OCD & Related Disorders
Obsessive-Compulsive and Related Disorders (DSM-5-TR)
Intrusive obsessions and/or compulsive behaviors. Includes OCD, body dysmorphic disorder, hoarding, trichotillomania, and excoriation. ERP is the gold-standard psychotherapy.
Prevalence: ~2-3% lifetime for OCD
Clinical Picture
OCD is one of the conditions where modality choice matters most. Exposure and Response Prevention (ERP) is the established first-line treatment, and its mechanism — preventing the compulsive behavior that temporarily reduces distress, thereby allowing habituation to the obsessional trigger — is well-understood. But OCD is also one of the conditions most resistant to pure technique-based treatment when deeper issues are at play. The content of obsessions often touches on the client's most cherished values (harm to loved ones, sexual identity, religious scrupulosity), creating a meaning-making dimension that pure behavioral approaches may not adequately address.
Treatment Considerations
ERP within a CBT framework is the gold standard. ACT-enhanced ERP is gaining evidence for cases where traditional ERP stalls, particularly when the client struggles with the acceptance component. Psychodynamic approaches are generally not recommended as standalone OCD treatment but may be valuable as adjuncts when the obsessional content connects to deeper characterological patterns. Medication (SSRIs, clomipramine) is often combined with therapy for moderate-to-severe presentations.
6 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.