Obsessive Compulsive Disorder (OCD) – A Primer on Neurobiology, Diagnosis and Treatment

Posted on January 28, 2018

The hallmark of obsessive-compulsive disorder (OCD) is the presence of obsessions and compulsions. It has a bimodal incidence with peaks occurring in late childhood/early adolescence and again in early adulthood (20-29).

The lifetime prevalence of OCD is believed to be between 1% and 3%, and patients can experience chronic or episodic OCD symptoms throughout their lifetime. OCD is a time-consuming and distressing mental state that has higher disability-adjusted years than Parkinson’s disease and multiple sclerosis, combined making OCD one of the top 10 most disabling medical conditions. [1]

OCD is believed to diminish the quality of life of the patient similar in extent to those individuals with schizophrenia. [2]

OCD symptoms are time-consuming and distressing and are often accompanied with strong avoidance behaviours.

OCD is under-recognised, under-treated as well as frequently mistreated. We summarise the key diagnosis and treatment modalities in OCD based on the latest guidelines. [3], [4]


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  • wenz

    How is this new information? We have known about the brain regions and circuits involved in OCD for decades now. Why has there been no targeted pharmacological treatment developed to specifically treat the brain regions and circuits involved in OCD rather than prescribing highest dose levels of SSRI’s (been around a while now, nothing new there), without accounting for the countless side effects because it’s like pouring chemical soup into the brain and hoping if you pour enough in, it might hit the right areas and circuits? Seems like sloppy science to me. And I suffer from OCD, and take Luvox 300 mg, and no doctor can tell me why it helps some of the time. Fancy names of brain regions and circuits doesn’t really help the patient if the treatment doesn’t target these regions.

    • Psychscenehub

      Newer pathways have been implicated particularly the glutamate pathways hence mood stabilisers such as Lamotrigine, Topiramate, NAC as augmenting agents are showing benefits.
      SSRI’s are only first line treatment. Other options are available. Another reason why OCD may be resistant is because co-morbid disorders may be playing a part e.g affective disorders.
      Medications plus ERP often has better response than ne or the other alone so medications re only a part of the solution.

  • wenz

    Thanks for your reply. It seems rather strange to me how we don’t ‘develop’ drugs for any psychiatric condition. All the SSRIs and Lithium to name a few were never developed in response to clearly identified biomarkers (which there are none) nor an understanding of the pathology of the disease. These are central processes that drive drug development in other areas of medicine. All I was asking was WHY even if more neural pathways were discovered for OCD, no NEW treatments have been developed specific to understanding the actual pathology of the disease. Blaming co-morbidity is not helpful as no psychiatric disorder has a known brain pathology as of yet, and suggesting multiple adjunct treatments of already existing drugs usually just creates more cost and side effects for the patient. I have engaged in group CBT and did find it of some value. I agree that there are mixed reviews on how well OCD responds to drug treatment compared to CBT. I was making a point about psychiatric drugs being dumped into the human brain without anyone knowing where they land and how they work at this point. There is a lot of placebo effects as well. More targeted drug treatment based on actual disease pathology will go a long way to improving the lives of people living with these conditions.

    • Psychscenehub

      Issue is with funding molecule development and at same time improving the understanding of the brain. Due to the high rates of neuroscience ‘failures’ in trials key companies have actually stopped investing in neuroscience e.g Astra Zeneca, BMS, GSK. This creates a real issue moving forward.

      • wenz

        Thank you for that very candid and honest reply. I have heard that from others as well. I do think that developing drugs without a clearer understanding of the brain pathology of mental illnesses will continue to yield more ‘failures’. I hear that now the movement is shifting away from drugs and more towards treatments like transcranial magnetic stimulation and the like. I think the same problems will keep occurring in the biochemical treatment of brain disorders which have not yet demonstrated a clear pathology and biomarkers. To me that should be first step, and then develop a treatment to treat the known disease. I am just a lay person and long term user of a variety of psychiatric drugs through the trial and error approach, and have got to the point of being quite disabled from all the chemicals in and out of the brain. That is why I am belabouring this point, but I know this is way beyond the scope of your article. I do appreciate your response. Cheers.

        • Psychscenehub

          You are right and this is a discussion psychiatry as a field keeps having. There are so many biological, psychological and social variables that play a part and the permutations and combinations are in the millions which is part of the issue. How do we personalise treatment yet create categories so research can be systematic. Million dollar question! Thanks for your thought provoking questions though.