Obsessive-compulsive disorder is characterised by recurrent obsessions (intrusive, unwanted thoughts, urges or images causing marked distress — recognised as irrational by the sufferer) and/or compulsions (repetitive behaviours or mental acts aimed at reducing anxiety). The obsessions are NOT pleasurable and are distinguished from OCD depictions in popular culture ("I'm so OCD about tidiness") — real OCD causes profound distress and disability, consuming hours daily. It affects 2-3% of the global population and is one of WHO's 10 most disabling conditions.

What are the most common OCD obsessions?

Contamination obsessions (fear of germs, contamination — leading to washing/cleaning compulsions); harm obsessions (fear of harming self or others — leading to checking compulsions, reassurance seeking); symmetry/ordering obsessions (things must be "just right" — leading to ordering, arranging, counting); intrusive sexual, violent or blasphemous thoughts (deeply distressing, ego-dystonic — the person does NOT want to act on them; intrusive thought content does not reflect character or intention); scrupulosity (religious/moral obsessions); and health-related obsessions. Most people with OCD have multiple obsession types.

What is ERP and how does it work?

Exposure and Response Prevention (ERP) is the gold-standard psychological treatment for OCD. It involves: (1) Exposure — deliberately and systematically confronting the feared stimulus (e.g., touching a "contaminated" object, writing the word "cancer") from lowest to highest anxiety-provoking on a hierarchy; (2) Response prevention — resisting the compulsion that would normally be triggered (e.g., not washing hands, not seeking reassurance). Through repeated exposures without compulsions, anxiety gradually extinguishes (habituation/inhibitory learning). This is anxiety-provoking and requires a skilled therapist and motivated patient — but is highly effective (65-80% response rates).

First-line: ERP therapy (alone or combined with medication); SSRIs at high doses (sertraline 200mg, fluoxetine 80mg, fluvoxamine 300mg, paroxetine 60mg, escitalopram 40mg — higher doses than for depression; adequate trial 12-16 weeks). First-line if SSRIs ineffective: clomipramine (most effective drug; used second-line due to side effects); ERP augmentation with antipsychotics (risperidone, aripiprazole) for partial responders. For severe treatment-resistant OCD: intensive/residential ERP programmes; glutamate-targeting agents (memantine, riluzole); deep brain stimulation (FDA humanitarian device exemption for refractory OCD).

Is OCD related to anxiety disorders?

OCD was historically classified as an anxiety disorder. In DSM-5 (2013), OCD was moved to its own category ("OCD and Related Disorders") — reflecting its distinct neurobiology (orbitofrontal cortex-striatum-thalamus circuit hyperactivity) and phenomenology. However, anxiety is central to OCD (obsessions cause anxiety; compulsions reduce it temporarily). OCD shares features with anxiety disorders (avoidance, distress) but differs in its specific ego-dystonic, intrusive, ritualistic character and its pattern of response to treatment (higher SSRI doses; specific ERP protocol rather than general CBT).

Can OCD affect children?

Yes — OCD commonly begins in childhood or adolescence. Approximately 25% of cases begin before age 14; the mean age of onset is approximately 19-20 years. Childhood OCD has similar phenomenology to adult OCD but may present differently (e.g., reassurance-seeking from parents, avoidance of school activities, contamination fears about food). Childhood OCD responds to ERP and SSRIs (fluoxetine, sertraline are FDA-approved for paediatric OCD). PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) — a controversial entity linking strep infections to acute OCD/tic onset in children — is an active research area.

What is the difference between OCD and OCPD?

OCD (obsessive-compulsive disorder) and OCPD (obsessive-compulsive personality disorder) are completely different conditions frequently confused: OCD involves ego-dystonic obsessions and compulsions (the person finds them intrusive and unwanted); OCPD involves a pervasive pattern of preoccupation with orderliness, perfectionism and control — experienced as ego-syntonic (the person sees these as positive traits). OCPD does not involve obsessions or compulsions in the OCD sense. OCD responds to ERP and SSRIs; OCPD responds to psychotherapy addressing personality rigidity.

How does GMJ News cover OCD?

GMJ News covers WHO OCD burden data, ERP therapy evidence, SSRI and clomipramine treatment, OCD spectrum disorders, deep brain stimulation for severe OCD, and the treatment gap. OCD is a major and underrecognised mental health condition in Georgia — directly relevant to PHIG's mental health priorities and the Georgian Medical Journal.

Home › Topics › Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD)

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Obsessive-compulsive disorder (OCD) — characterised by recurrent, ego-dystonic obsessions (intrusive thoughts causing marked anxiety) and compulsions (repetitive behaviours aimed at reducing anxiety) — affects approximately 2-3% of the global population (approximately 200 million people) and is ranked by WHO as one of the 10 most disabling conditions in the world in terms of reduced quality of life (WHO). OCD spans a vast spectrum — from contamination fears and handwashing rituals to intrusive thoughts of harm, religious obsessions, and symmetry compulsions. Exposure and response prevention (ERP) therapy and SSRIs (sertraline, fluvoxamine, clomipramine) are the evidence-based first-line treatments.

Key messages

2-3% globally — WHO ranks in top 10 most disabling

OCD affects approximately 2-3% of the global population (approximately 190-200 million people) and is ranked by WHO as one of the 10 most disabling conditions in the world in terms of lost years of healthy life.

Ego-dystonic obsessions and compulsions

OCD is characterised by ego-dystonic obsessions (intrusive, unwanted thoughts causing marked anxiety — recognised by the person as irrational) and compulsions (repetitive mental or physical acts performed to reduce anxiety). The obsessions are NOT pleasurable; they cause distress.

ERP is the gold-standard psychotherapy

Exposure and response prevention (ERP) — a specialised CBT — is the gold standard psychological treatment for OCD, with approximately 65-80% response rates. ERP involves deliberately triggering obsessions and then resisting the compulsive response, gradually reducing anxiety through habituation.

SSRIs and clomipramine

High-dose SSRIs (sertraline, fluoxetine, fluvoxamine, paroxetine, escitalopram) and clomipramine (the most effective — a TCA) are the pharmacological treatments. Higher doses and longer treatment duration (12+ weeks) are required than for depression.

Treatment gap is large

Despite highly effective treatments existing, approximately 57% of people with OCD receive no treatment. Average time from symptom onset to correct diagnosis and treatment is approximately 11-17 years. OCD is frequently misdiagnosed as anxiety disorder, depression or psychosis.

Deep brain stimulation for severe OCD

DBS (deep brain stimulation) targeting the anterior limb of the internal capsule or nucleus accumbens received FDA humanitarian device exemption for treatment-resistant OCD — the first non-psychiatric-medication brain stimulation treatment for OCD.

Key statistics

2-3%

global prevalence (~190-200M people)

WHO

Top 10

most disabling conditions (WHO rank)

WHO/GBD

11-17yr

average time from onset to treatment

IOCDF/research

57%

receive no treatment globally

WHO

65-80%

response rate with ERP therapy

WHO/Cochrane

Equal

male and female prevalence (unlike most anxiety disorders)

WHO

OCD obsession types — approximate frequency in clinical populations (%)

Source: Published OCD phenomenology data. Most patients have multiple obsession types.

Glossary of key terms

Obsession
DSM-5/WHORecurrent, persistent, intrusive and unwanted thoughts, urges or images that cause marked anxiety or distress. The person recognises them as products of their own mind (ego-dystonic) and typically tries to suppress them or neutralise them with another thought or action (compulsion). Distinguished from ruminative depression by intrusiveness and ego-dystonicity.

Compulsion
DSM-5/WHORepetitive behaviours (handwashing, checking, ordering, counting) or mental acts (praying, repeating words silently) performed in response to obsessions or rigid rules — aimed at preventing or reducing anxiety or preventing a dreaded event. The compulsions are time-consuming (>1 hour/day in OCD) and cause significant functional impairment.

ERP (Exposure and Response Prevention)
IOCDF/APAThe gold-standard CBT for OCD — involving deliberate exposure to the feared stimulus (e.g., touching a "contaminated" surface) while refraining from the compulsive response (e.g., not washing hands). Through repeated exposures without the compulsion, anxiety gradually diminishes through habituation and inhibitory learning. Requires trained OCD-specialist therapist.

Y-BOCS (Yale-Brown Obsessive Compulsive Scale)
ResearchThe standard clinical rating scale for OCD severity — assessing time occupied, distress, resistance, interference and control of obsessions and compulsions. Y-BOCS ≥16 = moderate; ≥24 = severe. A 35% reduction in Y-BOCS score defines "response" in clinical trials.

Clomipramine
WHO EMLA tricyclic antidepressant with potent serotonin reuptake inhibiting properties — the most effective pharmacological treatment for OCD, with slightly superior efficacy to SSRIs in meta-analyses. However, side effects (cardiac, anticholinergic, sedation) mean SSRIs are typically tried first.

OCD spectrum disorders
DSM-5/ICD-11DSM-5 and ICD-11 recognise an "OCD and related disorders" category including: body dysmorphic disorder (BDD — preoccupation with perceived physical defects); hoarding disorder; trichotillomania (hair-pulling); excoriation (skin-picking); and olfactory reference disorder. All share repetitive, preoccupying, and distressing features and respond to ERP and/or SSRIs.