Obsessive-compulsive disorder

Meet the patient

A 27-year-old primary school teacher has not driven to work for four months. She takes the bus because, after every trip, she used to circle the block three times to check she had not hit a pedestrian.[9][19]

She knows it is irrational. She says so, unprompted, with real shame. Her mother now drives the route for her each morning and phones to confirm there were no ambulances — and the mother believes she is helping.[19]

Her GP referral says: "generalised anxiety, has had CBT, no response". The examiner's question is the one you must be able to answer in a sentence: was that actually CBT?[3][13]

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1. [1]Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability Arch Gen Psychiatry, 1989.PMID 2684084
2. [2]Ruscio AM, Stein DJ, Chiu WT, Kessler RC The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication Mol Psychiatry, 2010.PMID 18725912
3. [3]Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder Am J Psychiatry, 2005.PMID 15625214
4. [4]Soomro GM, Altman D, Rajagopal S, Oakley-Browne M Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) Cochrane Database Syst Rev, 2008.PMID 18253995
5. [5]Bloch MH, McGuire J, Landeros-Weisenberger A, Leckman JF, Pittenger C Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder Mol Psychiatry, 2010.PMID 19468281
6. [6]Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder Mol Psychiatry, 2006.PMID 16585942
7. [7]Simpson HB, Foa EB, Liebowitz MR, Huppert JD, Cahill S, Maher MJ, et al. Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial JAMA Psychiatry, 2013.PMID 24026523
8. [8]Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder Am J Psychiatry, 2007.PMID 17849776
9. [9]Hirschtritt ME, Bloch MH, Mathews CA Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment JAMA, 2017.PMID 28384832
10. [10]Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis Lancet Psychiatry, 2016.PMID 27318812
11. [11]Carmi L, Tendler A, Bystritsky A, Hollander E, Blumberger DM, Daskalakis J, et al. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial Am J Psychiatry, 2019.PMID 31109199
12. [12]Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases Am J Psychiatry, 1998.PMID 9464208
13. [13]Öst LG, Havnen A, Hansen B, Kvale G Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014 Clin Psychol Rev, 2015.PMID 26117062
14. [14]Pittenger C, Bloch MH Pharmacological treatment of obsessive-compulsive disorder Psychiatr Clin North Am, 2014.PMID 25150568
15. [15]Pauls DL The genetics of obsessive-compulsive disorder: a review Dialogues Clin Neurosci, 2010.PMID 20623920
16. [16]Phillips KA Body dysmorphic disorder: recognizing and treating imagined ugliness World Psychiatry, 2004.PMID 16633443
17. [17]Fineberg NA, Hollander E, Pallanti S, Walitza S, Grünblatt E, Dell'Osso BM, et al. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders Int Clin Psychopharmacol, 2020.PMID 32433254
18. [18]Alonso P, Cuadras D, Gabriëls L, Denys D, Goodman W, Greenberg BD, et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response PLoS One, 2015.PMID 26208305
19. [19]Abramowitz JS, Abramovitch A, McKay D, Draffin A Management of obsessive-compulsive disorder in adults BMJ, 2026.PMID 41698714
20. [20]International Obsessive Compulsive Disorder Foundation Genetics Collaborative (IOCDF-GC) and OCD Collaborative Genetics Association Studies (OCGAS) Revealing the complex genetic architecture of obsessive-compulsive disorder using meta-analysis Mol Psychiatry, 2018.PMID 28761083