Obsessive-compulsive disorder is a condition with unwanted, intrusive thoughts or urges (obsessions) and repeated behaviors or mental acts (compulsions) done to reduce the distress. It takes up time and harms daily life, and exposure therapy and SSRIs are effective.
Key symptoms
- Fear of germs or contamination with repeated washing
- Doubts with repeated checking of locks or appliances
- Need for order, symmetry or doing things just right
- Unwanted thoughts about harm, sex or religion
- More than 1 hour a day spent on obsessions or compulsions
What you find on exam
- Mental status exam: insight into the obsessions
- Skin damage on the hands from washing
- Screen for depression, tics and suicidal thoughts
- Ask how symptoms affect work, school and family
Tests
- Diagnosis is clinical, using DSM-5 criteria
- Y-BOCS scale to rate severity
- Sudden onset in a child after infection: consider PANDAS work up
- Screen for body dysmorphic disorder and hoarding
Treatment basics
- Cognitive behavioral therapy with exposure and response prevention
- SSRI such as fluoxetine, sertraline or fluvoxamine, often at higher doses
- Clomipramine if SSRIs fail
- Add an antipsychotic such as aripiprazole in resistant cases
- Family education to avoid helping with rituals
Red flags
- Suicidal thoughts
- Unable to eat, work or leave home because of rituals
- Sudden onset in a child with tics or behavior changes
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.