Intensive Psychotherapy Treatment Options for Pediatric Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD), affecting ∼1% of the population,¹ is characterized by intrusive thoughts and compulsive behaviors that cause significant distress and impairment. Following an evidence-based assessment to identify OCD and to differentiate co-occurring conditions,² the front-line treatment is outpatient cognitive behavioral therapy (CBT) with exposure and response prevention (ERP), with or without serotonin reuptake inhibitors (SRIs).³ In severe cases, augmentation with neuroleptics is often used. Although standard outpatient treatment reduces OCD symptoms,⁴ many youth do not fully respond³ and require more intensive care, such as intensively delivered ERP. This article aims to guide clinicians in referring patients with severe and/or treatment-refractory OCD-defined as a failure of 2 SRI trials of adequate dose and duration and an adequate ERP trial-to appropriate intensive psychotherapeutic treatment.