Obsessive-compulsive disorder: update on assessment and treatment

Obsessive-compulsive disorder (OCD) is a frequently debilitating and often severe anxiety disorder that affects approximately 2% of the population. This article discusses the presentation of the disorder and theories of etiology and provides an overview of assessment and treatment. A case description is included to illustrate the cognitive-behavioral assessment and treatment approach. OCD has similar prevalence rates cross-culturally around the world. Although its etiology is not established, neurobiological, genetic, cognitive, and behavioral factors have been implicated. The process of assessment for OCD plays an important role in establishing a therapeutic alliance with the patient and identifying treatment goals. The assessment of OCD can be guided by using published semi-structured interview tools, including a standardized symptom checklist and severity rating scale. Treatments that have shown efficacy for OCD are cognitive-behavioral therapy, including exposure and response prevention, and pharmacotherapy. However, up to 25% of patients fail to benefit from these evidence-based treatments. Other treatment approaches have recently been developed to further increase the effectiveness of cognitive-behavioral interventions. Strategies based on traditional cognitive approaches that challenge core beliefs have been shown to be effective. Acceptance-based therapies and treatments based on meta-cognitive principles have also shown promise and need further research.