Obsessive-Compulsive Disorder Diagnosis and Treatment

Diagnostic Criteria and Assessment

The American Academy of Child and Adolescent Psychiatry recommends assessing thyroid function, as hyperthyroidism can mimic or exacerbate anxiety symptoms, including those of obsessive-compulsive disorder (OCD) 6.
The Annals of Internal Medicine suggests that a comprehensive suicide risk assessment should be conducted, including current suicidal thoughts, plans, means, and intent, especially in patients with OCD and comorbid depressive symptoms 2, 3.
The Nature Reviews Disease Primers states that OCD diagnosis requires the presence of recurrent, intrusive, and distressing obsessions or compulsions that are time-consuming or cause significant distress or impairment, with symptoms worsening over years 1.

The Annals of Internal Medicine recommends assessing for current major depressive episode, given the high comorbidity between anxiety disorders and major depressive disorder, and the significant suicide risk associated with comorbid presentations 3.
The Journal of the American Academy of Child and Adolescent Psychiatry suggests that medical rule-outs, such as hyperthyroidism, should be considered in the differential diagnosis of OCD and comorbid depressive symptoms 6.

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold standard clinician-rated instrument for measuring OCD symptom severity, with scores ≥28 indicating severe OCD, according to the Nature Reviews Disease Primers 1.
The Generalized Anxiety Disorder-7 (GAD-7) measures nervousness, inability to control worry, excessive worry, trouble relaxing, restlessness, and irritability to distinguish generalized anxiety from OCD-specific anxiety, as recommended by the Praxis Medical Insights 4.

The Praxis Medical Insights recommends starting sertraline 50 mg once daily, as SSRIs are first-line pharmacotherapy for OCD, and the combination of CBT plus SSRI is recommended for moderate-to-severe symptoms 4.
The Nature Reviews Disease Primers suggests that Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT with ERP) is the most effective psychological treatment for OCD, with evidence supporting its use alone or combined with SSRIs 1, 4.
The Annals of Internal Medicine recommends incorporating behavioral activation into CBT sessions to address social isolation and low energy, and to develop a graduated plan for increasing social contact 3.