From guidance to gaps: The CANMAT-ICOCS OCD guidelines and the need for a staging-oriented, transdiagnostic framework

The recent publication of the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) 2025 International Guidelines for the Management of Patients with Obsessive-Compulsive Disorder (OCD), or simply the CANMAT-ICOCS OCD guidelines, represents a timely and important reference for a field that has lacked updated, comprehensive treatment recommendations in the last decades. These guidelines provide a valuable synthesis of available evidence and offer practical direction for routine clinical care. However, many clinical scenarios still have limited empirical evidence to guide current treatment recommendation. In particular, greater attention is needed to the identification and management of at-risk phenotypes; limited guidance is given for acute and potentially life-threatening presentations of OCD, as well as for patients with severe, treatment-refractory illness, who may benefit from palliative approaches focused on quality of life and harm reduction. Finally, the potential clinical utility of a transdiagnostic, staging-oriented framework for OCD (capable of accommodating illness heterogeneity, comorbidity, and longitudinal progression) warrants more systematic consideration. Addressing these gaps may further enhance the relevance and applicability of future guideline iterations.