强迫症

… mental disorder owing to its prevalence and associated disability, and because it is a key example of a set of conditions known as obsessive–compulsive and related disorders (OCRDs; …

Key Clinical Points Obsessive–Compulsive Disorder Obsessive–compulsive disorder (OCD) is a common, disabling psychiatric disorder characterized by intrusive and unwanted …

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition. This heterogeneity can reduce the power and obscure the findings from natural history …

Obsessive compulsive disorder (OCD) is characterized by the presence of intrusive, anxiety-provoking thoughts, images, or impulses along with repetitive behaviors or mental acts …

… expose aspects of obsessive-compulsive disorder (OCD) and related psychopathology to a … Tics are frequent concomitants of OC psychopathology,‘*2317 and a high incidence of OCD …

… OCD features. Further, NJREs were shown to have particularly strong relationships with specific OCD … with features of OCD than symptoms from other domains of psychopathology (eg, …

… the more severe end of a OCD continuum or, alternatively, as … role of clinical features of OCD (severity of obsessions and … of insight over obsessive–compulsive phenomena, adopting …

The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession (‘with resistance’) and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive–compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.

… Obsessive–compulsive disorder (OCD) is characterized by … -IV is broadly similar in its definition of OCD). Furthermore, the … main areas of psychopathology of OCD, namely obsessions, …

Obsessive-compulsive disorder (OCD) is a heterogeneous condition, comprised of multiple symptom domains. This study used aggregate composite scales representing three core OCD dimensions (Checking, Cleaning, Rituals), as well as Hoarding, to examine the discriminant validity, diagnostic specificity, and predictive ability of OCD symptom scales. The core OCD scales demonstrated strong patterns of convergent and discriminant validity – suggesting that these dimensions are distinct from other self-reported symptoms – whereas hoarding symptoms correlated just as strongly with OCD and non-OCD symptoms in most analyses. Across analyses, our results indicated that Checking is a particularly strong, specific marker of OCD diagnosis, whereas the specificity of Cleaning and Hoarding to OCD was less strong. Finally, the OCD Checking scale was the only significant predictor of OCD diagnosis in logistic regression analyses. Results are discussed with regard to the importance of assessing OCD symptom dimensions separately and implications for classification.

Background: This study examines the presence of obsessions in the general population and in various psychiatric disorders. Second, the impact of obsessions is studied in terms of general functioning and quality of life in the general population. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the Dutch population (n = 7,076). Diagnostic criteria were assessed by the Composite International Diagnostic Interview (CIDI). The association of quality of life and obsessions on each subject was assessed by using Short Form 36 Health Survey (SF‐36) and General Health Questionnaire (GHQ). Results: Obsessions occurred frequently in the general population: the lifetime prevalence of obsessions was 5.3% and the 12‐month prevalence was 1.7%. Subjects with obsessions scored significantly worse (P<.0001) on all eight dimensions of the SF‐36 as well as on the GHQ. When controlling for the presence of any mental disorder, the negative association of obsessions and low general health and well‐being remained significantly intact. In patients with a psychiatric disorder, obsessions had a lifetime prevalence of 10.3% and a 12‐month prevalence of 6.8%. Conclusions: Obsessions are common phenomena in the general population and are associated with decreased functioning in several areas of health and well‐being. Furthermore, they occur frequently in the presence of various psychiatric disorders. Obsessions should be perceived, similar to delusions, as a distinct dimension across psychiatric disorders rather than a mere symptom of OCD. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.

… on peer victimization, symptoms of psychopathology, and a possible mediational model … with OCD. Our specific goals were to (a) examine rates of peer victimization in children with OCD …

… Psychopathology; HiTOP) has been proposed. However, the placement of obsessive-compulsive disorder (OCD) within this model remains unclear, as studies have variably found OCD …

OBJECTIVE Obsessive-compulsive symptoms (OCS) are common throughout development and often considered developmentally appropriate. We evaluated the prevalence and phenotypic heterogeneity of self-reported OCS in a large community youth sample not ascertained for seeking mental-health help. We aimed to identify patterns in OCS that are associated with serious psychopathology and may thus represent a "red flag" that merits psychiatric evaluation. METHOD Data were analyzed from youth from the Philadelphia Neurodevelopmental Cohort (N = 7,054, aged 11-21 years, 54% female). Participants underwent structured psychiatric interviews, including screening for OCS (8 obsessions, 8 compulsions, and hoarding) and other major psychopathology domains. Factor analysis was conducted to identify clustering of OCS presentation. Regression models were used to investigate association of OCS with threshold lifetime diagnoses of obsessive-compulsive disorder (OCD), depressive episode, psychosis, and suicide ideation. RESULTS OCS were common in non-mental health-seeking individuals (38.2%), although only 3% met threshold OCD criteria. OCS were more common in female participants and postpuberty. Factor analyses resulted in 4 factors: F1 - Bad Thoughts; F2 - Repeating/Checking; F3 - Symmetry; F4 - Cleaning/Contamination; and Hoarding as a separate item. All OCS were associated with higher rates of OCD, depression, psychosis, and suicide ideation. However, endorsement of F1 symptoms, prevalent in more than 20% of the sample, showed the most substantial associations with major psychiatric conditions. CONCLUSION OCS are common in community youth. Although for most youths OCS symptoms may be benign, some patterns of OCS are associated with major psychiatric conditions. These findings may help to identify youth at risk for serious psychopathology.

Family accommodation (FA) has been linked with myriad negative outcomes in pediatric obsessive–compulsive disorder (OCD), but extant literature has yielded differential relationships between FA and clinical variables of interest. Consequently, this study examined the phenomenology, clinical profile, and effects of comorbid psychopathology on FA to better understand these behaviors. A total of 150 youths and their caregivers completed clinician- and self-reported measures at a baseline visit for a larger randomized controlled trial. Sociodemographic variables were not associated with FA, but specific types of OCD symptom clusters were. Higher OC-symptom severity and functional impairment were associated with increased FA. Comorbid anxiety disorders moderated the relationship between OC-symptom severity and FA, but comorbid attention deficit hyperactivity, oppositional defiant, and mood disorders did not. Internalizing and externalizing problems both mediated the relationship between FA and functional impairment. These findings provide clinical implications for important treatment targets and factors that may impact FA.

… OCD are part of an OCD spectrum, or are distinct, by comparing measures of psychopathology in … or absence of tics or OCD on measures of psychopathology and blood serotonin within …

The aim of this study was to evaluate the degree of insight and resistance in a sample of obsessive-compulsive patients, and the predictive value of poor insight with respect to response to treatment with serotonin reuptake inhibitors (SRIs). Ninety-three patients fulfilling DSM-IV criteria for obsessive-compulsive disorder were evaluated. Seventy patients were treated with an SRI in a 24-week open-label trial. Sixteen percent of the patients did not recognize obsessions and compulsions as unreasonable or senseless. Fifty-two percent of the patients did not try to resist, 72% had little or no control over obsessions, and 64% were not able to exercise an effective control over compulsions. Patients with poor insight had a greater severity of obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives and a higher frequency of a history of psychiatric disorders during childhood. Fifty-two percent of the patients with normal insight responded to SRIs, whereas none of the patients with poor insight were found to be responders. These results suggest the utility of the assessment of insight and resistance in obsessive-compulsive patients, also for the prediction of response to treatment with SRIs.

&lt;i&gt;Objective:&lt;/i&gt; Our purpose was to determine the rates of psychopathology in parents of children and adolescents with obsessive-compulsive disorder (OCD) and compare these with that found in parents of children with learning disorders of reading and written expression. &lt;i&gt;Method:&lt;/i&gt; Thirty-one children with OCD, aged 8–15 years, and their parents (n = 62), aged 43–48 years, were studied and compared to 30 children with learning disorders, aged 7–16 years, and their parents (n = 58), aged 40–46 years. In order to investigate the parental psychopathology, the Symptom Checklist-90-R (SCL-90-R), the State and Trait Anxiety Inventory and the Yale-Brown Obsessive-Compulsive Scale were administered. The psychopathology of children was examined through the Schedule for Affective Disorders and Schizophrenia for school-aged children and other instruments. &lt;i&gt;Results:&lt;/i&gt; Both fathers and mothers of the probands differed from the controls in a variety of symptoms (i.e. anxiety, depression, obsessions, etc.). Both parents had increased severity of OC symptomatology in comparison to the controls. In addition, the probands’ fathers had severe OC symptomatology at a higher percentage than the mothers and respective controls. &lt;i&gt;Conclusion:&lt;/i&gt; The elevated scores of the parents of children with OCD in some SCL-90-R subscales can be perceived as an index of heightened psychopathology. More fathers in the OCD group, compared to mothers and controls, were found to have OC symptoms in the SCL-90-R and increased severity of OC symptoms on the Yale-Brown Obsessive-Compulsive Scale. The last finding requires further study. Parental psychopathology in children with OCD needs to be addressed clinically.

… Reduction in psychopathology was sustained under continuous stimulation. No deleterious … DBS may have important therapeutic benefits on psychopathology in OCD. No harmful side-…

… OCD patients. We hypothesized a higher prevalence of psychopathology (especially OCD) in parents of OCD … of this sample of Spanish children with OCD are described in an attempt to …

Background: Since the publication of the DSM‐IV in 1994, research on obsessive–compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM‐V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered “time‐consuming” for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a “general medical condition”; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to “poor insight,” and adding “tic‐related OCD”); and (7) highlighting in the DSM‐V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM‐V process progresses. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.

Only ten years ago, obsessive-compulsive disorder (OCD) was thought to be a rare illness with a poor prognosis. Results from the National Epidemiology Catchment Area (ECA) survey …

… has been paid to obsessive-compulsive disorder (OCD) and … in a novel diagnostic class: the obsessive-compulsive and … treatment implications of a diagnostic system that focuses on …

Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take ‘compulsivity’ and ‘anxiety’, putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.

… diagnostic criteria for OCD. Finally, we should have reliable tools to differentiate between obsessivecompulsive … role in people's life, obsessive-compulsive personality and OCD. The Y-…

BackgroundIn this study we compared subjects with obsessive and/or compulsive symptoms who did not meet all criteria for obsessive–compulsive disorder (OCD) (subthreshold subjects) to subjects with full-blown OCD and also to subjects without obsessions or compulsions.MethodThe data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the general Dutch population (n=7076). Using the Composite International Diagnostic Interview, Version 1.1 (CIDI 1.1), three groups were distinguished: subjects without lifetime obsessions or compulsions (94.2%), subthreshold subjects (4.9%) and subjects with full-blown OCD according to DSM-III-R (0.9%). These three groups were compared on various items, including psychological vulnerability, health and functional status, psychiatric co-morbidity and seeking treatment.ResultsSubthreshold and OCD subjects had similar scores on the majority of the items measured. Thus, there was little difference between subthreshold and OCD subjects in health, functional status, psychological vulnerability and psychiatric co-morbidity. However, OCD and subthreshold subjects scored worse on most of these items when compared to the controls without obsessions or compulsions.ConclusionHaving obsessions and compulsions is associated with substantial suffering and disability. Most subjects with obsessions and/or compulsions are not diagnosed with OCD according to the DSM-III-R criteria although these subjects generally display similar consequences to full-blown OCD subjects. We recommend that these subthreshold cases receive special attention in the development of DSM-V.

… At least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive–compulsive disorder (OCD). Defining the nosology of BD…

The diagnosis, treatment, and pathophysiology of obsessive-compulsive disorder (OCD) were examined in a series of studies utilizing psychobiological approaches. Putative biological …

… diagnostic features of GAD and OCD, particularly in the realm of chronic worry and obsessions, … GAD and OCD were distinguishable at the diagnostic level (via structured interview) and …

… the assessment and diagnosis of … diagnosis of OCD as well as a review of adjunctive measures used to assess associated symptoms. Types of instruments reviewed include diagnostic …

… obsessions and compulsions that cause marked distress and significant functional impairment. Obsessive-compulsive … with overlapping symptoms and compulsive qualities that are …

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder widely recognized for its recurrent obsessions and compulsions, which may cause severe impairment worldwide. This review explores the difficulties in diagnosing OCD, its comorbidities, and its treatment approaches. Psychiatry and neuroscience face noteworthy obstacles in treating OCD, which is frequently misdiagnosed and inadequately addressed. This illness, which causes upsetting symptoms that interfere with day-to-day living, affects not only adults but also children and adolescents to a great extent. Despite the availability of multiple therapy methods, such as pharmacological and psychological approaches, many patients exhibit resistance, emphasizing the necessity for alternative therapies. OCD and other psychiatric conditions like bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder substantially overlap, highlighting the complexity of mental health diagnoses. Furthermore, its comorbidity with these diseases further highlights OCD's intricacy. Several therapy considerations have been mentioned, such as using larger dosages of medications and combining different therapeutic approaches. Their association suggests possible common pathogenic pathways between OCD and other psychiatric illnesses. The review concludes that, given the significant number of people who still struggle with chronic symptoms, new treatment techniques and ongoing research are necessary, even in the face of improvements in the understanding and treatment of OCD.

… and separated from the conventional form of obsessive-compulsive neurosis (OCN). From a … Self-assessment forms allowed patients to make social adjustment and neurotic symptom …

SummaryEighty-two obsessional neurotics were studied from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to ascertain the frequency with which the different forms and content occur and their effect on the final outcome of the disorder. Five types of obsessions were identified: doubts, obsessive thinking, fears, impulses, and images, in order of frequency of their occurrence. Compulsive acts could be classified in two types, depending on whether they yielded to or diverted the underlying obsession. One-fourth of the patients displayed no compulsions. The content of obsession could be classified in five broad categories as relating to: dirt and contamination, aggression, inanimate-impersonal themes, religion, and sexual matters, in order of the frequency of their occurrence. The paper, while offering an interpretation of these findings, emphasizes the part played by socio-cultural factors in the character of an obsession's thought content.The absence of compulsions was found to be associated with good prognosis. A downward gradient was noted in the final outcome of patients without compulsions, those with controlling compulsions alone, those with both varieties of compulsions, and those displaying yielding compulsions alone, in that order. Based on this observation the paper suggests a prognosis-related hierarchical continuum of the severity of obsessional disorder.

… reported a nonimprovement rate of approximately 5070 for obsessivecompulsive neurosis … ways of conceptualizing and treating obsessive-compulsive neurosis in a manner that …

The first-degree relatives of 50 obsessive-compulsive patients and those of matched controls completed the General Health Questionnaire (GHQ) and the Leyton Obsessional Inventory (LOI). Relatives who were identified as possible ‘cases' by their high GHQ scores, or by their own or informant relatives' reports, were interviewed using the Schedule for Affective Disorders and Schizophrenia. Index relatives had a significantly higher lifetime prevalence of mental illness (36%) than had those of controls (17%), due mainly to an excess of depressive and neurotic disorders. However, only one relative from each group was diagnosed as having definite obsessive-compulsive neurosis. In addition, the LOI scores were similar for the index and control relatives.

SummaryForty-five patients with obsessive-compulsive neurosis were given a specially devised structured interview with the aim of elucidating aspects of the phenomenology. Four main kinds of ritual were found to predominate: cleaning, avoiding, repeating and checking. A surprisingly large number of patients had little or no resistance to carrying out their rituals. The recognition of senselessness of a ritual was a more important criterion than that of resistance, but patients with predominantly repeating rituals did demonstrate resistance. It is proposed that a redefinition of obsessive-compulsive neurosis with less emphasis on resistance as a necessary condition may be appropriate.

… treatment of obsessive compulsive neuroses be¬ fore 14 years of age. Benjamin4 along with … ' opinion that a significant percentage of the cases of obsessive compulsive neuroses for¬ …

SummaryThe case histories are examined of 41 patients who were admitted to hospital for the first time with a diagnosis of obsessive-compulsive neurosis. Aspects of the phenomenology are reported which presented between the first appearance of obsessive-compulsive symptoms and discharge from the first admission.The mean age for admission was 31·6 years (SD 14·3) and 68 per cent of the sample were women. The women showed significantly higher incidences of contamination phobia and of compulsive cleaning behaviour than did the men. Cleaning behaviour and avoidance of feared stimuli were the most frequently encountered manifestations of compulsive behaviour.

SummaryTwenty-five patients with obsessive-compulsive neurosis and matched controls had their life event scores (Paykel's Life Event Schedule) rated for the year prior to the onset of illness and the date of interview, respectively. The Standard Assessment of Personality Schedule, whose high inter-temporal and inter-informant reliability was confirmed, was used to rate the patients' premorbid personality.The obsessive-compulsive patients' mean life event score was significantly higher than the control subjects; and this excess spanned the six months prior to the onset of illness. Patients with abnormal personality traits (obsessional, anxious and self-conscious) experienced significantly fewer life events than those without such traits.

… 10 patients with chronic obsessive-compulsive neurosis a controlled study was made of the efficacy of 2 behavioural treatments-… and it is clear that phobic and obsessive-compulsive …

… the obsessive-compulsive neurosis and the anxiety neurosis is … The anxiety neurotic habitually refrains from performing … The obsessive-compulsive neurotic habitually performs certain …

… Despert6 mentioned that fifty-two out of sixty-eight cases of obsessive-compulsive neurotic children in her files were boys. Ingram”j listed the percentag e of obsessive-compulsive …

… Summary-Five patients with chronic obsessive-compulsive neurosis were treated by 15 … Flooding-plusmodelling produced significantly more improvement in obsessive-compulsive …

… To illustrate a potential answer to one instance of this broad question, we examine the correlates of obsessive–compulsive disorder (OCD) within our normal repertoire of thought and …

… obsessive-compulsive neurosis to other neuroses or “related” psychoses, eg, the relation between obsessive-compulsive neurosis … Some authors regard obsessive-compulsive neurosis …

Twenty-one obsessive-compulsive patients were treated by continuous exposure to discomfort-evoking stimuli and complete prevention of discomfort-reducing rituals. Inventories and …

… In obsessive-compulsive neurosis, we find all these functions to a larger or lesser extent, disordered. Especially the censorship against the id is affected and the repressive capacity of …

761 obsessions were recorded from 410 cases of obsessive-compulsive neurosis seen over a 10-year period. The obsessions were analysed according to form and content: 6 categories of form and 11 categories of content were delineated. Fear of contamination was the single most common theme, followed by thoughts of daily activities, thoughts about the past and fears of harm. The findings are discussed in the light of earlier literature.

… the findings in our studies on twins suffering from neurosis. Table 1 shows the types of neurosis in index twin cases and the concordance and discordance of neurosis in their co-twins …

Obsessive-compulsive disorder (OCD) is characterized by distressing thoughts and repetitive behaviors that are interfering, time-consuming, and difficult to control. Although OCD was once thought to be untreatable, the last few decades have seen great success in reducing symptoms with exposure and response prevention (ERP), which is now considered to be the first-line psychotherapy for the disorder. Despite these significant therapeutic advances, there remain a number of challenges in treating OCD. In this review, we will describe the theoretical underpinnings and elements of ERP, examine the evidence for its effectiveness, and discuss new directions for enhancing it as a therapy for OCD.

… exposure was more effective than self-controlled exposure. Further, the addition of complete response prevention to exposure … than partial or no response prevention. In reducing symp…

Abstract Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD. This review discusses the theoretical underpinnings of the treatment from a behavioral and neurobiological perspective and summarizes the evidence supporting the efficacy of ERP across child and adult populations. Next, we discuss predictors of ERP treatment outcome and discuss implementation strategies designed to improve feasibility and adoption. Finally, strategies to improve treatment dissemination are discussed.

BackgroundExposure and response prevention is considered a treatment of choice for obsessive–compulsive disorder (OCD). Yet there have been very few randomised controlled trials employing credible placebo conditions. This study compares exposure and response prevention with a general anxiety management intervention.MethodEighteen patients meeting DSM–IV criteria for OCD were randomly assigned to either exposure and response prevention or anxiety management. Both treatments involved approximately 15 hours of therapy over a three-week period.ResultsThere was a significant reduction in obsessive–compulsive symptoms following treatment with exposure and response prevention, while no change occurred in the control group. This was found to be statistically significant using a composite measure of OCD symptom severity, patient ratings of interference and therapist ratings of symptom severity.ConclusionsThese findings suggest that the symptom reductions associated with behaviour therapy for OCD are a result of the specific techniques of exposure and response prevention, rather than non-specific aspects of the therapy process. General anxiety management techniques are not effective in the treatment of OCD.

… When patients are focused on the cause of their OCD, we find it helpful to explain that OCD is a neurobehavioral disorder whose causes are not yet fully understood. Focusing on …

… of contemporary cognitive therapy for obsessive–compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) …

BACKGROUND Cognitive behavioural therapy (CBT), incorporating exposure and response prevention (ERP) is widely recognised as the psychological treatment of choice for obsessive-compulsive disorder (OCD). Uncertainty remains however about the magnitude of the effect of CBT with ERP and the impact of moderating factors in patients with OCD. METHOD This systematic review and meta-analysis assessed randomised-controlled trials of CBT with ERP in patients of all ages with OCD. The study was preregistered in PROSPERO (CRD42019122311). The primary outcome was end-of-trial OCD symptom scores. The moderating effects of patient-related and study-related factors including type of control intervention and risk of bias were examined. Additional exploratory analyses assessed the effects of treatment fidelity and impact of researcher allegiance. RESULTS Thirty-six studies were included, involving 2020 patients (537 children/adolescents and 1483 adults) with 1005 assigned to CBT with ERP and 1015 to control conditions. When compared against all control conditions, a large pooled effect size (ES) emerged in favour of CBT with ERP (g = 0.74: 95% CI = 0.51 to 0.97 k = 36), which appeared to diminish with increasing age. While CBT with ERP was more effective than psychological placebo (g = 1.13 95% CI 0.71 to 1.55, k = 10), it was no more effective than other active forms of psychological therapy (g = -0.05: 95% CI -0.27 to 0.16, k = 8). Similarly, whereas CBT with ERP was significantly superior when compared to all forms of pharmacological treatment (g = 0.36: 95% CI 0.7 to 0.64, k = 7), the effect became marginal when compared with adequate dosages of pharmacotherapy for OCD (g = 0.32: 95% CI -0.00 to 0.64, k = 6).A minority of studies (k = 8) were deemed to be at low risk of bias. Moreover, three quarters of studies (k = 28) demonstrated suspected researcher allegiance and these studies reported a large ES (g = 0.95: 95% CI 0.69 to 1.2), while those without suspected researcher allegiance (k = 8) indicated that CBT with ERP was not efficacious (g = 0.02: 95% CI -0.29 to 0.33). CONCLUSIONS A large effect size was found for CBT with ERP in reducing the symptoms of OCD, but depends upon the choice of comparator control. This meta-analysis also highlights concerns about the methodological rigor and reporting of published studies of CBT with ERP in OCD. In particular, efficacy was strongly linked to researcher allegiance and this requires further future investigation.

This meta-analysis mainly examined the effect size of exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) when compared with different control conditions, and the difference in the efficacy of different variants of ERP in the treatment of OCD. Thirty studies were included, involving 39 randomized controlled trials with 1793 participants, from 30 studies up to January 18, 2022. Hedge's g was calculated using random-effects models. The results showed that ERP had a definite effect on OCD (g = 0.37), and its effect was significant when the control condition was placebo (g = 0.97) or drug (g = 0.59). However, ERP did not show statistical differences with other therapies in improving OCD (g = -0.07). In addition, we found that both therapist and self-controlled exposure (at the same time as the therapist controls, self-control is exercised after the therapy session) and total response prevention can better improve OCD symptoms. In addition, compared with the control group, ERP reduced depression (g = 0.15) and anxiety symptoms (g = 0.23) in patients with OCD. Meta-regression results showed that the longer the length of sessions, the better the treatment effect (t = 2.41, p = 0.022).

Obsessive-compulsive disorder (OCD) is a highly debilitating disorder. Fortunately there are treatments that help the majority of OCD sufferers. The behavioral treatment with the most empirical support for its efficacy is exposure and response prevention (EX/RP). Over the years in our supervision meetings and in our clinical practice we have noted a number of relatively common therapist pitfalls that decrease the effectiveness of EX/RP. These pitfalls include not encouraging patients to approach the most distressing situations, doing imaginal exposure when in vivo is called for (and vice versa), encouraging distraction during exposure, providing reassurance, failing to address the core fear, ineffective handling of mental compulsions, and difficulty working with close others in the patient’s life. In the current article we describe these common pitfalls and how to avoid them.

… to: 1) determine the attrition rates for exposure with response prevention (ERP) for obsessive-compulsive disorder (OCD), 2) compare them to those in other treatments for OCD, and 3) …

… , which likely attenuate response to treatment and … of OCD focusing on these interpersonal dynamics and outline a couple-based exposure treatment program for individuals with OCD …

Recent research on the treatment of adults with anxiety disorders suggests that aspects of the in-session exposure therapy process are relevant to clinical outcomes. However, few comprehensive studies have been conducted with children and adolescents. In the present study, 35 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 12.9 years, 49 % male, 63 % Caucasian) completed 12 sessions of exposure and response prevention (ERP) in one of two treatment conditions as part of a pilot randomized controlled testing of a family focused intervention for OCD. Key exposure process variables, including youth self-reported distress during ERP and the quantity and quality of ERP completed, were computed. These variables were examined as predictors of treatment outcomes assessed at mid-treatment, post-treatment, and three-month follow-up, partialing treatment condition. In general, greater variability of distress during ERP and completing a greater proportion of combined exposures (i.e., exposures targeting more than one OC symptom at once) were predictive of better outcomes. Conversely, greater distress at the end of treatment was generally predictive of poorer outcomes. Finally, several variables, including within- and between-session decreases in distress during ERP, were not consistently predictive of outcomes. Findings signal potentially important facets of exposure for youth with OCD and have implications for treatment. A number of results also parallel recent findings in the adult literature, suggesting that there may be some continuity in exposure processes from child to adult development. Future work should examine additional measures of exposure process, such as psychophysiological arousal during exposure, in youth.

… neither exposure nor response prevention alone is sufficient to ameliorate obsessivecompulsive symptomatology, … Is it possible that response prevention is necessary only to prolong the …

… study was undertaken to estimate the effect of exposure plus response-prevention (E/RP), … children and adolescents with OCD. Twenty children and adolescents with OCD, not receiving …

Exposure and response prevention (ERP) constitutes the first-line treatment for obsessive-compulsive disorder (OCD). Despite robust empirical evidence supporting its efficacy, ERP has challenges, including high attrition rates and difficulty sustaining engagement. Research suggests that focusing on clients' strengths while addressing their difficulties can enhance therapy effectiveness. The present article details the case of a young adult with OCD characterized by sexual obsessions and mental compulsions, who initially underwent 12 sessions of cognitive-behavioral therapy (CBT) with limited progress. A subsequent transition to ERP throughout nine sessions resulted in positive treatment outcomes. The article illustrates how ERP may be coupled with a framework that capitalizes change using Innovative Moments (IMs)-changes in clients' discourse that reflect progress in therapy as manifested by new and adaptive ways of acting, feeling, or thinking. Therapists can be attentive, detect, and explore these moments to expand and promote further change. By attuning to and reinforcing IMs during ERP, the therapist assisted the client in disengaging from compulsions, increasing exposure tolerance, and consolidating therapeutic gains. This case underscores a practical strategy for clinicians: therapists can leverage naturally occurring change markers to enhance motivation and deepen learning in ERP rather than solely correcting dysfunctional patterns. The recognition and expansion of IMs have the potential to assist clients in maintaining engagement, tolerating distress, and cultivating more flexible responses to intrusive thoughts, which are all pivotal factors in the effective treatment of OCD.

… a combined exposure and response prevention (ERP) and prolonged exposure (PE) … Given the noted challenges in treating co-occurring OCD and PTSD, particularly in cases of …

The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was high in both conditions and there were no significant differences in exposure engagement, treatment acceptability, or dropout rates between ACT + ERP and ERP. OCD symptoms, depression, psychological inflexibility, and obsessional beliefs decreased significantly at posttreatment and were maintained at follow-up in both conditions. No between-group differences in outcome were observed using intent to treat and predicted data from multilevel modeling. ACT + ERP and ERP were both highly effective treatments for OCD, and no differences were found in outcomes, processes of change, acceptability, or exposure engagement.

Objective To systematically evaluate the effectiveness of exposure and response prevention (ERP) combined with medication on obsessive-compulsive disorder (OCD). Methods PubMed, Web of Science, EBSCO, Cochrane, Embase, and Science Direct databases were searched to include randomized controlled trials of ERP combined with medication for OCD that met the criteria. The Yale Brown Obsessive Compulsive Scale was used as the primary outcome indicator, and Depression scales were used as secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Review Manager 5.3 and Stata 16.0 software was used to perform meta-analysis of the extracted data. Results A total of 21 studies with 1113 patients were included. Meta-analysis showed that ERP combined with medication therapy was significantly better than medication therapy alone including selective serotonin reuptake inhibitors, clomipramine and risperidone (MD = –6.60, 95% CI: –8.35 to –4.84, P < 0.00001), but D-cycloserine (DCS) drugs do not enhance the effect of ERP intervention in patients with OCD (MD = 0.15, 95% CI: –0.87 to 1.17, P = 0.77). There is more significant maintenance by combined treatment method of medication plus ERP than medication treatment alone during the follow-up period (MD = –7.14, 95% CI: –9.17 to –5.10, P < 0.00001). DCS drugs did not enhance the effect of ERP intervention on depression in patients with OCD (SMD = –0.08, 95% CI: –0.31 to 0.15, P = 0.50). ERP combined with drug improved patients’ depression levels significantly better than providing drug alone (SMD = –0.40, 95% CI: –0.68 to –0.11, P = 0.006). Conclusion Patients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, however, not enough to prove that DCS can enhance ERP effectiveness.

… on ERP and cognitive therapy (CT) for OCD. Also … for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD …

For a number of reasons, it may be critical to involve a romantic partner or spouse in exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Indeed, relationship stress focal to OCD is associated with greater symptom severity, a more severe course, and poor global functioning. Research also indicates that involving partners or spouses to serve as coaches for their OCD-affected partners during ERP improves the efficacy of this treatment. This chapter describes the nature and treatment of OCD, focusing on interpersonal dynamics, and outlines a couple-based ERP program for individuals with OCD who are in long-term relationships. Case examples are included to illustrate the techniques used in this program.

Until the mid-1960s, obsessive-compulsive disorder (OCD) was considered to be treatment-resistant, as both psychodynamic psychotherapy and medication had been unsuccessful in significantly reducing OCD symptoms. The first real breakthrough came in 1966 with the introduction of exposure and ritual prevention. This paper will discuss the cognitive behavioral conceptualizations that influenced the development of cognitive behavioral treatments for OCD. There will be a brief discussion of the use of psychodynamic psychotherapy and early behavioral therapy, neither of which produced successful outcomes with OCD. The main part of the paper will be devoted to current cognitive behavioral therapy (CBT) with an emphasis on variants of exposure and ritual or response prevention (EX/RP) treatments, the therapy that has shown the most empirical evidence of its efficacy.

… efficacy of cognitive-behavioral therapy (CBT) for obsessive–compulsive disorder (OCD) as … Neither higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was …

The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate “dose” of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.

… involving a large sample of patients with OCD (N = 132). The … compare outcome of cognitive-behavioral therapy across the … that patients with primarily cognitive OCD symptoms do …

… trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events… CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD…

This paper reviews predictors of treatment response in open and controlled trials of cognitive-behavioral therapy for obsessive–compulsive disorder (OCD). We focus on demographic …

… that while some patients who undergo cognitive-behavior treatment by EX/… OCD symptoms, there are still a number of others who do not. Does cognitive-behavioral therapy cure OCD? …

… of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are … of OCD, including (a) the application of inhibitory learning approaches to exposure …

… with obsessive-compulsive disorder (range 7-19 years) received 14 sessions of weekly or intensive family-based cognitive-behavioral therapy… Yale-Brown Obsessive-Compulsive Scale, …

… Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is often … In this article we describe the components of CBT for OCD and then present a patient who …

… , the efficacy of mindfulness-based cognitive therapy in OCD patients in a large … OCD who had not responded well to cognitive behavioral therapy, mindfulness-based cognitive therapy …

… OCD of at least moderate severity despite an adequate SRI trial (based on a Yale-Brown Obsessive Compulsive … ), used a twice-weekly therapy format proven efficacious in prior trials of …

Objective To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). Method Thirty adults with OCD were randomized to EX/RP (n=15) or EX/RP augmented by motivational interviewing strategies (n=15). Both treatments included three introductory sessions and 15 exposure sessions. Because there were no significant group differences in adherence or outcome, the groups were combined to examine the effects of patient adherence on outcome. Independent evaluators assessed OCD severity using the Yale-Brown Obsessive Compulsive Scale. Therapists assessed patient adherence to EX/RP assignments at each session using the Patient EX/RP Adherence Scale (PEAS). Linear regression models examined the effects of PEAS scores on outcome, adjusting for baseline severity. The relationship between patient adherence and other predictors of outcome was explored using structural equation modeling. Results Higher average PEAS ratings significantly predicted lower post-treatment OCD severity in ITT and completer samples. PEAS ratings in early sessions (5–9) also significantly predicted post-treatment OCD severity. The effects of other significant predictors of outcome in this sample (baseline OCD severity, hoarding subtype, and working alliance) were fully mediated by patient adherence. Conclusions Patient adherence to between-session EX/RP assignments significantly predicted treatment outcome, as did early patient adherence and change in early adherence. Patient adherence mediated the effects of other predictors of outcome. Future research should develop interventions that increase adherence and then test whether increasing adherence improves outcome. If effective, these interventions could then be used to personalize care.

… Cognitive-behavioral therapy (CBT) incorporating exposure and response prevention is a … for obsessive-compulsive disorder (OCD). Although, the efficacy of CBT in reducing OCD …

The precise causal factors for obsessive-compulsive disorder (OCD) are not known, however, decades of research have honed in on the cortico-striatal-thalamo-cortical (CSTC) circuitry in the brain as a critical pathway involved in obsessions and the intimately linked compulsive-repetitive behaviors. Recent progress in human and mouse genetics have led to the identification of novel candidate susceptibility genes, which in turn have facilitated a more focused approach to unraveling the nature of circuitry dysfunction in OCD. The ability to perform invasive techniques in genetic animal models of OCD will be crucial for rapid advances in this field, and as such we review the most recent developments and highlight the importance of searching out common circuitry defects underlying compulsive-repetitive behaviors.

Goal-directed and habitual actions are essential for normal functioning in everyday life. Goal-directed behaviors are actions that are executed to achieve specific goals. With repetition, such as a daily routine, these goal-directed actions become automatized and habitual. However, these useful behaviors can become aberrant, manifesting as key symptoms in several psychiatric disorders, including obsessive-compulsive disorder (OCD). A comprehensive understanding of the neural circuits underlying both aberrant and non-pathological goal-directed and habitual behaviors can lead to improved treatments for OCD. Here we review the preclinical research that has advanced our understanding of the brain structures that control goal-directed and habitual behavior and discuss their relationships to the pathophysiology of OCD.

Opinion StatementClinical and preclinical studies have uncovered substantial evidence that dysfunction in cortico-striatal-thalamo-cortical (CSTC) loops central to the selection of action strategies may underlie obsessive compulsive disorder (OCD) symptoms. In human OCD, data suggest that the balance between selections of habitual versus goal-directed action strategies is disrupted, with concomitant hyperactivation of CSTC regions associated with these strategies. Preclinical lesion and inactivation studies of homologous CSTC regions in rodents have shed light on how sub-regions of the frontal cortex and striatum can have dissociable effects on the exhibition of goal-directed or habitual behavior. However, these traditional methods lack the precision necessary to dissect the exact projections and cell types underlying these behaviors. It is essential to uncover this information to begin to determine how disruption in these circuits may lead to disease pathology. Here, we summarize several recent studies that utilize optogenetics, a technique that allows stimulation or inhibition of specific neural projections and cell types using light, to further understand the contribution of CSTC activity to both action selection and the OCD-relevant behavior of perseverative grooming. Based on these experiments and findings in human OCD patients, we argue that OCD symptoms may not only be associated with an enhancement of habitual behavior, but also with aberrant recruitment of goal-directed neural circuits. We also discuss the current status of translating optogenetic technology to primates, as well as how findings in rodents may help inform treatment of patients suffering from OCD and related disorders.

Over the past century, much research has investigated how the brain processes signals from the body (interoception) and how this processing may be disturbed in patients with psychiatric disorders. In this paper, I discuss the literature examining the relationship between interoceptive awareness and emotional and cognitive processes, and review the evidence suggesting that anxiety and obsessive-compulsive disorder (OCD) are characterized by abnormal interoception. A network of cortical and subcortical brain regions centered on the insula has repeatedly been implicated in interoception and is abnormal in anxiety and OCD. The investigation of interoception provides a framework for understanding behavioral and neural mechanisms of anxiety and OCD, although additional research is needed to directly link insula functioning to aberrant interoception in these disorders. Future work targeting interoception may be useful for the development of novel treatments.

Dopamine plays a central role in various brain functions and has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD). This scoping review examines the role of dopamine in OCD, focusing on its impact on neural circuits, brain regions, and behavioral manifestations. Evidence from 19 studies reveals consistent dopaminergic dysfunction across key brain structures, particularly in the cortico-striato-thalamo-cortical (CSTC) circuits. Altered dopamine receptor availability was observed in the dorsal striatum, ventral striatum, and anterior cingulate cortex, contributing to cognitive rigidity, emotional dysregulation, and compulsive behaviors. Pharmacological findings highlight the complexity of dopamine's role, with both hyperdopaminergic and hypodopaminergic states influencing symptoms. Dopamine antagonists and partial agonists have demonstrated efficacy in targeting overactivation of striatum and restoring cortical balance. These findings underscore the importance of dopamine as a therapeutic target and highlight the need for circuit-specific interventions and tailored treatment strategies.

Abstract Compulsions are repetitive, stereotyped thoughts and behaviors designed to reduce harm. Growing evidence suggests that the neurocognitive mechanisms mediating behavioral inhibition (motor inhibition, cognitive inflexibility) reversal learning and habit formation (shift from goal-directed to habitual responding) contribute toward compulsive activity in a broad range of disorders. In obsessive compulsive disorder, distributed network perturbation appears focused around the prefrontal cortex, caudate, putamen, and associated neuro-circuitry. Obsessive compulsive disorder-related attentional set-shifting deficits correlated with reduced resting state functional connectivity between the dorsal caudate and the ventrolateral prefrontal cortex on neuroimaging. In contrast, experimental provocation of obsessive compulsive disorder symptoms reduced neural activation in brain regions implicated in goal-directed behavioral control (ventromedial prefrontal cortex, caudate) with concordant increased activation in regions implicated in habit learning (presupplementary motor area, putamen). The ventromedial prefrontal cortex plays a multifaceted role, integrating affective evaluative processes, flexible behavior, and fear learning. Findings from a neuroimaging study of Pavlovian fear reversal, in which obsessive compulsive disorder patients failed to flexibly update fear responses despite normal initial fear conditioning, suggest there is an absence of ventromedial prefrontal cortex safety signaling in obsessive compulsive disorder, which potentially undermines explicit contingency knowledge and may help to explain the link between cognitive inflexibility, fear, and anxiety processing in compulsive disorders such as obsessive compulsive disorder.

… at modulating components of the putative OCD circuit has shown promise in symptom … on OCD that comprehensively integrates recent thinking regarding mechanisms underlying OCD …

… in recent circuit-based and energy-informed models of neuronal … that OCD arises not from isolated regional dysfunction, but from dynamic imbalances within distributed neural circuits [16…

An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive–compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.

Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.

Abstract Functional imaging studies have reported with remarkable consistency hyperactivity in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus of patients with obsessive–compulsive disorder (OCD). These findings have often been interpreted as evidence that abnormalities in cortico–basal ganglia–thalamo–cortical loops involving the OFC and ACC are causally related to OCD. This interpretation remains controversial, however, because such hyperactivity may represent either a cause or a consequence of the symptoms. This article analyzes the evidence for a causal role of these loops in producing OCD in children and adults. The article first reviews the strong evidence for anatomical abnormalities in these loops in patients with OCD. These findings are not sufficient to establish causality, however, because anatomical alterations may themselves be a consequence rather than a cause of the symptoms. The article then reviews three lines of evidence that, despite their own limitations, permit stronger causal inferences: the development of OCD following brain injury, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and neurosurgical lesions that attenuate OCD. Converging evidence from these various lines of research supports a causal role for the cortico–basal ganglia–thalamo–cortical loops that involve the OFC and ACC in the pathogenesis of OCD in children and adults.

Abstract Background Cognitive theories of obsessive–compulsive disorder (OCD) stress the importance of dysfunctional beliefs in the development and maintenance of the disorder. However, a neurobiological understanding of these cognitive models, including thought-action fusion (TAF), is surprisingly lacking. Thus, this functional magnetic resonance imaging study aimed to investigate whether altered functional connectivity (FC) is associated with the TAF paradigm in OCD patients. Methods Forty-one OCD patients and 47 healthy controls (HCs) participated in a functional magnetic resonance imaging study using a TAF task, in which they were asked to read the name of a close or a neutral person in association with positive and negative statements. Results The conventional TAF condition (negative statements/close person) induced significant FC between the regions of interest (ROIs) identified using multivoxel pattern analysis and the visual association areas, default mode network subregions, affective processing, and several subcortical regions in both groups. Notably, sparser FC was observed in OCD patients. Further analysis confined to the cortico-striato-thalamo-cortical (CSTC) and affective networks demonstrated that OCD patients exhibited reduced ROI FC with affective regions and greater ROI FC with CSTC components in the TAF condition compared to HCs. Within the OCD patients, middle cingulate cortex–insula FC was correlated with TAF and responsibility scores. Conclusions Our TAF paradigm revealed altered context-dependent engagement of the CSTC and affective networks in OCD patients. These findings suggest that the neurobiology of cognitive models corresponds to current neuroanatomical models of OCD. Further, they elucidate the underlying neurobiological mechanisms of OCD at the circuit-based level.

… These observations suggest that, in OCD, neural circuits can trigger repetitive behaviors and thoughts that coexist with others in conscious awareness, and suggest that the triggering …

Obsessive–compulsive disorder (OCD) is a chronic, severe mental illness with up to 2–3% prevalence worldwide. In fact, OCD has been classified as one of the world's 10 leading causes of illness‐related disability according to the World Health Organization, largely because of the chronic nature of disabling symptoms.[1] Despite the severity and high prevalence of this chronic and disabling disorder, there is still relatively limited understanding of its pathophysiology. However, this is now rapidly changing due to development of powerful technologies that can be used to dissect the neural circuits underlying pathologic behaviors. In this article, we describe recent technical advances that have allowed neuroscientists to start identifying the circuits underlying complex repetitive behaviors using animal model systems. In addition, we review current surgical and stimulation‐based treatments for OCD that target circuit dysfunction. Finally, we discuss how findings from animal models may be applied in the clinical arena to help inform and refine targeted brain stimulation‐based treatment approaches.

… with OCD and to significantly predict contamination fear. Likewise, functional imaging studies of OCD patients with contamination concerns demonstrate activation of the same neural …

… in corticostriatal circuits in the pathophysiology of obsessive–compulsive disorder (OCD) and OC-… The view that striatal circuit dysfunction is involved in OC-spectrum disorders is …

… the neural circuits underlying the neurobiology of OCD in rodents. Genetic and circuit-… the neurobiology of OCD by identifying the molecular, cellular, and circuit events that induce …

Background: Obsessive–compulsive disorder (OCD) remains refractory to conventional pharmacological and psychotherapeutic treatments in a substantial proportion of patients. Neuromodulation has emerged as a promising intervention, but optimal neural circuit targets remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of invasive and non-invasive neuromodulation for OCD using a circuit-based framework and to translate these findings into clinical practice. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials investigating neuromodulation for OCD. PubMed/MEDLINE, Web of Science, and the Cochrane Library were searched from database inception to December 2023. Eligible studies included adult patients with a primary diagnosis of OCD receiving invasive or non-invasive neuromodulation, with symptom outcomes assessed using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Random- or fixed-effects meta-analyses were performed using mean differences or standardized mean differences, depending on heterogeneity. The review was registered in PROSPERO (CRD42024518326). Results: Twenty-seven randomized controlled trials involving 868 patients met inclusion criteria. Overall, neuromodulation significantly reduced OCD symptoms compared with control conditions. Circuit-based subgroup analyses indicated that modulation of the fronto-limbic circuit—primarily via invasive deep brain stimulation—was associated with the largest and most consistent Y-BOCS improvements, while sensorimotor, dorsal cognitive, and ventral affective circuits also demonstrated significant but more heterogeneous effects. Invasive neuromodulation showed greater efficacy than non-invasive approaches. These findings informed a translational multi-target deep brain stimulation case, demonstrating clinically meaningful symptom improvement (Y-BOCS decreased from 25 to 16 after 6 months). Limitations: Heterogeneity across non-invasive studies, short follow-up durations, and limited circuit-specific data constrain interpretation of long-term and symptom–domain-specific effects. Conclusions: This systematic review, meta-analysis, and case study suggest that circuit-based neuromodulation—particularly targeting the fronto-limbic circuit—may offer the most consistent benefit for treatment-refractory OCD. Larger, longer-term, and circuit-informed trials are needed to optimize individualized neuromodulation strategies.

… of OCD, we hypothesize that the neural circuit subserving the cognitive dysfunction of OCD should share or interact with the neural circuit for the symptom manifestation of OCD. To test …

Useful clinician-rated measures of OCD are now available. The Y-BOCS and NIMH Global OC both seem suitable for monitoring outcome in drug trials of OCD. These two scales seem relatively specific for symptoms of OCD and are sensitive to drug-induced changes in symptoms. Neither the Y-BOCS nor the NIMH Global OC confuse trait with state. There are ample data suggesting that the Y-BOCS is reliable and valid scale. Unlike some of the symptom inventories, such as the LOI and MOCI, final scores on the NIMH Global OC and Y-BOCS are not influenced directly by the type or number of obsessions and compulsions present. A computer-administered version of the Y-BOCS has been developed. Currently available patient-rated instruments suffer from serious shortcomings, including insensitivity to change and poor representation of patients with mono-symptomatic clinical pictures (e.g., hoarding alone). Some rating scales have been adapted for use in children with OCD. Several groups, including our own, have elected to use change scores on the 10-item Y-BOCS and a global measure of OCD, such as the NIMH Global OC or modified OGI, as the principal outcome variables in drug trials in patients with OCD. Several studies have selected a 35% decrease in Y-BOCS scores from baseline as indicative of clinically significant improvement. A limitation of all single-item global measures is that they cannot be resolved into smaller components. The more fine-grained analysis that is possible with the multi-item Y-BOCS makes it more desirable as a primary outcome measure, with a global scale as a secondary outcome measure.

… Five rating scales have been briefly described in this article. A number of other rating scales exist, but limitation of space does not allow us to discuss them at this time. As we have …

… We found good test-retest reliability for both rating scales in a sample of nondepressed OCD patients. The reliability of the Y-BOCS , however, was greater than that of the LO1 when …

… Obsessive Compulsive Scale (Y-BOCS), the Hamilton Rating Scale for Depression, and the Hamilton Rating Scale … the Y-BOCS total score and a rating of "improved" or "very improved" …

… To determine whether (1) insight in obsessive-compulsive disorder (OCD) improves when … the Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS) and a rating scale to evaluate …

… anxiety disorder, obsessive-compulsive disorder, schizophrenia, … In this chapter, we will briefly summarize the major rating scales … Although most of the rating scales used in treatment …

… of obsessive–compulsive disorder (OCD) in research studies is the Yale–Brown Obsessive–Compulsive Scale (… from 10 items, each rated on a 5-point scale where 0 denotes …

Abstract Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive–compulsive symptoms and diagnosis of obsessive–compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date. Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population. Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category “Obsessive–compulsive related disorders”, accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive–compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS. Results: Principal component factor analysis produced five subscales titled “Symmetry”, “Forbidden thoughts”, “Contamination”, “Magical thoughts” and “Dysmorphic thoughts”. The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62–70% Cronbach's α = 0.81; Severity Scale: sensitivity = 72%, specificities = 75–84%, Cronbach's α = 0.94). Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive–compulsive symptoms in clinical psychiatry.

Although obsessive-compulsive disorder (OCD) is regarded as a unitary nosological entity, it encompasses a rich variety of heterogeneous mental and behavioural phenomena. The identification of clinical subtypes within this broad concept has been a focus of attention in recent years. In the present study, we administered a clinician-rated scale, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) with the Y-BOCS Symptom Checklist (Y-BOCS CL), as well as a self-report questionnaire, the Padua Inventory revised (PI-R), to 150 outpatients with OCD. A principal component analysis on the Y-BOCS CL, along with the PI-R, identified 6 consistent symptom clusters: (1) contamination obsessions and cleaning compulsions, (2) sexual/religious/somatic obsessions and checking, (3) high risk assessment and checking, (4) impulses and fear of loss of control, (5) need for symmetry and exactness, and ordering and counting compulsions, and finally (6) rumination. The Y-BOCS CL and PI-R showed great overlap and consistency regarding content and severity of the OCD symptoms. On inspection of items with identical content, only half of the items showed significant agreement. Both inventories have unique factors: rumination is represented solely in the PI-R, somatic obsessions and checking solely in the Y-BOCS CL. This means that the use of both clinician-administered and self-report measures is recommended, so that the entire spectrum of symptoms is represented.

The reliability and validity of the Yale-Brown Obsessive-Compulsive Scale were examined according to a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). Internal consistency was acceptable but was improved by deletion of items concerning resistance to obsessions and compulsions. Inter-rater reliability was excellent, but test-retest reliability over an average interval of 48.5 days was lower than desirable. The YBOCS demonstrated good convergent validity with most other measures of OCD, but divergent validity vis à vis depression was poor. Analyses of new items assessing avoidance and the duration of obsession-free and compulsion-free intervals indicated that only the avoidance rating added meaningfully to the full scale score. In future research the authors recommend deletion of the resistance items and inclusion of the avoidance item to yield a revised 9-item YBOCS total score.

Comorbid depression is frequent in obsessive–compulsive disorder (OCD) and is acknowledged as a major confound in biological and neurocognitive investigations in OCD. The aim …

… was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). … A rating scale for depression …

… rating scales that 1) are the most commonly used in assessing patients with obsessive-compulsive … on scores on semistructured rating scales for obsessive-compulsive, depressive, and …

… These are clinician-rated, semi-structured interview-based scales that are widely used to assess OC symptom severity. Considerable data support the reliability and validity of both the …