Obsessive-Compulsive Disorder (OCD)
BASICS
DESCRIPTION
- A disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and/or compulsions (repetitive, ritualistic behaviors, or mental acts) that are time-consuming and cause significant distress
- Not to be confused with obsessive-compulsive (anankastic) personality disorder
EPIDEMIOLOGY
Incidence
- Three subtypes: child/adolescent-onset (age <18 years), adult-onset (18 to 39 years), and late-onset (age ≥40 years).
- Child/adolescent-onset in 50% of cases (usually by age 18 years) (1)
- Consider pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) in acute presentation of OCD and tics in children (2).
- Consider neurologic or neurodegenerative disorders in new-onset OCD.
Prevalence
~2% lifetime prevalence; slight female predominance when including postpartum OCD
ETIOLOGY AND PATHOPHYSIOLOGY
- While the exact etiology of OCD is unknown, genetic, anatomical, neurochemical, and environmental factors are believed to contribute to the disorder.
- Dysregulation of serotonergic, catecholaminergic and glutamatergic pathways
- Dysfunction of cortico-striatal-thalamo-cortical (CSTC) circuit, involving the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC)
- Stressors, trauma, and learned behaviors may be contributing factors to development of OCD symptoms
Genetics
- Prevalence rates of 7–15% in first-degree relatives of children/adolescents with OCD
- ~45–65% of the variance of OCD is explained by genetics
RISK FACTORS
- Family history of OCD
- Advanced paternal and maternal age
- Coexisting psychiatric disorders, most commonly anxiety disorders and schizophrenia
- Antipsychotics such as clozapine and olanzapine with greater serotonergic blockade may cause symptoms of OCD
- Brain insult (i.e., encephalitis, pediatric streptococcal infection, or head injury)
- History of childhood traumatic events, including social isolation and physical abuse
GENERAL PREVENTION
Early diagnosis and treatment can decrease distress and impairment.
COMMONLY ASSOCIATED CONDITIONS
- Major depressive disorder
- Anxiety disorders including panic disorder/phobia/social phobia/generalized anxiety disorder
- Tourette syndrome/tic syndromes
- Substance abuse/eating disorder/body dysmorphic disorder
- Other obsessive-compulsive-spectrum disorders including body-focused repetitive behaviors (trichotillomania, excoriation disorder), body dysmorphia, and hoarding disorder
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Citation
Domino, Frank J., et al., editors. "Obsessive-Compulsive Disorder (OCD)." 5-Minute Clinical Consult, 34th ed., Wolters Kluwer, 2026. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688204/all/Obsessive_Compulsive_Disorder__OCD_.
Obsessive-Compulsive Disorder (OCD). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2026. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688204/all/Obsessive_Compulsive_Disorder__OCD_. Accessed July 18, 2025.
Obsessive-Compulsive Disorder (OCD). (2026). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (34th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688204/all/Obsessive_Compulsive_Disorder__OCD_
Obsessive-Compulsive Disorder (OCD) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2026. [cited 2025 July 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688204/all/Obsessive_Compulsive_Disorder__OCD_.
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