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Obsessive-Compulsive Disorder (OCD)

NICE CKS Obsessive-compulsive disorder. Last revised: Feb 2024.

Guidelines

Disclaimer: the author is aware of the existence of a NICE guideline however it was published in 2005, with no further revision or updates. Therefore, this article is mainly based on NICE CKS article on OCD which is last revised in 2024.

Referral for specialist assessment is indicated in:

Severe OCD
At risk of suicide or risk to life due to OCD symptoms
Severe self-neglect
Presence of a significant comorbidity (e.g. substance misuse, severe depression, anorexia nervosa, or schizophrenia)
Initial treatment has not led to an adequate response
<18 y/o

Management depends on the degree of functional impairment caused by OCD.

Offer low-intensity CBT, including exposure and response prevention (ERP)

Options include:

Individual CBT with ERP with self-help material
Individual CBT with ERP by phone
Group CBT with ERP

Offer either:

Intensive CBT including exposure and response prevention (ERP)

Drug treatment
- 1st line: SSRI
- 2nd line: clomipramine (esp. if there is previous good response to it)

SSRI counselling:

Symptoms may worsen in the first week
If <30 y/o → review the patient 1 week after starting the drug (due to risk of suicidal thinking and self-harm)
In OCD, benefits usually take at least 12 weeks to be noted
Continue treatment for at least 1 year
Advise the patient not to stop the medication themselves

Refer to secondary care

While awaiting assessment offer:

Intensive CBT including exposure and response prevention (ERP), and
Drug treatment
- 1st line: SSRI
- 2nd line: clomipramine (esp. if there is previous good response to it)

References

NICE CKS Obsessive-compulsive disorder

Author: Adams Lau
Reviewer:
Last edited: 25/07/25

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