Obsessive-compulsive disorder: a treatment review

Obsessive-compulsive disorder, which may affect 2% to 3% of the U.S. population, can be severely disabling, permeating an individual's personal, social, and work life. Only within the past 2 decades have effective treatments been proposed and tested. Specific behavior therapies such as exposure in vivo and response prevention have proved successful in decreasing compulsive rituals in 70% to 80% of patients who accept and comply with treatment. For those patients who do not respond to behavior therapy, medications should be used. To date the tricyclic clomipramine is the only medication that has been consistently effective in controlled studies. However, for certain patients other medications may be of benefit. For the minority of patients who do not respond to either behavior therapy or medication, psychosurgery--specifically stereotactic limbic leucotomy--should be considered a viable option.