Obsessive-compulsive disorder (OCD) is a chronic, often debilitating psychiatric condition characterized by intrusive thoughts and behavioral or mental rituals. Although exposure and response prevention (ERP) remains the first line treatment, many individuals do not experience full remission, highlighting the need for innovation. This review provides a comprehensive and up-to-date synthesis of evidence based treatments for OCD in adults, as well as emerging psychological and biological approaches. It first describes established psychological and pharmacological therapies, highlighting recent findings and factors affecting treatment outcomes. It then examines innovations in psychological care including inhibitory learning informed ERP, acceptance and commitment therapy, inference based therapy, and telehealth delivery methods, as well as emerging biological treatments such as psilocybin, ketamine, and neuromodulation techniques. Cultural and identity related considerations are also discussed, emphasizing the importance of tailoring interventions for diverse populations.

STUDY OBJECTIVES:Anxiety is common during the perinatal period and is associated with adverse maternal and infant outcomes, highlighting a need to identify predictors of perinatal anxiety. Accumulating research implicates sleep disruption in perinatal anxiety and related symptoms, including obsessive-compulsive symptoms. We examined the associations among insomnia symptoms and sleep duration with perinatal anxiety, obsessive beliefs, and obsessive-compulsive symptoms and the moderating role of coping from pregnancy through postpartum. METHODS:A sample of 231 women (agemean = 32.97 ± 4.36 years; 74% white) completed interview and self-report measures of sleep, coping, perinatal anxiety, obsessive beliefs, and obsessive-compulsive symptoms in early and late pregnancy, 6 weeks postpartum, and 6 months postpartum. Multilevel models were used for data analysis. RESULTS:Shorter sleep duration predicted increases in subsequent perinatal anxiety (B = -.63, p < .05) and obsessive beliefs (B = -2.17, p < .05), whereas perinatal anxiety and related symptoms did not predict subsequent sleep disruption (p's > .05). Those who reported higher insomnia symptoms and shorter sleep duration reported higher perinatal anxiety (B = 1.19, p < .001; B = -3.18, p < .001), obsessive beliefs (B = 3.42, p < .001; B = -11.57, p < .001), and obsessive-compulsive symptoms (B = .69, p < .001; B = -1.94, p < .001) on average. The relation between insomnia symptoms and perinatal anxiety was moderated by coping (B = -.18, p < .01). CONCLUSIONS:These findings suggest that sleep disruption is a modifiable risk factor for perinatal anxiety and related symptoms.

Although inferential confusion (IC), fear of self (FOS), and obsessive beliefs have each been linked to obsessive-compulsive disorder (OCD), they have rarely been examined together within the inferential-based approach (IBA) or considered across different cultural contexts. This study examined a cross-sectional model in which IC was associated with scrupulosity, mental contamination, and OCD symptom dimensions via indirect paths involving FOS and obsessive beliefs in undergraduate samples from the United States and Turkey. Participants were 903 undergraduate students (347 US, 556 Turkish) who completed measures of IC, FOS, obsessive beliefs, scrupulosity, mental contamination, and OCD symptoms. Path analyses provided stronger support for the modified final model in the Turkish sample, whereas the US model showed more limited overall fit and should therefore be interpreted cautiously. Within this context, significant indirect associations between IC and scrupulosity, mental contamination, and most OCD dimensions were observed through FOS and/or obsessive beliefs in one or both samples. Indirect pathways through FOS were significant for scrupulosity, mental contamination, and unacceptable thoughts in both samples, whereas other OCD dimensions showed sample-specific patterns: responsibility for harm and symmetry were significant only in the Turkish sample, and contamination was significant only in the US sample. Indirect pathways through obsessive beliefs were significant for scrupulosity, mental contamination, responsibility for harm, unacceptable thoughts, contamination, and symmetry in both samples. These findings suggest that an IBA-consistent pattern may be present in both US and Turkish samples, although the role of self-related concerns and obsessive beliefs may vary across symptom domains and samples. However, given the limited fit of the US model and the nonidentical final models, cross-sample comparisons should be considered exploratory rather than confirmatory.

This study explores the distinct roles of religiosity and scrupulosity in relation to cognitive factors-obsessive beliefs, fear of self, and inferential confusion-across contact and mental contamination (MC). Unlike prior research, it examines how religiosity and scrupulosity differentially predict contamination concerns through these cognitive factors. A sample of 235 undergraduates (83.4% female, M = 18.84 years) completed self-report measures assessing contamination types, scrupulosity, religiosity, fear of self, inferential confusion, and obsessive beliefs. Results showed that scrupulosity, compared with religiosity, was a stronger predictor of contamination, particularly MC, suggesting the importance of distinguishing between normative religious belief and pathological doubt. Fear of self and inferential confusion mediated the link between scrupulosity and MC, while inferential confusion alone mediated contact contamination. These findings highlight the distinct cognitive pathways underlying mental and contact contamination and emphasize the clinical relevance of targeting scrupulosity, fear of self, and inferential confusion-rather than religiosity-in interventions for contamination-related obsessive-compulsive disorder symptoms. Limitations include the sample's limited generalizability, cross-sectional design, and Western context, which may not fully capture cultural and religious influences.

Existential obsessions-persistent, intrusive doubts about unanswerable questions such as the nature of reality, identity, free will, and death-are an understudied and underrecognized presentation of obsessive-compulsive disorder (OCD). Although these symptoms align with core OCD features, their abstract and philosophical content distinguishes them from more commonly studied presentations. This article provides a conceptualization of existential obsessions, outlining their phenomenology, cognitive-behavioral underpinnings, and implications for assessment and treatment. We identify four primary content domains, namely, metaphysical, thanatological, ontological, and deterministic obsessions, and draw on established OCD models to explain their development and maintenance. Sociocultural and developmental influences are also highlighted. We then outline treatment recommendations based on the conceptual model and present a research agenda to address gaps in the literature, including the need for targeted assessment tools, empirical tests of proposed mechanisms, and treatment trials. Just as other manifestations of OCD have gained clarity through empirical study, existential obsessions merit scientific attention to enhance recognition and improve outcomes.

Perinatal obsessive–compulsive (OC) symptoms are common and distressing, yet their impact on early parenting outcomes such as maternal-infant bonding remains poorly understood. Although prior research links maternal depression and anxiety to bonding difficulties, less is known about how perinatal OC symptoms relate to maternal-infant bonding over time, or the extent to which maternal-partner relationship quality is associated with these outcomes, and whether depressive symptoms explain observed associations. Data were drawn from a longitudinal study of 256 pregnant women recruited from two U.S. sites between 2020 and 2023. Participants completed self-report and clinician-administered assessments at 20 weeks (PGWK20), 34 weeks gestation (PGWK34), and at 6 weeks (PP6WK) and 6 months postpartum (PP6MO). OC symptoms were measured using the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) and the Perinatal Thoughts and Behaviors Checklist (PTBC), depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS), maternal-partner relationship quality with the Dyadic Adjustment Scale (DAS), and maternal-infant bonding with the Postnatal Bonding Questionnaire (PBQ). Prenatal OC symptom severity (PGWK34) and OC symptom severity assessed at PP6WK did not directly predict maternal-infant bonding difficulties at PP6WK or PP6MO. Depressive symptoms at PP6WK significantly mediated the association between prenatal OC symptoms and bonding difficulties at PP6MO. Higher maternal-partner relationship quality during pregnancy (PGWK34) predicted fewer bonding difficulties at PP6MO but was not associated with the strength of associations between OC symptoms and bonding outcomes. Perinatal OC symptoms may indirectly influence maternal-infant bonding through co-occurring depressive symptoms, highlighting the importance of mood-focused assessment and personalized intervention during pregnancy. Maternal-partner relationship quality emerged as a general protective factor associated with fewer bonding difficulties but did not moderate associations between OC symptoms and bonding outcomes. Integrated screening and intervention approaches targeting both mood and OC features may enhance maternal well-being and early relational outcomes.

Obsessive-compulsive disorder (OCD) can emerge during pregnancy and the postpartum and may adversely affect mother and newborn. However, little is known about potential risk factors for the onset of OCD in the perinatal period. Therefore, we investigated the onset of diagnosed DSM-5 OCD in women followed from the second trimester of pregnancy to 6-months postpartum. We followed 256 women from the 20-24th week of pregnancy to 6-month postpartum. Participants had psychiatric diagnostic interviews at baseline and 6-month postpartum and completed self-report instruments. We compared women with and without incident OCD on sociodemographic characteristics and clinical features. Of the 143 participants without past or current OCD at baseline, 12 (8.4

The Obsessive-Compulsive Inventory-Child Version (OCI-CV), which was developed to assess OCD symptoms in children and adolescents, was recently revised (OCI-CV-R) after hoarding was removed as an OCD symptom dimension in the DSM-5. The study aimed to examine the validity of the OCI-CV-R for assessing OCD symptoms in Turkish culture. A total of 1,062 youths, aged 9 to 18 years, participated in this study to assess the OCI-CV-R's psychometric properties in the Turkish culture. Analysis included factor analyses and assessments of validity and reliability. Results demonstrated that the Turkish version of the OCI-CV-R had good model fit values for the five-factor structure of the scale. The revised scale also revealed measurement invariance between two age groups: children (ages 9-11) and adolescents (ages 12-18). The findings indicate that the OCI-CV-R is a valid and reliable instrument for assessing OCD symptoms among Turkish-speaking populations and thus can replace the previous version.

Obsessive compulsive disorder (OCD) has an increased prevalence throughout pregnancy and in the postpartum period relative to non-peripartum periods. While some obsessive-compulsive symptoms in this period present in the same manner to those in non-postpartum OCD, others are more specific to the postpartum period (e.g., obsessions related to sudden infant death syndrome [SIDS]). However, there are few validated scales assessing obsessive-compulsive symptoms during the postpartum period. This study examined the psychometric properties of the Postpartum Thoughts and Behaviors Checklist (PTBC), a semi-structured interview of intrusive thoughts and repetitive, neutralizing behaviors developed to address this gap. In a sample of 257 women at 6 weeks postpartum, the PTBC demonstrated good internal consistency, criterion validity between individuals with a diagnosis of OCD and those without, and convergent validity with the Yale-Brown Obsessive Compulsive Scale, and Obsessive-Compulsive Inventory-Revised. Additionally, using a LCA approach, the PTBC demonstrated a 3-class structure of the thoughts and the behaviors subscales. Overall, these results provide psychometric evidence that the PTBC is reliable and valid and can be used to assess the prevalence and severity of postpartum obsessions and compulsions.

Consistent with the cognitive-behavioral model of posttraumatic stress disorder (PTSD), research has found associations among posttraumatic cognitions, avoidance coping, and posttraumatic stress symptoms (PTSS). Less is known, however, about the occurrence of these relationships in the context of "armed and dangerous person" university lockdowns that affect campus communities at large. This cross-sectional study evaluated predictors of PTSS following two sequential lockdowns. In the aftermath of these lockdowns, campus community members (N = 287) completed self-report measures assessing posttraumatic cognitions, avoidance coping, and PTSS. Results indicated that posttraumatic cognitions involving negative views of oneself or the world (but not self-blame), avoidance coping, and physical proximity were positively associated with PTSS. These relationships remained robust after controlling for general distress and retrospectively reported peritraumatic fear. Findings are interpreted and discussed in light of conceptual models of PTSD and provide paths for early screening of those experiencing community-wide stressors, such as university lockdowns.

PURPOSE:Although many women experience obsessive-compulsive symptoms during the perinatal period, the Yale-Brown Obsessive Compulsive Scale (YBOCS) has not yet been psychometrically evaluated in this population. This study examined the internal consistency, convergent and divergent validity, and factor structure of the YBOCS among pregnant women. METHODS:256 Women who were 20 to 24 weeks pregnant completed the clinician-administered YBOCS and Mini International Neuropsychiatric Interview (MINI) along with a series of self-report questionnaires including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Obsessive-Compulsive Inventory-Revised (OCI-R). RESULTS:Internal consistency of the YBOCS was excellent, and there were strong inter-scale correlations between the YBOCS Total Score, YBOCS Obsessions and Compulsions Severity Scales. The YBOCS demonstrated good known-groups validity differentiating women with and without OCD. Convergent validity with the OCI-R was demonstrated while relations with divergent validity were more mixed. CONCLUSION:The YBOCS possesses strong psychometric properties in pregnant women.

Background: OCD symptoms are well documented in anorexia nervosa (AN) and to a lesser extent in bulimia nervosa (BN), yet remain virtually unstudied in binge-eating disorder (BED). Methods: In this cross-sectional observational study, 5927 participants with lifetime eating disorders (EDs) (i.e., past or current) were categorized into five groups based on their diagnostic histories: AN only (n = 2330), BN only (n = 740), BED only (n = 665), AN and another ED diagnosis (AN Mixed) (n = 1293), and BN and BED (BNBED) (n = 899). Obsessive-Compulsive Inventory-12 scores were compared across these groups and with OCD (n = 1040), anxiety-related disorders (ANX) (n = 423), and non-clinical community (NCC) (n = 1194) cohorts. Results: OCD symptoms were common among individuals with lifetime AN, BN, BED, and multiple EDs, with obsessing being the most prevalent dimension, followed by ordering, checking, and washing. The obsessing scale, which captures general intrusive thoughts rather than traditional OCD obsessions, was notably high. ED groups generally scored higher on the OCI-12 subscales than the ANX and NCC cohorts but lower than the OCD cohort, although ordering severity was higher in some ED groups. Positive correlations were found between ED symptoms and OCI-12 subscales, and gender-diverse individuals and men had greater OCD symptoms than women. Conclusions: Clinicians should be vigilant for OCD symptoms in individuals with AN, BN, and BED. These findings call for research on the mechanisms linking EDs and OCD symptoms and support integrated treatment approaches for both conditions.

Background Obsessive-Compulsive Disorder (OCD) is a prevalent and debilitating condition that is frequently under- or misdiagnosed in clinical practice, leading to significant delays between symptom onset and accurate diagnosis. To improve the diagnostic process for individuals with OCD, there is an urgent need for screening instruments that are both syndromally valid and reliable. Accordingly, the current study aims to evaluate the psychometric properties of the German version of the ultra-brief, four-item Obsessive-Compulsive Inventory (OCI-4). Methods The psychometric properties of the OCI-4 were investigated in a German-speaking sample composed of 102 participants with OCD, 69 participants with an anxiety-related disorder, and 248 non-clinical individuals. Results The OCI-4 showed good test-retest reliability, moderate-to-good construct validity, and good-to-excellent screening accuracy. Conclusions The results support that the German version of the OCI-4 is a valid and reliable screening tool for OCD symptoms with good-to-excellent psychometric properties. The OCI-4 could be established as a screening tool in various settings to identify those with likely OCD.

An updated edition of the popular guide to successfully assessing and treating adults with OCD - Compact and current overview of science and practice - Details the best treatment approaches - Includes downloadable tools for clinical use The new edition of this concise and popular guide delivers up-to-date, hands-on guidance on the assessment and treatment of obsessive-compulsive disorder (OCD), offering a framework for understanding and helping people with this complex and challenging condition. Written by leading experts in the field, this book unpacks the intricacies of diagnosing OCD and explores models that explain the onset, development, and persistence of the disorder as well as its various manifestations. Using case studies and examples throughout, the authors detail the most evidence-based therapeutic approaches, emphasizing two techniques that have proven most effective in clinical practice: exposure and response prevention. Methods such as optimizing inhibitory learning, using acceptance and commitment therapy, and techniques for working with couples and families affected by OCD are also integrated to address the disorder's core symptoms and collateral effects. Further sections explore multicultural issues, less common forms of OCD (e.g., relationship obsessions), and in-person vs. virtual treatment. Printable tools and worksheets in the appendices provide invaluable resources allowing for immediate use in practice. This is essential reading for clinical psychologists, therapists, psychiatrists, counselors, and students engaged in treating OCD.

While obsessive-compulsive disorder (OCD) is often responsive to treatments like serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP), many patients remain unresponsive or relapse after discontinuation. Intensive outpatient programs (IOPs) offer a solution for those needing more support than standard outpatient care, but not requiring the extensive supervision of residential treatment. The present effectiveness study evaluated the outcome of an IOP delivered to a large sample of adults and children with OCD in-person and via telehealth. Results indicated substantial symptom reduction (over 50%) in both formats. Greater baseline severity predicted greater improvement, but no other variables moderated the effects of treatment. These findings demonstrate the effectiveness of IOPs in providing substantial symptom relief for individuals with OCD in both in-person and telehealth formats. Implications for bridging the science-practice gap are discussed.

This longitudinal study examined whether specific cognitive patterns during pregnancy predict postpartum obsessive-compulsive (OC) symptoms. A diverse sample of 256 women was assessed at 20 weeks of pregnancy (Time 1), 6 weeks postpartum (Time 2; n = 233), and 6 months postpartum (Time 3; n = 231). At each point, participants completed interview and/or self-report measures of OC symptoms, psychological distress, and obsessive beliefs (i.e., cognitive patterns related to OC symptoms). Postpartum OC symptoms were common, reported by 87.1 % at Time 2 and 74.5 % at Time 3. Stronger prenatal obsessive beliefs during pregnancy predicted greater postpartum OC symptom severity and higher likelihood of an OCD diagnosis at Time 3, even after controlling for baseline OC symptoms and distress. Findings highlight the clinical importance of prenatal cognitive risk factors and support cognitive-behavioral models of postpartum OCD.