Clinical practice guidelines for obsessive-compulsive disorder: 2025 update

The current guidelines are an updated version of the Indian Psychiatric Society's Clinical Practice Guidelines (CPG) for Obsessive-Compulsive Disorder (OCD), published in 2017. The CPG aims to provide an evidence-based framework for the assessment and management of OCD across different age groups and those with comorbidities. We conducted a systematic literature search since the publication of the previous guidelines in 2017. We provide the level of evidence and strength of recommendation for the treatment strategies in different phases of illness. A comprehensive evaluation of OCD symptoms, insight, comorbidities, and relevant treatment history is essential for formulating a detailed management plan. Selective serotonin reuptake inhibitors and cognitive behavior therapy remain the first-line treatment for OCD. The choice of treatment strategy is based on various factors, including illness severity, psychiatric and other medical comorbidities, previous treatment trials, affordability, accessibility, hypersensitivity, side-effect profile, and patients' preferences. Current evidence on different forms and modes of psychotherapy delivery is provided. We discuss the level of evidence and strength of recommendations for pharmacological and psychological augmentation strategies as well as for neuromodulatory and neurosurgical interventions. The challenges and strategies for management of OCD in those with comorbid psychiatric and physical illnesses are discussed. Evaluation and evidence-based management strategies in the pediatric and geriatric populations are also discussed. The guidelines provide an evidence-based framework that can be adapted by the practitioner to suit the distinctive needs of individual patients and the clinical setting.