensemutationassociatedwithacomplexneuropsychiatricphenotype".Mol.Psychiatry.8(11):933–6.doi:10.1038/sj.mp.4001365.PMID 14593431. ^Bloch,MH;Landeros-Weisenberger,A;Sen,S;Dombrowski,P;Kelmendi,B;Coric,V;Pittenger,C;Leckman,JF(5September2008)."Associationoftheserotonintransporterpolymorphismandobsessive-compulsivedisorder:systematicreview".AmericanJournalofMedicalGenetics.PartB,NeuropsychiatricGenetics.147B(6):850–8.doi:10.1002/ajmg.b.30699.PMID 18186076.S2CID 23223447. ^Lin,PY(13April2007)."Meta-analysisoftheassociationofserotonintransportergenepolymorphismwithobsessive-compulsivedisorder".ProgressinNeuro-psychopharmacology&BiologicalPsychiatry.31(3):683–9.doi:10.1016/j.pnpbp.2006.12.024.PMID 17291658.S2CID 40442832. ^Stewart,SE;Yu,D;Scharf,JM;Neale,BM;Fagerness,JA;Mathews,CA;Arnold,PD;Evans,PD;Gamazon,ER;Davis,LK;Osiecki,L;McGrath,L;Haddad,S;Crane,J;Hezel,D;Illman,C;Mayerfeld,C;Konkashbaev,A;Liu,C;Pluzhnikov,A;Tikhomirov,A;Edlund,CK;Rauch,SL;Moessner,R;Falkai,P;Maier,W;Ruhrmann,S;Grabe,HJ;Lennertz,L;et al.(July2013)."Genome-wideassociationstudyofobsessive-compulsivedisorder".MolecularPsychiatry.18(7):788–98.doi:10.1038/mp.2012.85.PMC 4218751.PMID 22889921. ^Stewart,SE;Mayerfeld,C;Arnold,PD;Crane,JR;O'Dushlaine,C;Fagerness,JA;Yu,D;Scharf,JM;Chan,E;Kassam,F;Moya,PR;Wendland,JR;Delorme,R;Richter,MA;Kennedy,JL;Veenstra-VanderWeele,J;Samuels,J;Greenberg,BD;McCracken,JT;Knowles,JA;Fyer,AJ;Rauch,SL;Riddle,MA;Grados,MA;Bienvenu,OJ;Cullen,B;Wang,Y;Shugart,YY;Piacentini,J;Rasmussen,S;Nestadt,G;Murphy,DL;Jenike,MA;Cook,EH;Pauls,DL;Hanna,GL;Mathews,CA(June2013)."Meta-analysisofassociationbetweenobsessive-compulsivedisorderandthe3'regionofneuronalglutamatetransportergeneSLC1A1"(PDF).AmericanJournalofMedicalGenetics.PartB,NeuropsychiatricGenetics.162B(4):367–79.doi:10.1002/ajmg.b.32137.hdl:2027.42/98412.PMID 23606572.S2CID 20929721. ^Pooley,EC;Fineberg,N;Harrison,PJ(June2007)."Themet(158)alleleofcatechol-O-methyltransferase(COMT)isassociatedwithobsessive-compulsivedisorderinmen:case-controlstudyandmeta-analysis".MolecularPsychiatry.12(6):556–61.doi:10.1038/sj.mp.4001951.PMID 17264842. ^Azzam,A;Mathews,CA(15November2003)."Meta-analysisoftheassociationbetweenthecatecholamine-O-methyl-transferasegeneandobsessive-compulsivedisorder".AmericanJournalofMedicalGenetics.PartB,NeuropsychiatricGenetics.123B(1):64–9.doi:10.1002/ajmg.b.20013.PMID 14582147.S2CID 42840925. ^BrachaHS(2006)."Humanbrainevolutionandthe"NeuroevolutionaryTime-depthPrinciple:"ImplicationsfortheReclassificationoffear-circuitry-relatedtraitsinDSM-Vandforstudyingresiliencetowarzone-relatedposttraumaticstressdisorder"(PDF).ProgressinNeuro-PsychopharmacologyandBiologicalPsychiatry.30(5):827–853.doi:10.1016/j.pnpbp.2006.01.008.PMC 7130737.PMID 16563589. ^abc"Obsessive-CompulsiveDisorder".NationalInstituteofMentalHealth(NIMH).Retrieved23March2022. ^ab"Overview-Obsessivecompulsivedisorder(OCD)".nhs.uk.16February2021.Retrieved23March2022. ^"Obsessive-compulsiveDisorder|NAMI:NationalAllianceonMentalIllness".www.nami.org.Retrieved23March2022. ^ab"HowSSRIswork|OCD-UK".Retrieved23March2022. ^SigraS,HesselmarkE,BejerotS(March2018)."TreatmentofPANDASandPANS:asystematicreview".NeurosciBiobehavRev.86:51–65.doi:10.1016/j.neubiorev.2018.01.001.PMID 29309797.S2CID 40827012. ^WilburC,BitnunA,KronenbergS,LaxerRM,LevyDM,LoganWJ,ShouldiceM,YehEA(May2019)."PANDAS/PANSinchildhood:Controversiesandevidence".PaediatrChildHealth.24(2):85–91.doi:10.1093/pch/pxy145.PMC 6462125.PMID 30996598. ^BoileauB(2011)."Areviewofobsessive-compulsivedisorderinchildrenandadolescents".DialoguesClinNeurosci.13(4):401–11.doi:10.31887/DCNS.2011.13.4/bboileau.PMC 3263388.PMID 22275846. ^abDaleRC(December2017)."TicsandTourette:aclinical,pathophysiologicalandetiologicalreview".CurrOpinPediatr(Review).29(6):665–673.doi:10.1097/MOP.0000000000000546.PMID 28915150.S2CID 13654194. ^abcdMarazzitiD,MucciF,FontenelleLF(July2018)."Immunesystemandobsessive-compulsivedisorder".Psychoneuroendocrinology(Review).93:39–44.doi:10.1016/j.psyneuen.2018.04.013.PMID 29689421.S2CID 13681480. ^abcdZibordiF,ZorziG,CarecchioM,NardocciN(March2018)."CANS:Childhoodacuteneuropsychiatricsyndromes".EurJPaediatrNeurol(Review).22(2):316–320.doi:10.1016/j.ejpn.2018.01.011.PMID 29398245. ^ShulmanST(February2009)."Pediatricautoimmuneneuropsychiatricdisordersassociatedwithstreptococci(PANDAS):update".Curr.Opin.Pediatr.21(1):127–30.doi:10.1097/MOP.0b013e32831db2c4.PMID 19242249.S2CID 37434919.Despitecontinuedresearchinthefield,therelationshipbetweenGASandspecificneuropsychiatricdisorders(PANDAS)remainselusive. ^MaiaTV,CooneyRE,PetersonBS(2008)."TheneuralbasesofOCDinchildrenandadults".Dev.Psychopathol.20(4):1251–83.doi:10.1017/S0954579408000606.PMC 3079445.PMID 18838041. ^RobertsonMM(February2011)."GillesdelaTourettesyndrome:thecomplexitiesofphenotypeandtreatment"(PDF).BrJHospMed(Lond).72(2):100–7.doi:10.12968/hmed.2011.72.2.100.PMID 21378617. ^SingerHS(2011)."Tourettesyndromeandotherticdisorders".HyperkineticMovementDisorders.HandbClinNeurol.HandbookofClinicalNeurology.Vol. 100.pp. 641–57.doi:10.1016/B978-0-444-52014-2.00046-X.ISBN 9780444520142.PMID 21496613. ^Pearlman,DM;Vora,HS;Marquis,BG;Najjar,S;Dudley,LA(July2014)."Anti-basalgangliaantibodiesinprimaryobsessive-compulsivedisorder:systematicreviewandmeta-analysis".TheBritishJournalofPsychiatry.205(1):8–16.doi:10.1192/bjp.bp.113.137018.PMID 24986387. ^Rotge,Jean-Yves;Guehl,Dominique;Dilharreguy,Bixente;Cuny,Emmanuel;Tignol,Jean;Bioulac,Bernard;Allard,Michele;Burbaud,Pierre;Aouizerate,Bruno(3March2017)."Provocationofobsessive–compulsivesymptoms:aquantitativevoxel-basedmeta-analysisoffunctionalneuroimagingstudies".JournalofPsychiatry&Neuroscience.33(5):405–412.ISSN 1180-4882.PMC 2527721.PMID 18787662. ^Whiteside,StephenP.;Port,JohnD.;Abramowitz,JonathanS.(2004)."Ameta–analysisoffunctionalneuroimaginginobsessive–compulsivedisorder".PsychiatryResearch:Neuroimaging.132(1):69–79.doi:10.1016/j.pscychresns.2004.07.001.PMID 15546704.S2CID 9941792. ^Rasgon,A;Lee,WH;Leibu,E;Laird,A;Glahn,D;Goodman,W;Frangou,S(October2017)."Neuralcorrelatesofaffectiveandnon-affectivecognitioninobsessivecompulsivedisorder:Ameta-analysisoffunctionalimagingstudies".EuropeanPsychiatry.46:25–32.doi:10.1016/j.eurpsy.2017.08.001.PMID 28992533.S2CID 5368803. ^Brem,Silvia;Grünblatt,Edna;Drechsler,Renate;Riederer,Peter;Walitza,Susanne(1January2014)."TheneurobiologicallinkbetweenOCDandADHD".AttentionDeficitandHyperactivityDisorders.6(3):175–202.doi:10.1007/s12402-014-0146-x.ISSN 1866-6116.PMC 4148591.PMID 25017045. ^abcRaduaJ,vandenHeuvelOA,SurguladzeS,Mataix-ColsD(5July2010)."Meta-analyticalcomparisonofvoxel-basedmorphometrystudiesinobsessive-compulsivedisordervsotheranxietydisorders".ArchivesofGeneralPsychiatry.67(7):701–711.doi:10.1001/archgenpsychiatry.2010.70.PMID 20603451. ^Piras,Federica;Piras,Fabrizio;Chiapponi,Chiara;Girardi,Paolo;Caltagirone,Carlo;Spalletta,Gianfranco(1January2015)."WidespreadstructuralbrainchangesinOCD:asystematicreviewofvoxel-basedmorphometrystudies".Cortex.62:89–108.doi:10.1016/j.cortex.2013.01.016.ISSN 1973-8102.PMID 23582297.S2CID 206984783. ^RaduaJ,Mataix-ColsD(November2009)."Voxel-wisemeta-analysisofgreymatterchangesinobsessive–compulsivedisorder".BritishJournalofPsychiatry.195(5):393–402.doi:10.1192/bjp.bp.108.055046.PMID 19880927. ^Radua,J;Grau,M;vandenHeuvel,OA;ThiebautdeSchotten,M;Stein,DJ;Canales-Rodríguez,EJ;Catani,M;Mataix-Cols,D(June2014)."Multimodalvoxel-basedmeta-analysisofwhitematterabnormalitiesinobsessive-compulsivedisorder".Neuropsychopharmacology.39(7):1547–57.doi:10.1038/npp.2014.5.PMC 4023155.PMID 24407265. ^Friedlander,L;Desrocher,M(January2006)."Neuroimagingstudiesofobsessive-compulsivedisorderinadultsandchildren".ClinicalPsychologyReview.26(1):32–49.doi:10.1016/j.cpr.2005.06.010.PMID 16242823. ^Stern,ER;Taylor,SF(September2014)."Cognitiveneuroscienceofobsessive-compulsivedisorder".ThePsychiatricClinicsofNorthAmerica.37(3):337–52.doi:10.1016/j.psc.2014.05.004.PMID 25150566. ^abWood,J;Ahmari,SE(2015)."AFrameworkforUnderstandingtheEmergingRoleofCorticolimbic-VentralStriatalNetworksinOCD-AssociatedRepetitiveBehaviors".FrontiersinSystemsNeuroscience.9:171.doi:10.3389/fnsys.2015.00171.PMC 4681810.PMID 26733823. ^Nakao,Tomohiro;Okada,Kayo;Kanba,Shigenobu(August2014)."Neurobiologicalmodelofobsessive-compulsivedisorder:Evidencefromrecentneuropsychologicalandneuroimagingfindings".PsychiatryandClinicalNeurosciences.68(8):587–605.doi:10.1111/pcn.12195.PMID 24762196.S2CID 5528241. ^Barahona-Corrêa,JB;Camacho,M;Castro-Rodrigues,P;Costa,R;Oliveira-Maia,AJ(2015)."FromThoughttoAction:HowtheInterplayBetweenNeuroscienceandPhenomenologyChangedOurUnderstandingofObsessive-CompulsiveDisorder".FrontiersinPsychology.6:1798.doi:10.3389/fpsyg.2015.01798.PMC 4655583.PMID 26635696. ^Davis,KennethL(2002).Neuropsychopharmacology :thefifthgenerationofprogress :anofficialpublicationoftheAmericanCollegeofNeuropsychopharmacology(5th ed.).Philadelphia,Pa.:LippincottWilliams&Wilkins.pp. 1609–1610.ISBN 978-0-7817-2837-9. ^Muller,ChristianP;Jacobs,BarryL;ADijk;AKlompmakers;DDenys(2009)."4.4TheSerotonergicSysteminObsessive-CompulsiveDisorder".Handbookofthebehavioralneurobiologyofserotonin(1st ed.).London:Academic.pp. 547–558.ISBN 978-0-12-374634-4. ^KimKW,LeeDY(2002)."Obsessive-CompulsiveDisorderAssociatedWithaLeftOrbitofrontalInfarct".JournalofNeuropsychiatryandClinicalNeurosciences.14(1):88–89.doi:10.1176/appi.neuropsych.14.1.88.PMID 11884667. ^Wood,Jesse;Ahmari,SusanneE.(17December2015)."AFrameworkforUnderstandingtheEmergingRoleofCorticolimbic-VentralStriatalNetworksinOCD-AssociatedRepetitiveBehaviors".FrontiersinSystemsNeuroscience.9:171.doi:10.3389/fnsys.2015.00171.ISSN 1662-5137.PMC 4681810.PMID 26733823. ^abPittenger,Christopher;Bloch,MichaelH.;Williams,Kyle(3March2017)."Glutamateabnormalitiesinobsessivecompulsivedisorder:Neurobiology,pathophysiology,andtreatment".Pharmacology&Therapeutics.132(3):314–332.doi:10.1016/j.pharmthera.2011.09.006.ISSN 0163-7258.PMC 3205262.PMID 21963369. ^Graat,I;Figee,M;Denys,D."NeurotransmitterDysregulationinOCD".InPittinger,C(ed.).Obsessive-CompulsiveDisorder:Phenomenology,PathophysiologyandTreatment.OxfordUniversityPress. ^Aoki,Y;Aoki,A;Suwa,H(14August2012)."ReductionofN-acetylaspartateinthemedialprefrontalcortexcorrelatedwithsymptomseverityinobsessive-compulsivedisorder:meta-analysesof(1)H-MRSstudies".TranslationalPsychiatry.2(8):e153.doi:10.1038/tp.2012.78.PMC 3432192.PMID 22892718. ^abQuickReferencetotheDiagnosticCriteriafromDSM-IV-TR.Arlington,VA:AmericanPsychiatricAssociation,2000. ^Goodman,WayneK.(1November1989)."TheYale-BrownObsessiveCompulsiveScale:I.Development,Use,andReliability".ArchivesofGeneralPsychiatry.46(11):1006–1011.doi:10.1001/archpsyc.1989.01810110048007.ISSN 0003-990X.PMID 2684084. ^Foa,EdnaB.;Huppert,JonathanD.;Leiberg,Susanne;Langner,Robert;Kichic,Rafael;Hajcak,Greg;Salkovskis,PaulM.(2012)."TheObsessive-CompulsiveInventory:developmentandvalidationofashortversion".PsychologicalAssessment.14(4):485–496.doi:10.1037/1040-3590.14.4.485.ISSN 1040-3590.PMID 12501574. ^Starcevic,V;Janca,A(January2011)."Obsessive-compulsivespectrumdisorders:stillinsearchoftheconcept-affirmingboundaries".CurrentOpinioninPsychiatry.24(1):55–60.doi:10.1097/yco.0b013e32833f3b58.PMID 20827198.S2CID 41312244. ^abAardema,Frederick;o'Connor,Kieron(2007)."Themenacewithin:obsessionsandtheself".JournalofCognitivePsychotherapy.21(3):182–197.doi:10.1891/088983907781494573.S2CID 143731458. ^Aardema,Frederick;o'Connor,Kieron(2003)."Seeingwhitebearsthatarenotthere:Inferenceprocessesinobsessions".JournalofCognitivePsychotherapy.17:23–37.doi:10.1891/jcop.17.1.23.58270.S2CID 143040967. ^abCarter,K."Obsessive–compulsivepersonalitydisorder."PSYC210lecture:OxfordCollegeofEmoryUniversity.Oxford,GA.11April2006. ^abNationalInstituteforHealthandClinicalExcellence(NICE)(November2005)."Obsessive-compulsivedisorder:Coreinterventionsinthetreatmentofobsessive-compulsivedisorderandbodydysmorphicdisorder".InformationaboutNICEClinicalGuideline31.UKNationalHealthService(NHS).Archivedfromtheoriginalon12January2017.Retrieved24July2016. ^abHuppert&Roth:(2003)TreatingObsessive-CompulsiveDisorderwithExposureandResponsePrevention.TheBehaviorAnalystToday,4(1),66–70BAOArchived23March2010attheWaybackMachine ^KleinDF(2000)."Flawedmeta-analysescomparingpsychotherapywithpharmacotherapy".AmJPsychiatry.157(8):1204–11.doi:10.1176/appi.ajp.157.8.1204.PMID 10910778. ^Twohig,MichaelP.;Hayes,StevenC.;Masuda,Akihiko(1March2006)."IncreasingWillingnesstoExperienceObsessions:AcceptanceandCommitmentTherapyasaTreatmentforObsessive-CompulsiveDisorder".BehaviorTherapy.37(1):3–13.doi:10.1016/j.beth.2005.02.001.ISSN 0005-7894. ^Twohig,MichaelP.;Abramowitz,JonathanS.;Bluett,EllenJ.;Fabricant,LauraE.;Jacoby,RyanJ.;Morrison,KateL.;Reuman,Lillian;Smith,BrookeM.(1July2015)."ExposuretherapyforOCDfromanacceptanceandcommitmenttherapy(ACT)framework".JournalofObsessive-CompulsiveandRelatedDisorders.6:167–173.doi:10.1016/j.jocrd.2014.12.007.ISSN 2211-3649. ^Hayes,StevenC."ACT|AssociationforContextualBehavioralScience".contextualscience.org.Retrieved7July2022. ^Hayes,StevenC.(2012).Acceptanceandcommitmenttherapy :theprocessandpracticeofmindfulchange.KirkStrosahl,KellyG.Wilson(2nd ed.).NewYork:GuilfordPress.ISBN 978-1-60918-962-4.OCLC 713181786. ^I,Gava;C,Barbui;E,Aguglia;D,Carlino;R,Churchill;M,DeVanna;Hf,McGuire(18April2007)."PsychologicalTreatmentsVersusTreatmentasUsualforObsessiveCompulsiveDisorder(OCD)".TheCochraneDatabaseofSystematicReviews(2):CD005333.doi:10.1002/14651858.CD005333.pub2.PMID 17443583. ^KoranLM,HannaGL,HollanderE,NestadtG,SimpsonHB(July2007)."Practiceguidelineforthetreatmentofpatientswithobsessive-compulsivedisorder".TheAmericanJournalofPsychiatry.164(7Suppl):5–53.PMID 17849776. ^Skapinakis,P(15June2016)."Pharmacologicalandpsychotherapeuticinterventionsformanagementofobsessive-compulsivedisorderinadults:asystematicreviewandnetworkmeta-analysis".LancetPsychiatry.3(8):730–739.doi:10.1016/S2215-0366(16)30069-4.PMC 4967667.PMID 27318812. ^Wheaton,MichaelG.;DeSantis,StaciaM.;Simpson,H.Blair(2016)."Networkmeta-analysesandtreatmentrecommendationsforobsessive-compulsivedisorder".TheLancet.Psychiatry.3(10):920.doi:10.1016/S2215-0366(16)30280-2.ISSN 2215-0366.PMC 6690590.PMID 27692263. ^Hirschtritt,MatthewE.;Bloch,MichaelH.;Mathews,CarolA.(4April2017)."Obsessive-CompulsiveDisorder:AdvancesinDiagnosisandTreatment".JAMA.317(13):1358–1367.doi:10.1001/jama.2017.2200.ISSN 1538-3598.PMID 28384832.S2CID 13660201. ^ArrollB,ElleyCR,FishmanT,Goodyear-SmithFA,KenealyT,BlashkiG,KerseN,MacgillivrayS(2009).ArrollB(ed.)."Antidepressantsversusplacebofordepressioninprimarycare".TheCochraneDatabaseofSystematicReviews.2009(3):CD007954.doi:10.1002/14651858.CD007954.PMID 19588448. ^"ReviewFindsSSRIsModestlyEffectiveinShort-TermTreatmentofOCD".Archivedfromtheoriginalon13April2013. ^FinebergNA,BrownA,ReghunandananS,PampaloniI(2012)."Evidence-basedpharmacotherapyofobsessive-compulsivedisorder".TheInternationalJournalofNeuropsychopharmacology.15(8):1173–91.doi:10.1017/S1461145711001829.PMID 22226028. ^"Sertralineprescribinginformation"(PDF).Archived(PDF)fromtheoriginalon16June2015.Retrieved30January2015. ^"Paroxetineprescribinginformation"(PDF).Archivedfromtheoriginal(PDF)on19February2015.Retrieved30January2015. ^Pignon,B;TezenasduMontcel,C;Carton,L;Pelissolo,A(7November2017)."ThePlaceofAntipsychoticsintheTherapyofAnxietyDisordersandObsessive-CompulsiveDisorders".CurrentPsychiatryReports.19(12):103.doi:10.1007/s11920-017-0847-x.PMID 29110139.S2CID 41312623. ^Komossa,K;Depping,AM;Meyer,M;Kissling,W;Leucht,S(8December2010)."Second-generationantipsychoticsforobsessivecompulsivedisorder".TheCochraneDatabaseofSystematicReviews(12):CD008141.doi:10.1002/14651858.CD008141.pub2.PMID 21154394.S2CID 205193449. ^Koran,Lorrin;Hanna,Gregory;Hollander,Eric;Nestadt,Gerald;Helen,Simpson(2007)."PracticeGuidelinefortheTreatmentofPatientsWithObsessive-CompulsiveDisorder"(PDF).TheAmericanJournalofPsychiatry.AmericanPsychiatricAssociation.164(7Suppl):5–53.PMID 17849776. ^CybulskaEvaM(2006)."ObsessiveCompulsivedisorder,thebrainandelectroconvulsivetherapy".BritishJournalofHospitalMedicine.67(2):77–82.doi:10.12968/hmed.2006.67.2.20466.PMID 16498907. ^Barlow,D.H.andV.M.Durand.EssentialsofAbnormalPsychology.California:ThomsonWadsworth,2006. ^BarlasS(8April2009)."FDAApprovesPioneeringTreatmentforObsessive-CompulsiveDisorder".PsychiatricTimes.26(4).Archivedfromtheoriginalon10July2009. ^SurgicalProceduresforObsessive–CompulsiveDisorderArchived25July2008attheWaybackMachine,byM.JahnandM.Williams,PhD,.BrainPhysicsOCDResource,Accessed6July2008. ^O'DonohueWilliam;FergusonKyleE(2006)."Evidence-BasedPracticeinPsychologyandBehaviorAnalysis".TheBehaviorAnalystToday.7(3):335–347.doi:10.1037/h0100155. ^abFreeman,J;Garcia,A;Frank,H;Benito,K;Conelea,C;Walther,M;Edmunds,J(2014)."Evidencebaseupdateforpsychosocialtreatmentsforpediatricobsessive-compulsivedisorder".JournalofClinicalChildandAdolescentPsychology.43(1):7–26.doi:10.1080/15374416.2013.804386.PMC 3815743.PMID 23746138. ^Rapoport,J.E.(1989).Obsessive-compulsiveDisorderinChildren&Adolescents.Washington:AmericanPsychiatricPress. ^Adams,P.L.(1973).ObsessiveChildren:ASociopsychiatricStudy.Philadelphia:Brunner/Mazel. ^D'AlessandroTM(2009)."Factorsinfluencingtheonsetofchildhoodobsessivecompulsivedisorder".PediatrNurs.35(1):43–6.PMID 19378573. ^EddyKT,DutraL,BradleyR,WestenD(2004)."Amultidimensionalmeta-analysisofpsychotherapyandpharmacotherapyforobsessive-compulsivedisorder".ClinPsycholRev.24(8):1011–30.doi:10.1016/j.cpr.2004.08.004.PMID 15533282. ^Subramaniam,M;Soh,P;Vaingankar,JA;Picco,L;Chong,SA(May2013)."Qualityoflifeinobsessive-compulsivedisorder:impactofthedisorderandoftreatment".CNSDrugs.27(5):367–83.doi:10.1007/s40263-013-0056-z.PMID 23580175.S2CID 8038340. ^Boileau,B(2011)."Areviewofobsessive-compulsivedisorderinchildrenandadolescents".DialoguesinClinicalNeuroscience.13(4):401–11.doi:10.31887/DCNS.2011.13.4/bboileau.PMC 3263388.PMID 22275846. ^Summers,Jesse;Sinnott-Armstrong,Walter(2019).ObsessiveCompulsiveDisorder:ALittleHistory.CleanHands:PhilosophicalLessonsfromScrupulosity.OxfordUniversityPress.p. 19.ISBN 978-019-005-869-2. ^Friedrich,Patricia(29April2016).TheLiteraryandLinguisticConstructionofObsessive-CompulsiveDisorder:NoOrdinaryDoubt.Springer.ISBN 978-1-137-42733-5. ^Plutarch,SelectedLivesandEssays.ClassicsClub.1951.p.375 ^abcdefghijklmOsborn,Ian(1998).TormentingThoughtsandSecretRituals:TheHiddenEpidemicofObsessive-CompulsiveDisorder.NewYorkCity,NewYork:DellPublishing.ISBN 978-0-440-50847-2. ^abM.A.Jenike;Baer,L.;&W.E.Minichiello.ObsessiveCompulsiveDisorders:TheoryandManagement.Littleton,MA:PSGPublishing,1986. ^Berrios,GE(1989)."ObsessiveCompulsiveDisorder:ItsconceptualhistoryinFranceduringthe19thCentury".ComprehensivePsychiatry.30(4):283–95.doi:10.1016/0010-440x(89)90052-7.PMID 2667880. ^FreudS(1950).TotemandTaboo:SomePointsofAgreementbetweentheMentalLivesofSavagesandNeurotics.trans.Strachey.NewYork:W.W.Norton&Company.ISBN 978-0-393-00143-3.p.29. ^"SamuelJohnson(1709–1784):APatronSaintofOCD?byFredPenzel,Ph.D.fromtheScientificAdvisoryBoardoftheInternationalOCDFoundation".Westsuffolkpsych.homestead.com.Archivedfromtheoriginalon15June2013.Retrieved29November2013. ^Dittmann,M(July–August2005)."Hughes'sgermphobiarevealedinpsychologicalautopsy".AmericanPsychologicalAssociation.Archivedfromtheoriginalon5January2015.Retrieved9January2015. ^M.Dittmann(July–August2005)."Hughes'sgermphobiarevealedinpsychologicalautopsy".MonitoronPsychology.36(7).Archivedfromtheoriginalon29December2008. ^Chosak,Anne(12October2012)."TheAviator:Areal-lifeportrayalofOCDinthemedia".MassachusettsGeneralHospitalOCDandRelatedDisordersProgram.Archivedfromtheoriginalon22February2015.Retrieved9January2015. ^"GeorgeEzraopensupaboutOCDstruggle".BBCNews.31August2020. ^"GretaThunbergwasnearlyhospitalisedduetodisorderedeating,saysmother".Independent.co.uk.24February2020. ^"JamesSpader:TheStrangestManonTV".RollingStone.21April2014. ^"Don'tBeAfraidoftheWord"Disorder"".BeyondOCD.Retrieved11November2020. ^GoldbergFR(2007).Turnboxofficemoviesintomentalhealthopportunities:Aliteraturereviewandresourceguideforcliniciansandeducators(PDF).BeneficialFilmGuides,Inc.p. 8.Archivedfromtheoriginal(PDF)on8July2011.Retrieved17February2010. ^Berman,Noah(5October2012)."IsThis'AsGoodasItGets?':PopularMedia'sRepresentationofOCD".MassachusettsGeneralHospitalOCDandRelatedDisordersProgram.Archivedfromtheoriginalon22February2015.Retrieved9January2015. ^Almeida."RoyalCollegeofPsychiatrists,DiscoverPsychiatry,MindsonFilmBlog,MatchstickMen".RoyalCollegeofPsychiatrists.Archivedfromtheoriginalon22February2015.Retrieved14January2015. ^Stewart,Susan(16September2007)."HappytoBeNeurotic,atLeastOnceaWeek".TheNewYorkTimes.Archivedfromtheoriginalon11December2008.Retrieved8December2008. ^AnietyDisordersAssociationofAmerica."WHATISOCD?".USANetwork.Archivedfromtheoriginalon17December2008.Retrieved8December2008. ^Flood,Alison(14October2017)."JohnGreen:'HavingOCDisanongoingpartofmylife'".TheGuardian.Retrieved21September2019. ^Mangan,Lucy(30January2019)."Purereview–amasterlycomedyaboutsexandmentalhealth".TheGuardian.Retrieved7April2021. ^CamfieldDA,SarrisJ,BerkM(1June2011)."Nutraceuticalsinthetreatmentofobsessivecompulsivedisorder(OCD):areviewofmechanisticandclinicalevidence".ProgressinNeuro-psychopharmacology&BiologicalPsychiatry.35(4):887–95.doi:10.1016/j.pnpbp.2011.02.011.PMID 21352883.S2CID 30024004. ^DavidsonJ,BjorgvinssonT(June2003)."Currentandpotentialpharmacologicaltreatmentsforobsessive-compulsivedisorder".ExpertOpiniononInvestigationalDrugs.12(6):993–1001.doi:10.1517/13543784.12.6.993.PMID 12783603.S2CID 35971588. ^KoranLM(2007)."Obsessive-CompulsiveDisorder:AnUpdatefortheClinician".Focus(5):3. ^WuK,HannaGL,RosenbergDR,ArnoldPD(2012)."Theroleofglutamatesignalinginthepathogenesisandtreatmentofobsessive–compulsivedisorder".PharmacologyBiochemistryandBehavior.100(4):726–735.doi:10.1016/j.pbb.2011.10.007.PMC 3437220.PMID 22024159. Externallinks WikimediaCommonshasmediarelatedtoObsessive–compulsivedisorder. Obsessive–compulsivedisorderatCurlie NationalInstituteOfMentalHealth AmericanPsychiatricAssociation APADivision12treatmentpageforobsessive-compulsivedisorder Davis,LennardJ.(2008).Obsession:AHistory.UniversityofChicagoPress.ISBN 978-0-226-13782-7. ClassificationDICD-10:F42ICD-9-CM:300.3OMIM:164230MeSH:D009771DiseasesDB:33766ExternalresourcesMedlinePlus:000929eMedicine:article/287681 vteMentaldisorders (Classification)AdultpersonalityandbehaviorSexual Ego-dystonicsexualorientation Paraphilia Fetishism Voyeurism Sexualmaturationdisorder Sexualrelationshipdisorder Other Factitiousdisorder Munchausensyndrome Genderdysphoria Intermittentexplosivedisorder Dermatillomania Kleptomania Pyromania Trichotillomania Personalitydisorder ChildhoodandlearningEmotionalandbehavioral ADHD Conductdisorder ODD Emotionalandbehavioraldisorders Separationanxietydisorder Movementdisorders Stereotypic Socialfunctioning DAD RAD Selectivemutism Speech Cluttering Stuttering Ticdisorder Tourettesyndrome Intellectualdisability X-linkedintellectualdisability Lujan–Frynssyndrome Psychologicaldevelopment(developmentaldisabilities) Pervasive Specific Mood(affective) Bipolar BipolarI BipolarII BipolarNOS Cyclothymia Depression Atypicaldepression Dysthymia Majordepressivedisorder Melancholicdepression Seasonalaffectivedisorder Mania NeurologicalandsymptomaticAutismspectrum Autism Aspergersyndrome High-functioningautism PDD-NOS Savantsyndrome Dementia AIDSdementiacomplex Alzheimer'sdisease Creutzfeldt–Jakobdisease Frontotemporaldementia Huntington'sdisease Mildcognitiveimpairment Parkinson'sdisease Pick'sdisease Sundowning Vasculardementia Wandering Other Delirium Organicbrainsyndrome Post-concussionsyndrome Neurotic,stress-relatedandsomatoformAdjustment Adjustmentdisorderwithdepressedmood AnxietyPhobia Agoraphobia Socialanxiety Socialphobia Anthropophobia Specificsocialphobia Specificphobia Claustrophobia Other Generalizedanxietydisorder OCD Panicattack Panicdisorder Stress Acutestressdisorder PTSD Dissociative Depersonalization-derealizationdisorder Dissociativeidentitydisorder Fuguestate Psychogenicamnesia Somaticsymptom Bodydysmorphicdisorder Conversiondisorder Gansersyndrome Globuspharyngis Psychogenicnon-epilepticseizures Falsepregnancy Hypochondriasis Masspsychogenicillness Nosophobia Psychogenicpain Somatizationdisorder PhysiologicalandphysicalbehaviorEating Anorexianervosa Bulimianervosa Ruminationsyndrome Otherspecifiedfeedingoreatingdisorder Nonorganicsleep Hypersomnia Insomnia Parasomnia Nightterror Nightmare REMsleepbehaviordisorder Postnatal Postpartumdepression Postpartumpsychosis SexualdysfunctionArousal Erectiledysfunction Femalesexualarousaldisorder Desire Hypersexuality Hypoactivesexualdesiredisorder Orgasm Anorgasmia Delayedejaculation Prematureejaculation Sexualanhedonia Pain Nonorganicdyspareunia Nonorganicvaginismus Psychoactivesubstances,substanceabuseandsubstance-related Drugoverdose Intoxication Physicaldependence Reboundeffect Stimulantpsychosis Substancedependence Withdrawal Schizophrenia,schizotypalanddelusionalDelusional Delusionaldisorder Folieàdeux Psychosisandschizophrenia-like Briefreactivepsychosis Schizoaffectivedisorder Schizophreniformdisorder Schizophrenia Childhoodschizophrenia Disorganized(hebephrenic)schizophrenia Paranoidschizophrenia Pseudoneuroticschizophrenia Simple-typeschizophrenia Other Catatonia Symptomsanduncategorized Impulse-controldisorder Klüver–Bucysyndrome Psychomotoragitation Stereotypy vteObsessive–compulsivedisorderHistory DimensionalObsessive-CompulsiveScale Yale–BrownObsessiveCompulsiveScale BiologyNeuroanatomy Basalganglia(striatum) Orbitofrontalcortex Cingulatecortex Brain-derivedneurotrophicfactor Receptors 5-HT1Dβ 5-HT2A 5-HT2C μOpioid H2 NK1 M4 NMDA Symptoms Obsessions(associative diagnostic injurious scrupulous pathogenic sexual) Compulsions(impulses,rituals tics) Thoughtsuppression(avoidance) Hoarding(animals,books possessions) TreatmentSerotonergicsSelectiveserotoninreuptakeinhibitors Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Nefazodone Serotonin–norepinephrinereuptakeinhibitors Venlafaxine Desvenlafaxine Duloxetine Serotonin–norepinephrine–dopaminereuptakeinhibitors Nefazodone Monoamineoxidaseinhibitors Phenelzine Tranylcypromine Tricyclicantidepressants Clomipramine Serotonergicpsychedelics Lysergicaciddiethylamide Psilocin Atypicalantipsychotics Aripiprazole Quetiapine Muopioidergics Hydrocodone Morphine Tramadol Anticholinergics Diphenhydramine NMDAglutamatergics Riluzole NK-1tachykininergics Aprepitant Other Nicotine Memantine Tautomycin Behavioral Acceptanceandcommitmenttherapy Cognitivebehavioraltherapy(Exposureandresponseprevention) Inference-basedtherapy Metacognitivetherapy Notablepeople EdnaB.Foa WayneK.Goodman StanleyRachman AdamS.Radomsky JeffreyM.Schwartz JonathanAbramowitz SusanSwedo EmilyColas VicMeyer DanielA.Geller DavidShannahoff-Khalsa GaryRoyGeffken ChristopherPittenger PopularcultureLiteratureFictional MatchstickMen Plyushkin Xenocide Nonfiction EverythinginItsPlace JustChecking Media AsGoodasItGets TheAviator MatchstickMen AdrianMonk Pure "$pringfield" StraightUp Related Obsessive–compulsivepersonalitydisorder Obsessionaljealousy PANDAS PrimarilyObsessionalOCD Relationshipobsessive–compulsivedisorder Socialanxietydisorder Tourettesyndrome vteOCDpharmacotherapiesAntidepressants SSRIs(citalopram,escitalopram,fluoxetine,fluvoxamine,paroxetine,sertraline) TCAs(clomipramine) Others Atypicalantipsychotics(aripiprazole,olanzapine,quetiapine,risperidone) Authoritycontrol:Nationallibraries France(data) Germany Israel UnitedStates Latvia Japan CzechRepublic Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Obsessive–compulsive_disorder&oldid=1099474095" Categories:Obsessive–compulsivedisorderAnxietydisordersMagicalthinkingRitualHiddencategories:CS1maint:url-statusHarvandSfnno-targeterrorsWebarchivetemplatewaybacklinksArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataWikipediaindefinitelysemi-protectedpagesWikipediaarticlesneedingcopyeditfromNovember2021AllarticlesneedingcopyeditUsedmydatesfromApril2021UseAmericanEnglishfromDecember2017AllWikipediaarticleswritteninAmericanEnglishAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromDecember2021CommonscategorylinkfromWikidataArticleswithCurlielinksArticleswithBNFidentifiersArticleswithGNDidentifiersArticleswithJ9UidentifiersArticleswithLCCNidentifiersArticleswithLNBidentifiersArticleswithNDLidentifiersArticleswithNKCidentifiersWikipedianeurologyarticlesreadytotranslateWikipediamedicinearticlesreadytotranslate Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadViewsourceViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages AfrikaansالعربيةAzərbaycancaবাংলাБългарскиBoarischBosanskiCatalàČeštinaCymraegDanskDeutschEestiΕλληνικάEspañolEuskaraفارسیFrançaisGalego한국어Հայերենहिन्दीHrvatskiBahasaIndonesiaÍslenskaItalianoעבריתಕನ್ನಡქართულიҚазақшаKiswahiliLatviešuLietuviųMagyarമലയാളംमराठीمصرىمازِرونیBahasaMelayuMinangkabauNederlands日本語Norskbokmålଓଡ଼ିଆPolskiPortuguêsRomânăРусскийSarduShqipSimpleEnglishSlovenčinaSlovenščinaСрпски/srpskiSrpskohrvatski/српскохрватскиSuomiSvenskaTagalogதமிழ்ไทยTürkçeУкраїнськаاردوTiếngViệtWolof吴语ייִדיש粵語中文 Editlinks