Obsessive-compulsive disorder in people with multiple sclerosis: a systematic review and meta-analysis

Multiple sclerosis (MS) is a chronic, immune-mediated neurological disorder that is frequently associated with psychiatric comorbidities, particularly obsessive-compulsive disorder (OCD). OCD may increase psychological burden, reduce quality of life, and exacerbate disease activity in people with MS (PwMS). However, the frequency of OCD in PwMS and its association with MS remain mostly uncertain. This review aimed to estimate the overall prevalence of OCD in PwMS and to evaluate the association between MS and OCD.

A comprehensive search of PubMed, Scopus, Embase, and Web of Science was conducted up to January 2025 to identify studies that assessed the frequency rate of OCD in PwMS or explored the relationship between MS and OCD. The meta-analysis was performed using a random-effects model in R version 4.4.0.

Ten studies on 1024 PwMS and 172 healthy controls met the inclusion criteria. The pooled prevalence of OCD among PwMS was 10.7% (95% CI: 5.6% to 15.9%, I² = 67%). Meta-analysis on three studies indicated that the odds of OCD was significantly increased in PwMS (OR = 3.25, 95% CI: 1.13 to 9.36, p-value = 0.03). Although moderate to high heterogeneity was observed, sensitivity analyses confirmed the robustness of the results, and no significant evidence of publication bias was identified.

This review indicated that the overall frequency 10.7% of OCD increased risk (3.2-fold) of OCD among PwMS. Screening and targeted interventions for OCD may enhance clinical outcomes and quality of life of PwMS.