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class="vector-toc-link" href="#Video_game_addiction"> <div class="vector-toc-text"> 1.5 Video game addiction </div> </a> <ul id="toc-Video_game_addiction-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pediatric_OCD" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pediatric_OCD"> <div class="vector-toc-text"> 1.6 Pediatric OCD </div> </a> <ul id="toc-Pediatric_OCD-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Associated_conditions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Associated_conditions"> <div class="vector-toc-text"> 1.7 Associated conditions </div> </a> <ul id="toc-Associated_conditions-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Causes" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Causes"> <div class="vector-toc-text"> 2 Causes </div> </a> <button aria-controls="toc-Causes-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Causes subsection </button> <ul id="toc-Causes-sublist" class="vector-toc-list"> <li id="toc-Drug-induced_OCD" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Drug-induced_OCD"> <div class="vector-toc-text"> 2.1 Drug-induced OCD </div> </a> <ul id="toc-Drug-induced_OCD-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Genetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genetics"> <div class="vector-toc-text"> 2.2 Genetics </div> </a> <ul id="toc-Genetics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Brain_structure_and_functioning" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Brain_structure_and_functioning"> <div class="vector-toc-text"> 2.3 Brain structure and functioning </div> </a> <ul id="toc-Brain_structure_and_functioning-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Autoimmune" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Autoimmune"> <div class="vector-toc-text"> 2.4 Autoimmune </div> </a> <ul id="toc-Autoimmune-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Environment" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Environment"> <div class="vector-toc-text"> 2.5 Environment </div> </a> <ul id="toc-Environment-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanisms" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Mechanisms"> <div class="vector-toc-text"> 3 Mechanisms </div> </a> <button aria-controls="toc-Mechanisms-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Mechanisms subsection </button> <ul id="toc-Mechanisms-sublist" class="vector-toc-list"> <li id="toc-Neuroimaging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neuroimaging"> <div class="vector-toc-text"> 3.1 Neuroimaging </div> </a> <ul id="toc-Neuroimaging-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cognitive_models" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cognitive_models"> <div class="vector-toc-text"> 3.2 Cognitive models </div> </a> <ul id="toc-Cognitive_models-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Neurobiological" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neurobiological"> <div class="vector-toc-text"> 3.3 Neurobiological </div> </a> <ul id="toc-Neurobiological-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 4 Diagnosis </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Diagnosis subsection </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Differential_diagnosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential_diagnosis"> <div class="vector-toc-text"> 4.1 Differential diagnosis </div> </a> <ul id="toc-Differential_diagnosis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> 5 Management </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Management subsection </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Therapy"> <div class="vector-toc-text"> 5.1 Therapy </div> </a> <ul id="toc-Therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication"> <div class="vector-toc-text"> 5.2 Medication </div> </a> <ul id="toc-Medication-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Procedures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Procedures"> <div class="vector-toc-text"> 5.3 Procedures </div> </a> <ul id="toc-Procedures-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Children" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Children"> <div class="vector-toc-text"> 5.4 Children </div> </a> <ul id="toc-Children-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> 6 Prognosis </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> 7 Epidemiology </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 8 History </div> </a> <button aria-controls="toc-History-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle History subsection </button> <ul id="toc-History-sublist" class="vector-toc-list"> <li id="toc-Notable_cases" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Notable_cases"> <div class="vector-toc-text"> 8.1 Notable cases </div> </a> <ul id="toc-Notable_cases-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> 9 Society and culture </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Society and culture subsection </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Art,_entertainment_and_media" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Art,_entertainment_and_media"> <div class="vector-toc-text"> 9.1 Art, entertainment and media </div> </a> <ul id="toc-Art,_entertainment_and_media-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> 10 Research </div> </a> <ul id="toc-Research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_animals" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Other_animals"> <div class="vector-toc-text"> 11 Other animals </div> </a> <ul id="toc-Other_animals-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Advocacy" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Advocacy"> <div class="vector-toc-text"> 12 Advocacy </div> </a> <ul id="toc-Advocacy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 13 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 14 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 15 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Obsessive–compulsive disorder</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 86 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-86" aria-hidden="true" > 86 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ace mw-list-item"><a href="https://ace.wikipedia.org/wiki/Gangguan_obsessive-compulsive_disorder_(OCD)" title="Gangguan obsessive-compulsive disorder (OCD) – Acehnese" lang="ace" hreflang="ace" data-title="Gangguan obsessive-compulsive disorder (OCD)" data-language-autonym="Acèh" data-language-local-name="Acehnese" class="interlanguage-link-target">Acèh</a></li><li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Obsessief-kompulsiewe_steuring" title="Obsessief-kompulsiewe steuring – Afrikaans" lang="af" hreflang="af" data-title="Obsessief-kompulsiewe steuring" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target">Afrikaans</a></li><li class="interlanguage-link interwiki-am mw-list-item"><a href="https://am.wikipedia.org/wiki/%E1%8A%A6%E1%89%A5%E1%88%B0%E1%88%B2%E1%89%AD-%E1%8A%AE%E1%88%9D%E1%8D%90%E1%88%8D%E1%88%B2%E1%89%AD_%E1%8B%B2%E1%88%B5%E1%8A%A6%E1%88%AD%E1%8B%B0%E1%88%AD" title="ኦብሰሲቭ-ኮምፐልሲቭ ዲስኦርደር – Amharic" lang="am" hreflang="am" data-title="ኦብሰሲቭ-ኮምፐልሲቭ ዲስኦርደር" data-language-autonym="አማርኛ" data-language-local-name="Amharic" class="interlanguage-link-target">አማርኛ</a></li><li class="interlanguage-link interwiki-ar badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://ar.wikipedia.org/wiki/%D8%A7%D8%B6%D8%B7%D8%B1%D8%A7%D8%A8_%D9%88%D8%B3%D9%88%D8%A7%D8%B3%D9%8A_%D9%82%D9%87%D8%B1%D9%8A" title="اضطراب وسواسي قهري – Arabic" lang="ar" hreflang="ar" data-title="اضطراب وسواسي قهري" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Obsessiv-kompulsiv_pozuntu" title="Obsessiv-kompulsiv pozuntu – Azerbaijani" lang="az" hreflang="az" data-title="Obsessiv-kompulsiv pozuntu" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target">Azərbaycanca</a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D8%B3%D8%A7%D8%B1%DB%8C%D8%B4%D8%A7%D9%86_%D8%AD%D8%A7%D9%84%D9%84%D8%A7%D8%B1_%D8%A8%D9%88%D8%B2%D9%88%DA%A9%D9%84%D9%88%D9%82" title="ساریشان حاللار بوزوکلوق – South Azerbaijani" lang="azb" hreflang="azb" data-title="ساریشان حاللار بوزوکلوق" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target">تۆرکجه</a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%86%E0%A6%AC%E0%A7%87%E0%A6%B6%E0%A6%BF%E0%A6%95_%E0%A6%85%E0%A6%A8%E0%A7%81%E0%A6%95%E0%A6%B0%E0%A7%8D%E0%A6%B7%E0%A7%80_%E0%A6%AC%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%A7%E0%A6%BF" title="আবেশিক অনুকর্ষী ব্যাধি – Bangla" lang="bn" hreflang="bn" data-title="আবেশিক অনুকর্ষী ব্যাধি" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target">বাংলা</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%9E%D0%B1%D1%81%D0%B5%D1%81%D0%B8%D0%B2%D0%BD%D0%BE-%D0%BA%D0%BE%D0%BC%D0%BF%D1%83%D0%BB%D1%81%D0%B8%D0%B2%D0%BD%D0%BE_%D1%80%D0%B0%D0%B7%D1%81%D1%82%D1%80%D0%BE%D0%B9%D1%81%D1%82%D0%B2%D0%BE" title="Обсесивно-компулсивно разстройство – Bulgarian" lang="bg" hreflang="bg" data-title="Обсесивно-компулсивно разстройство" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bar mw-list-item"><a href="https://bar.wikipedia.org/wiki/Zwaungsstearung" title="Zwaungsstearung – Bavarian" lang="bar" hreflang="bar" data-title="Zwaungsstearung" data-language-autonym="Boarisch" data-language-local-name="Bavarian" class="interlanguage-link-target">Boarisch</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Opsesivno-kompulzivni_poreme%C4%87aj" title="Opsesivno-kompulzivni poremećaj – Bosnian" lang="bs" hreflang="bs" data-title="Opsesivno-kompulzivni poremećaj" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Trastorn_obsessivocompulsiu" title="Trastorn obsessivocompulsiu – Catalan" lang="ca" hreflang="ca" data-title="Trastorn obsessivocompulsiu" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-ceb mw-list-item"><a href="https://ceb.wikipedia.org/wiki/Obsessive-compulsive_disorder" title="Obsessive-compulsive disorder – Cebuano" lang="ceb" hreflang="ceb" data-title="Obsessive-compulsive disorder" data-language-autonym="Cebuano" data-language-local-name="Cebuano" class="interlanguage-link-target">Cebuano</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Obsedantn%C4%9B-kompulzivn%C3%AD_porucha" title="Obsedantně-kompulzivní porucha – Czech" lang="cs" hreflang="cs" data-title="Obsedantně-kompulzivní porucha" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Anhwylder_Gorfodaeth_Obsesiynol" title="Anhwylder Gorfodaeth Obsesiynol – Welsh" lang="cy" hreflang="cy" data-title="Anhwylder Gorfodaeth Obsesiynol" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/OCD" title="OCD – Danish" lang="da" hreflang="da" data-title="OCD" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Zwangsst%C3%B6rung" title="Zwangsstörung – German" lang="de" hreflang="de" data-title="Zwangsstörung" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Obsessiiv-kompulsiivne_h%C3%A4ire" title="Obsessiiv-kompulsiivne häire – Estonian" lang="et" hreflang="et" data-title="Obsessiiv-kompulsiivne häire" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%99%CE%B4%CE%B5%CE%BF%CF%88%CF%85%CF%87%CE%B1%CE%BD%CE%B1%CE%B3%CE%BA%CE%B1%CF%83%CF%84%CE%B9%CE%BA%CE%AE_%CE%B4%CE%B9%CE%B1%CF%84%CE%B1%CF%81%CE%B1%CF%87%CE%AE" title="Ιδεοψυχαναγκαστική διαταραχή – Greek" lang="el" hreflang="el" data-title="Ιδεοψυχαναγκαστική διαταραχή" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Trastorno_obsesivo-compulsivo" title="Trastorno obsesivo-compulsivo – Spanish" lang="es" hreflang="es" data-title="Trastorno obsesivo-compulsivo" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Obseda-Kompulsia_Malsano" title="Obseda-Kompulsia Malsano – Esperanto" lang="eo" hreflang="eo" data-title="Obseda-Kompulsia Malsano" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Nahasmendu_obsesibo-konpultsibo" title="Nahasmendu obsesibo-konpultsibo – Basque" lang="eu" hreflang="eu" data-title="Nahasmendu obsesibo-konpultsibo" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%84_%D9%88%D8%B3%D9%88%D8%A7%D8%B3%DB%8C-%D8%AC%D8%A8%D8%B1%DB%8C" title="اختلال وسواسی-جبری – Persian" lang="fa" hreflang="fa" data-title="اختلال وسواسی-جبری" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Trouble_obsessionnel_compulsif" title="Trouble obsessionnel compulsif – French" lang="fr" hreflang="fr" data-title="Trouble obsessionnel compulsif" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Trastorno_obsesivo%E2%80%93compulsivo" title="Trastorno obsesivo–compulsivo – Galician" lang="gl" hreflang="gl" data-title="Trastorno obsesivo–compulsivo" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B0%95%EB%B0%95%EC%9E%A5%EC%95%A0" title="강박장애 – Korean" lang="ko" hreflang="ko" data-title="강박장애" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%95%D5%A2%D5%BD%D5%A5%D5%BD%D5%AB%D5%BE-%D5%AF%D5%B8%D5%B4%D5%BA%D5%B8%D6%82%D5%AC%D5%BD%D5%AB%D5%BE_%D5%AD%D5%A1%D5%B6%D5%A3%D5%A1%D6%80%D5%B8%D6%82%D5%B4" title="Օբսեսիվ-կոմպուլսիվ խանգարում – Armenian" lang="hy" hreflang="hy" data-title="Օբսեսիվ-կոմպուլսիվ խանգարում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%AE%E0%A4%A8%E0%A5%8B%E0%A4%97%E0%A5%8D%E0%A4%B0%E0%A4%B8%E0%A4%BF%E0%A4%A4-%E0%A4%AC%E0%A4%BE%E0%A4%A7%E0%A5%8D%E0%A4%AF%E0%A4%A4%E0%A4%BE_%E0%A4%B5%E0%A4%BF%E0%A4%95%E0%A4%BE%E0%A4%B0" title="मनोग्रसित-बाध्यता विकार – Hindi" lang="hi" hreflang="hi" data-title="मनोग्रसित-बाध्यता विकार" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Opsesivno-kompulzivni_poreme%C4%87aj" title="Opsesivno-kompulzivni poremećaj – Croatian" lang="hr" hreflang="hr" data-title="Opsesivno-kompulzivni poremećaj" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Gangguan_obsesif_kompulsif" title="Gangguan obsesif kompulsif – Indonesian" lang="id" hreflang="id" data-title="Gangguan obsesif kompulsif" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-xh mw-list-item"><a href="https://xh.wikipedia.org/wiki/Ubume_obungalunganga_obuphambanisayo" title="Ubume obungalunganga obuphambanisayo – Xhosa" lang="xh" hreflang="xh" data-title="Ubume obungalunganga obuphambanisayo" data-language-autonym="IsiXhosa" data-language-local-name="Xhosa" class="interlanguage-link-target">IsiXhosa</a></li><li class="interlanguage-link interwiki-zu mw-list-item"><a href="https://zu.wikipedia.org/wiki/I-Obsessive-compulsive_disorder" title="I-Obsessive-compulsive disorder – Zulu" lang="zu" hreflang="zu" data-title="I-Obsessive-compulsive disorder" data-language-autonym="IsiZulu" data-language-local-name="Zulu" class="interlanguage-link-target">IsiZulu</a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/%C3%81r%C3%A1ttu-%C3%BEr%C3%A1hyggjur%C3%B6skun" title="Áráttu-þráhyggjuröskun – Icelandic" lang="is" hreflang="is" data-title="Áráttu-þráhyggjuröskun" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target">Íslenska</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Disturbo_ossessivo-compulsivo" title="Disturbo ossessivo-compulsivo – Italian" lang="it" hreflang="it" data-title="Disturbo ossessivo-compulsivo" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%A4%D7%A8%D7%A2%D7%94_%D7%98%D7%95%D7%A8%D7%93%D7%A0%D7%99%D7%AA-%D7%9B%D7%A4%D7%99%D7%99%D7%AA%D7%99%D7%AA" title="הפרעה טורדנית-כפייתית – Hebrew" lang="he" hreflang="he" data-title="הפרעה טורדנית-כפייתית" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-jv mw-list-item"><a href="https://jv.wikipedia.org/wiki/Kelainan_obsesif-kompulsif" title="Kelainan obsesif-kompulsif – Javanese" lang="jv" hreflang="jv" data-title="Kelainan obsesif-kompulsif" data-language-autonym="Jawa" data-language-local-name="Javanese" class="interlanguage-link-target">Jawa</a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%97%E0%B3%80%E0%B2%B3%E0%B3%81_%E0%B2%AE%E0%B2%A8%E0%B3%8B%E0%B2%B0%E0%B3%8B%E0%B2%97" title="ಗೀಳು ಮನೋರೋಗ – Kannada" lang="kn" hreflang="kn" data-title="ಗೀಳು ಮನೋರೋಗ" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target">ಕನ್ನಡ</a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%90%E1%83%99%E1%83%95%E1%83%98%E1%83%90%E1%83%A2%E1%83%94%E1%83%91%E1%83%90" title="აკვიატება – Georgian" lang="ka" hreflang="ka" data-title="აკვიატება" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target">ქართული</a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%9E%D0%B1%D1%81%D0%B5%D1%81%D1%81%D0%B8%D0%B2%D1%82%D1%96%D0%BB%D1%96%D0%BA" title="Обсессивтілік – Kazakh" lang="kk" hreflang="kk" data-title="Обсессивтілік" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target">Қазақша</a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Tatizo_la_kutojizuia_kurudiarudia_tendo" title="Tatizo la kutojizuia kurudiarudia tendo – Swahili" lang="sw" hreflang="sw" data-title="Tatizo la kutojizuia kurudiarudia tendo" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target">Kiswahili</a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Obses%C4%ABvi_kompuls%C4%ABvie_trauc%C4%93jumi" title="Obsesīvi kompulsīvie traucējumi – Latvian" lang="lv" hreflang="lv" data-title="Obsesīvi kompulsīvie traucējumi" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target">Latviešu</a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Obsesinis_kompulsinis_sutrikimas" title="Obsesinis kompulsinis sutrikimas – Lithuanian" lang="lt" hreflang="lt" data-title="Obsesinis kompulsinis sutrikimas" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target">Lietuvių</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Obszessz%C3%ADv-kompulz%C3%ADv_zavar" title="Obszesszív-kompulzív zavar – Hungarian" lang="hu" hreflang="hu" data-title="Obszesszív-kompulzív zavar" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%9E%D0%BF%D1%81%D0%B5%D1%81%D0%B8%D0%B2%D0%BD%D0%BE-%D0%BA%D0%BE%D0%BC%D0%BF%D1%83%D0%BB%D1%81%D0%B8%D0%B2%D0%BD%D0%BE_%D1%80%D0%B0%D1%81%D1%82%D1%80%D0%BE%D1%98%D1%81%D1%82%D0%B2%D0%BE" title="Опсесивно-компулсивно растројство – Macedonian" lang="mk" hreflang="mk" data-title="Опсесивно-компулсивно растројство" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%92%E0%B4%AC%E0%B5%8D%E0%B4%B8%E0%B5%86%E0%B4%B8%E0%B5%8D%E0%B4%B8%E0%B4%BF%E0%B4%B5%E0%B5%8D_%E0%B4%95%E0%B4%82%E0%B4%AA%E0%B5%BE%E0%B4%B8%E0%B4%BF%E0%B4%B5%E0%B5%8D_%E0%B4%A1%E0%B4%BF%E0%B4%B8%E0%B5%8B%E0%B5%BC%E0%B4%A1%E0%B5%BC" title="ഒബ്സെസ്സിവ് കംപൾസിവ് ഡിസോർഡർ – Malayalam" lang="ml" hreflang="ml" data-title="ഒബ്സെസ്സിവ് കംപൾസിവ് ഡിസോർഡർ" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target">മലയാളം</a></li><li class="interlanguage-link interwiki-mt mw-list-item"><a href="https://mt.wikipedia.org/wiki/Disturb_obsessive-compulsive" title="Disturb obsessive-compulsive – Maltese" lang="mt" hreflang="mt" data-title="Disturb obsessive-compulsive" data-language-autonym="Malti" data-language-local-name="Maltese" class="interlanguage-link-target">Malti</a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%85%E0%A4%A4%E0%A5%8D%E0%A4%AF%E0%A4%BE%E0%A4%97%E0%A5%8D%E0%A4%B0%E0%A4%B9%E0%A5%80_%E0%A4%B5%E0%A4%BF%E0%A4%95%E0%A4%BE%E0%A4%B0" title="अत्याग्रही विकार – Marathi" lang="mr" hreflang="mr" data-title="अत्याग्रही विकार" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target">मराठी</a></li><li class="interlanguage-link interwiki-xmf mw-list-item"><a href="https://xmf.wikipedia.org/wiki/%E1%83%90%E1%83%A9%E1%83%94%E1%83%9B%E1%83%94%E1%83%91%E1%83%90" title="აჩემება – Mingrelian" lang="xmf" hreflang="xmf" data-title="აჩემება" data-language-autonym="მარგალური" data-language-local-name="Mingrelian" class="interlanguage-link-target">მარგალური</a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D9%88%D8%B3%D9%88%D8%A7%D8%B3_%D9%82%D9%87%D8%B1%D9%89" title="وسواس قهرى – Egyptian Arabic" lang="arz" hreflang="arz" data-title="وسواس قهرى" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target">مصرى</a></li><li class="interlanguage-link interwiki-mzn mw-list-item"><a href="https://mzn.wikipedia.org/wiki/%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%84_%D9%88%D8%B3%D9%88%D8%A7%D8%B3%DB%8C_%D8%AC%D8%A8%D8%B1%DB%8C" title="اختلال وسواسی جبری – Mazanderani" lang="mzn" hreflang="mzn" data-title="اختلال وسواسی جبری" data-language-autonym="مازِرونی" data-language-local-name="Mazanderani" class="interlanguage-link-target">مازِرونی</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Kecelaruan_obsesif_kompulsif" title="Kecelaruan obsesif kompulsif – Malay" lang="ms" hreflang="ms" data-title="Kecelaruan obsesif kompulsif" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-min mw-list-item"><a href="https://min.wikipedia.org/wiki/Gangguan_obsesif_kompulsif" title="Gangguan obsesif kompulsif – Minangkabau" lang="min" hreflang="min" data-title="Gangguan obsesif kompulsif" data-language-autonym="Minangkabau" data-language-local-name="Minangkabau" class="interlanguage-link-target">Minangkabau</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Obsessieve-compulsieve_stoornis" title="Obsessieve-compulsieve stoornis – Dutch" lang="nl" hreflang="nl" data-title="Obsessieve-compulsieve stoornis" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%BC%B7%E8%BF%AB%E6%80%A7%E9%9A%9C%E5%AE%B3" title="強迫性障害 – Japanese" lang="ja" hreflang="ja" data-title="強迫性障害" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Tvangslidelse" title="Tvangslidelse – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Tvangslidelse" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%85%E0%AC%AC%E0%AC%B8%E0%AD%87%E0%AC%B8%E0%AC%BF%E0%AC%AD-%E0%AC%95%E0%AC%AE%E0%AD%8D%E0%AC%AA%E0%AC%B2%E0%AC%B8%E0%AC%BF%E0%AC%AD_%E0%AC%A1%E0%AC%BF%E0%AC%9C%E0%AC%85%E0%AC%B0%E0%AD%8D%E0%AC%A1%E0%AC%BC%E0%AC%B0" title="ଅବସେସିଭ-କମ୍ପଲସିଭ ଡିଜଅର୍ଡ଼ର – Odia" lang="or" hreflang="or" data-title="ଅବସେସିଭ-କମ୍ପଲସିଭ ଡିଜଅର୍ଡ଼ର" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-ps mw-list-item"><a href="https://ps.wikipedia.org/wiki/%D8%B9%D8%B5%D8%A8%D9%8A%D8%8C_%D8%AC%D8%A8%D8%B1%D9%8A_%D8%B3%D9%88%DA%86%D9%88%D9%86%D9%87_OCD" title="عصبي، جبري سوچونه OCD – Pashto" lang="ps" hreflang="ps" data-title="عصبي، جبري سوچونه OCD" data-language-autonym="پښتو" data-language-local-name="Pashto" class="interlanguage-link-target">پښتو</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Zaburzenia_obsesyjno-kompulsyjne" title="Zaburzenia obsesyjno-kompulsyjne – Polish" lang="pl" hreflang="pl" data-title="Zaburzenia obsesyjno-kompulsyjne" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Transtorno_obsessivo-compulsivo" title="Transtorno obsessivo-compulsivo – Portuguese" lang="pt" hreflang="pt" data-title="Transtorno obsessivo-compulsivo" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-crh mw-list-item"><a href="https://crh.wikipedia.org/wiki/Obsessiv-kompulsiv_hastal%C4%B1q" title="Obsessiv-kompulsiv hastalıq – Crimean Tatar" lang="crh" hreflang="crh" data-title="Obsessiv-kompulsiv hastalıq" data-language-autonym="Qırımtatarca" data-language-local-name="Crimean Tatar" class="interlanguage-link-target">Qırımtatarca</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Tulburare_obsesiv-compulsiv%C4%83" title="Tulburare obsesiv-compulsivă – Romanian" lang="ro" hreflang="ro" data-title="Tulburare obsesiv-compulsivă" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9E%D0%B1%D1%81%D0%B5%D1%81%D1%81%D0%B8%D0%B2%D0%BD%D0%BE-%D0%BA%D0%BE%D0%BC%D0%BF%D1%83%D0%BB%D1%8C%D1%81%D0%B8%D0%B2%D0%BD%D0%BE%D0%B5_%D1%80%D0%B0%D1%81%D1%81%D1%82%D1%80%D0%BE%D0%B9%D1%81%D1%82%D0%B2%D0%BE" title="Обсессивно-компульсивное расстройство – Russian" lang="ru" hreflang="ru" data-title="Обсессивно-компульсивное расстройство" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sc mw-list-item"><a href="https://sc.wikipedia.org/wiki/Istrobu_Ossessivu-Compulsivu" title="Istrobu Ossessivu-Compulsivu – Sardinian" lang="sc" hreflang="sc" data-title="Istrobu Ossessivu-Compulsivu" data-language-autonym="Sardu" data-language-local-name="Sardinian" class="interlanguage-link-target">Sardu</a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/%C3%87rregulimi_obsesiv-kompulsiv" title="Çrregulimi obsesiv-kompulsiv – Albanian" lang="sq" hreflang="sq" data-title="Çrregulimi obsesiv-kompulsiv" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target">Shqip</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder" title="Obsessive–compulsive disorder – Simple English" lang="en-simple" hreflang="en-simple" data-title="Obsessive–compulsive disorder" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-ss mw-list-item"><a href="https://ss.wikipedia.org/wiki/Kutiphatsa_kabi_ngekutiphatsa" title="Kutiphatsa kabi ngekutiphatsa – Swati" lang="ss" hreflang="ss" data-title="Kutiphatsa kabi ngekutiphatsa" data-language-autonym="SiSwati" data-language-local-name="Swati" class="interlanguage-link-target">SiSwati</a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Obses%C3%ADvno-kompulz%C3%ADvna_porucha" title="Obsesívno-kompulzívna porucha – Slovak" lang="sk" hreflang="sk" data-title="Obsesívno-kompulzívna porucha" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target">Slovenčina</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Obsesivno-kompulzivna_motnja" title="Obsesivno-kompulzivna motnja – Slovenian" lang="sl" hreflang="sl" data-title="Obsesivno-kompulzivna motnja" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%9E%D0%BF%D1%81%D0%B5%D1%81%D0%B8%D0%B2%D0%BD%D0%BE-%D0%BA%D0%BE%D0%BC%D0%BF%D1%83%D0%BB%D0%B7%D0%B8%D0%B2%D0%BD%D0%B8_%D0%BF%D0%BE%D1%80%D0%B5%D0%BC%D0%B5%D1%9B%D0%B0%D1%98" title="Опсесивно-компулзивни поремећај – Serbian" lang="sr" hreflang="sr" data-title="Опсесивно-компулзивни поремећај" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Opsesivno-kompulzivni_poreme%C4%87aj" title="Opsesivno-kompulzivni poremećaj – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Opsesivno-kompulzivni poremećaj" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Pakko-oireinen_h%C3%A4iri%C3%B6" title="Pakko-oireinen häiriö – Finnish" lang="fi" hreflang="fi" data-title="Pakko-oireinen häiriö" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Tv%C3%A5ngssyndrom" title="Tvångssyndrom – Swedish" lang="sv" hreflang="sv" data-title="Tvångssyndrom" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder" title="Obsessive–compulsive disorder – Tagalog" lang="tl" hreflang="tl" data-title="Obsessive–compulsive disorder" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target">Tagalog</a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%AA%E0%AF%86%E0%AE%B0%E0%AF%81%E0%AE%B5%E0%AE%BF%E0%AE%B0%E0%AF%81%E0%AE%AA%E0%AF%8D%E0%AE%AA_%E0%AE%95%E0%AE%9F%E0%AF%8D%E0%AE%9F%E0%AE%BE%E0%AE%AF_%E0%AE%AE%E0%AE%A9%E0%AE%AA%E0%AF%8D%E0%AE%AA%E0%AE%BF%E0%AE%B1%E0%AE%B4%E0%AF%8D%E0%AE%B5%E0%AF%81" title="பெருவிருப்ப கட்டாய மனப்பிறழ்வு – Tamil" lang="ta" hreflang="ta" data-title="பெருவிருப்ப கட்டாய மனப்பிறழ்வு" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target">தமிழ்</a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%85%E0%B0%AC%E0%B1%8D%E0%B0%B8%E0%B1%86%E0%B0%B8%E0%B0%BF%E0%B0%B5%E0%B1%8D_%E0%B0%95%E0%B0%82%E0%B0%AA%E0%B0%B2%E0%B1%8D%E0%B0%B8%E0%B0%BF%E0%B0%B5%E0%B1%8D_%E0%B0%A1%E0%B0%BF%E0%B0%9C%E0%B0%BE%E0%B0%B0%E0%B1%8D%E0%B0%A1%E0%B0%B0%E0%B1%8D" title="అబ్సెసివ్ కంపల్సివ్ డిజార్డర్ – Telugu" lang="te" hreflang="te" data-title="అబ్సెసివ్ కంపల్సివ్ డిజార్డర్" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target">తెలుగు</a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%A2%E0%B9%89%E0%B8%B3%E0%B8%84%E0%B8%B4%E0%B8%94%E0%B8%A2%E0%B9%89%E0%B8%B3%E0%B8%97%E0%B8%B3" title="โรคย้ำคิดย้ำทำ – Thai" lang="th" hreflang="th" data-title="โรคย้ำคิดย้ำทำ" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-ti mw-list-item"><a href="https://ti.wikipedia.org/wiki/%E1%8B%8D%E1%8C%A5%E1%88%A8%E1%89%B5-%E1%8C%8D%E1%8B%B4%E1%89%B3%E1%8B%8A_%E1%8C%B8%E1%8C%88%E1%88%9D" title="ውጥረት-ግዴታዊ ጸገም – Tigrinya" lang="ti" hreflang="ti" data-title="ውጥረት-ግዴታዊ ጸገም" data-language-autonym="ትግርኛ" data-language-local-name="Tigrinya" class="interlanguage-link-target">ትግርኛ</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Obsesif_kompulsif_bozukluk" title="Obsesif kompulsif bozukluk – Turkish" lang="tr" hreflang="tr" data-title="Obsesif kompulsif bozukluk" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9E%D0%B1%D1%81%D0%B5%D1%81%D0%B8%D0%B2%D0%BD%D0%BE-%D0%BA%D0%BE%D0%BC%D0%BF%D1%83%D0%BB%D1%8C%D1%81%D0%B8%D0%B2%D0%BD%D0%B8%D0%B9_%D1%80%D0%BE%D0%B7%D0%BB%D0%B0%D0%B4" title="Обсесивно-компульсивний розлад – Ukrainian" lang="uk" hreflang="uk" data-title="Обсесивно-компульсивний розлад" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target">Українська</a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D9%88%D8%B3%D9%88%D8%A7%D8%B3%DB%8C_%D8%A7%D8%AC%D8%A8%D8%A7%D8%B1%DB%8C_%D8%A7%D8%B6%D8%B7%D8%B1%D8%A7%D8%A8" title="وسواسی اجباری اضطراب – Urdu" lang="ur" hreflang="ur" data-title="وسواسی اجباری اضطراب" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target">اردو</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/R%E1%BB%91i_lo%E1%BA%A1n_%C3%A1m_%E1%BA%A3nh_c%C6%B0%E1%BB%A1ng_ch%E1%BA%BF" title="Rối loạn ám ảnh cưỡng chế – Vietnamese" lang="vi" hreflang="vi" data-title="Rối loạn ám ảnh cưỡng chế" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li class="interlanguage-link interwiki-wa mw-list-item"><a href="https://wa.wikipedia.org/wiki/Marote_mal%C3%A5rdiveuse" title="Marote malårdiveuse – Walloon" lang="wa" hreflang="wa" data-title="Marote malårdiveuse" data-language-autonym="Walon" data-language-local-name="Walloon" class="interlanguage-link-target">Walon</a></li><li class="interlanguage-link interwiki-wo mw-list-item"><a href="https://wo.wikipedia.org/wiki/Feebaru_t%C3%ABlb%C3%ABti_bu_amul_app" title="Feebaru tëlbëti bu amul app – Wolof" lang="wo" hreflang="wo" data-title="Feebaru tëlbëti bu amul app" data-language-autonym="Wolof" data-language-local-name="Wolof" class="interlanguage-link-target">Wolof</a></li><li class="interlanguage-link interwiki-wuu mw-list-item"><a href="https://wuu.wikipedia.org/wiki/%E5%BC%BA%E8%BF%AB%E7%97%87" title="强迫症 – Wu" lang="wuu" hreflang="wuu" data-title="强迫症" data-language-autonym="吴语" data-language-local-name="Wu" class="interlanguage-link-target">吴语</a></li><li class="interlanguage-link interwiki-yi mw-list-item"><a href="https://yi.wikipedia.org/wiki/%D7%90%D7%91%D7%A1%D7%A2%D7%A1%D7%99%D7%95%D7%95_%D7%A7%D7%90%D7%9E%D7%A4%D7%90%D7%9C%D7%A1%D7%99%D7%95%D7%95_%D7%93%D7%99%D7%A1%D7%90%D7%A8%D7%93%D7%A2%D7%A8" title="אבסעסיוו קאמפאלסיוו דיסארדער – Yiddish" lang="yi" hreflang="yi" data-title="אבסעסיוו קאמפאלסיוו דיסארדער" data-language-autonym="ייִדיש" data-language-local-name="Yiddish" class="interlanguage-link-target">ייִדיש</a></li><li class="interlanguage-link interwiki-zh-yue mw-list-item"><a href="https://zh-yue.wikipedia.org/wiki/%E5%BC%B7%E8%BF%AB%E7%97%87" title="強迫症 – Cantonese" lang="yue" hreflang="yue" data-title="強迫症" data-language-autonym="粵語" data-language-local-name="Cantonese" class="interlanguage-link-target">粵語</a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E5%BC%BA%E8%BF%AB%E7%97%87" title="强迫症 – Chinese" lang="zh" 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decoding="async" width="20" height="20" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/1/1b/Semi-protection-shackle.svg/30px-Semi-protection-shackle.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/1/1b/Semi-protection-shackle.svg/40px-Semi-protection-shackle.svg.png 2x" data-file-width="512" data-file-height="512" /></a></div></div> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle">(Redirected from <a href="/w/index.php?title=Obsessive_compulsive_disorder&redirect=no" class="mw-redirect" title="Obsessive compulsive disorder">Obsessive compulsive disorder</a>)</div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Mental and behavioral disorder</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"OCD" redirects here. Not to be confused with <a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">Obsessive–compulsive personality disorder</a>. For other uses, see <a href="/wiki/OCD_(disambiguation)" class="mw-disambig" title="OCD (disambiguation)">OCD (disambiguation)</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Obsessive–compulsive disorder</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:OCD_handwash_(1).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/bf/OCD_handwash_%281%29.jpg/220px-OCD_handwash_%281%29.jpg" decoding="async" width="220" height="229" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/bf/OCD_handwash_%281%29.jpg/330px-OCD_handwash_%281%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/bf/OCD_handwash_%281%29.jpg/440px-OCD_handwash_%281%29.jpg 2x" data-file-width="1728" data-file-height="1800" /></a></td></tr><tr><td colspan="2" class="infobox-full-data">Frequent and excessive hand washing occurs in some people with OCD.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Feel the need to check things repeatedly, perform <a href="/wiki/Compulsive_behavior" title="Compulsive behavior">certain routines repeatedly</a>, have <a href="/wiki/Intrusive_thought" title="Intrusive thought">certain thoughts repeatedly</a><a href="#cite_note-NIH20152-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Tic_disorders" class="mw-redirect" title="Tic disorders">Tics</a>, <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorder</a>, <a href="/wiki/Suicide" title="Suicide">suicide</a><a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-Ang2015-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Before 35 years<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-DSM52-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><a href="/wiki/Genetics" title="Genetics">Genetics</a>, <a href="/wiki/Biology" title="Biology">biology</a>, <a href="/wiki/Temperament" title="Temperament">temperament</a>, <a href="/wiki/Child_abuse" title="Child abuse">childhood trauma</a><a href="#cite_note-NIH20152-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Clinically based on symptoms; Y-BOCS is the gold standard tool to assess severity<a href="#cite_note-DSM52-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety disorder</a>, <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>, <a href="/wiki/Eating_disorder" title="Eating disorder">eating disorders</a>, <a href="/wiki/Tic_disorder" title="Tic disorder">tic disorders</a>, <a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">obsessive–compulsive personality disorder</a><a href="#cite_note-DSM52-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Psychotherapy" title="Psychotherapy">Counseling</a>, <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitors</a>, <a href="/wiki/Clomipramine" title="Clomipramine">clomipramine</a><a href="#cite_note-NEJM2014-4">[4]</a><a href="#cite_note-Ve2014-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">2.3%<a href="#cite_note-Good2014-6">[6]</a></td></tr></tbody></table> Obsessive–compulsive disorder (OCD) is a <a href="/wiki/Mental_disorder" title="Mental disorder">mental</a> and <a href="/wiki/Abnormality_(behavior)" title="Abnormality (behavior)">behavioral</a> <a href="/wiki/Mental_disorder" title="Mental disorder">disorder</a> in which an individual has <a href="/wiki/Intrusive_thought" title="Intrusive thought">intrusive thoughts</a> (an obsession) and feels the need to perform certain routines (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-:14-7">[7]</a> Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of <a href="/wiki/Anxiety" title="Anxiety">anxiety</a>, <a href="/wiki/Disgust" title="Disgust">disgust</a>, or discomfort.<a href="#cite_note-:0-8">[8]</a> Some common obsessions include fear of <a href="/wiki/Contamination" title="Contamination">contamination</a>, obsession with <a href="/wiki/Symmetry" title="Symmetry">symmetry</a>, the fear of acting <a href="/wiki/Blasphemy" title="Blasphemy">blasphemously</a>, the sufferer's <a href="/wiki/Sexual_orientation" title="Sexual orientation">sexual orientation</a>, and the fear of possibly harming others or themselves.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-:4-9">[9]</a> Compulsions are repeated actions or routines that occur in response to obsessions to achieve a relief from anxiety. Common compulsions include excessive <a href="/wiki/Hand_washing" title="Hand washing">hand washing</a>, <a href="/wiki/Cleaning" title="Cleaning">cleaning</a>, <a href="/wiki/Counting" title="Counting">counting</a>, ordering, repeating, avoiding triggers, <a href="/wiki/Hoarding" title="Hoarding">hoarding</a>, neutralizing, seeking assurance, praying, and checking things.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-:4-9">[9]</a><a href="#cite_note-10">[10]</a> People with OCD may only perform mental compulsions such as needing to know or remember things. While this is sometimes referred to as <a href="/wiki/Primarily_obsessional_obsessive%E2%80%93compulsive_disorder" title="Primarily obsessional obsessive–compulsive disorder">primarily obsessional obsessive–compulsive disorder</a> (Pure O), it is also considered a misnomer due to associated mental compulsions and reassurance seeking behaviors that are consistent with OCD.<a href="#cite_note-11">[11]</a> Compulsions occur often and typically take up at least one hour per day, impairing one's quality of life.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-:4-9">[9]</a> Compulsions cause relief in the moment, but cause obsessions to grow over time due to the repeated reward-seeking behavior of completing the ritual for relief. Many adults with OCD are aware that their compulsions do not make sense, but they still perform them to relieve the distress caused by obsessions.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-:0-8">[8]</a><a href="#cite_note-:4-9">[9]</a><a href="#cite_note-:3-12">[12]</a> For this reason, thoughts and behaviors in OCD are usually considered <a href="/wiki/Egosyntonic_and_egodystonic" title="Egosyntonic and egodystonic">egodystonic</a>. In contrast, thoughts and behaviors in <a href="/wiki/Obsessive-compulsive_personality_disorder" class="mw-redirect" title="Obsessive-compulsive personality disorder">obsessive–compulsive personality disorder</a> (OCPD) are usually considered <a href="/wiki/Egosyntonic_and_egodystonic" title="Egosyntonic and egodystonic">egosyntonic</a>, helping differentiate between the two.<a href="#cite_note-The_role_of_personality_disorders_i-13">[13]</a> Although the exact cause of OCD is unknown, several regions of the brain have been implicated in its neuroanatomical model including the <a href="/wiki/Anterior_cingulate_cortex" title="Anterior cingulate cortex">anterior cingulate cortex</a>, <a href="/wiki/Orbitofrontal_cortex" title="Orbitofrontal cortex">orbitofrontal cortex</a>, <a href="/wiki/Amygdala" title="Amygdala">amygdala</a>, and <a href="/wiki/BNST" class="mw-redirect" title="BNST">BNST</a>.<a href="#cite_note-14">[14]</a><a href="#cite_note-NIH20152-1">[1]</a> The presence of a <a href="/wiki/Genetics" title="Genetics">genetic</a> component is evidenced by the increased likelihood for both <a href="/wiki/Identical_twins" class="mw-redirect" title="Identical twins">identical twins</a> to be affected than both <a href="/wiki/Fraternal_Twins" class="mw-redirect" title="Fraternal Twins">fraternal twins</a>.<a href="#cite_note-15">[15]</a> Risk factors include a history of <a href="/wiki/Child_abuse" title="Child abuse">child abuse</a> or other <a href="/wiki/Stress_(psychological)" class="mw-redirect" title="Stress (psychological)">stress</a>-inducing events such as during the postpartum period or after <a href="/wiki/Streptococcal_infections" class="mw-redirect" title="Streptococcal infections">streptococcal infections</a>.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-Symptoms_of_Obsessive-Compulsive_Di-16">[16]</a> Diagnosis is based on clinical presentation and requires ruling out other drug-related or medical causes; rating scales such as the <a href="/wiki/Yale%E2%80%93Brown_Obsessive%E2%80%93Compulsive_Scale" title="Yale–Brown Obsessive–Compulsive Scale">Yale–Brown Obsessive–Compulsive Scale</a> (Y-BOCS) assess severity.<a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-Fenske_2009-17">[17]</a> Other disorders with similar symptoms include <a href="/wiki/Generalized_anxiety_disorder" title="Generalized anxiety disorder">generalized anxiety disorder</a>, <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>, <a href="/wiki/Eating_disorder" title="Eating disorder">eating disorders</a>, <a href="/wiki/Tic_disorder" title="Tic disorder">tic disorders</a>, <a href="/wiki/Body-focused_repetitive_behavior" title="Body-focused repetitive behavior">body-focused repetitive behavior</a>, and <a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">obsessive–compulsive personality disorder</a>.<a href="#cite_note-DSM52-2">[2]</a> Personality disorders are a common comorbidity, with schizotypal and OCPD having poor treatment response.<a href="#cite_note-The_role_of_personality_disorders_i-13">[13]</a> The condition is also associated with a general increase in <a href="/wiki/Suicide" title="Suicide">suicidality</a>.<a href="#cite_note-Ang2015-3">[3]</a><a href="#cite_note-18">[18]</a><a href="#cite_note-19">[19]</a> The phrase obsessive–compulsive is sometimes used in an informal manner unrelated to OCD to describe someone as excessively meticulous, <a href="/wiki/Perfectionism_(psychology)" title="Perfectionism (psychology)">perfectionistic</a>, absorbed, or otherwise fixated.<a href="#cite_note-:5-20">[20]</a> However, the actual disorder can vary in presentation, and individuals with OCD may not be concerned with cleanliness or symmetry. OCD is chronic and long-lasting with periods of severe symptoms followed by periods of improvement.<a href="#cite_note-:10-21">[21]</a><a href="#cite_note-22">[22]</a> Treatment can improve ability to function and quality of life, and is usually reflected by improved <a href="/wiki/Y-BOCS" class="mw-redirect" title="Y-BOCS">Y-BOCS</a> scores.<a href="#cite_note-23">[23]</a> Treatment for OCD may involve <a href="/wiki/Psychotherapy" title="Psychotherapy">psychotherapy</a>, <a href="/wiki/Pharmacotherapy" title="Pharmacotherapy">pharmacotherapy</a> such as <a href="/wiki/Antidepressant" title="Antidepressant">antidepressants</a>, or <a href="/wiki/Surgery" title="Surgery">surgical</a> procedures such as <a href="/wiki/Deep_brain_stimulation" title="Deep brain stimulation">deep brain stimulation</a> or, in extreme cases, <a href="/wiki/Psychosurgery" title="Psychosurgery">psychosurgery</a>.<a href="#cite_note-NEJM2014-4">[4]</a><a href="#cite_note-Ve2014-5">[5]</a><a href="#cite_note-:6-24">[24]</a><a href="#cite_note-25">[25]</a> Psychotherapies derived from <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> (CBT) models, such as <a href="/wiki/Exposure_and_response_prevention" class="mw-redirect" title="Exposure and response prevention">exposure and response prevention</a>, <a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">acceptance and commitment therapy</a>, and <a href="/wiki/Inference-based_therapy" title="Inference-based therapy">inference based-therapy</a>, are more effective than non-CBT interventions.<a href="#cite_note-:17-26">[26]</a> <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">Selective serotonin reuptake inhibitors</a> (SSRIs) are more effective when used in excess of the recommended depression dosage; however, higher doses can increase side effect intensity.<a href="#cite_note-:7-27">[27]</a> Commonly used SSRIs include <a href="/wiki/Sertraline" title="Sertraline">sertraline</a>, <a href="/wiki/Fluoxetine" title="Fluoxetine">fluoxetine</a>, <a href="/wiki/Fluvoxamine" title="Fluvoxamine">fluvoxamine</a>, <a href="/wiki/Paroxetine" title="Paroxetine">paroxetine</a>, <a href="/wiki/Citalopram" title="Citalopram">citalopram</a>, and <a href="/wiki/Escitalopram" title="Escitalopram">escitalopram</a>.<a href="#cite_note-:6-24">[24]</a> Some patients fail to improve after taking the maximum tolerated dose of multiple SSRIs for at least two months; these cases qualify as treatment-resistant and can require second-line treatment such as <a href="/wiki/Clomipramine" title="Clomipramine">clomipramine</a> or <a href="/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">atypical antipsychotic</a> augmentation.<a href="#cite_note-NEJM2014-4">[4]</a><a href="#cite_note-Ve2014-5">[5]</a><a href="#cite_note-:7-27">[27]</a><a href="#cite_note-Dec2010-28">[28]</a> While SSRIs continue to be first-line, recent data for treatment-resistant OCD supports adjunctive use of neuroleptic medications, deep brain stimulation, and neurosurgical ablation.<a href="#cite_note-29">[29]</a> There is growing evidence to support the use of <a href="/wiki/Deep_brain_stimulation" title="Deep brain stimulation">deep brain stimulation</a> and repetitive <a href="/wiki/Repetitive_transcranial_magnetic_stimulation" class="mw-redirect" title="Repetitive transcranial magnetic stimulation">transcranial magnetic stimulation</a> for treatment-resistant OCD.<a href="#cite_note-30">[30]</a><a href="#cite_note-31">[31]</a> Obsessive–compulsive disorder affects about 2.3% of people at some point in their lives, while rates during any given year are about 1.2%.<a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-Good2014-6">[6]</a> More than three million Americans suffer from OCD.<a href="#cite_note-32">[32]</a> According to <a href="/wiki/Mercy_(healthcare_organization)" title="Mercy (healthcare organization)">Mercy</a>, approximately 1 in 40 U.S. adults and 1 in 100 U.S. children have OCD.<a href="#cite_note-33">[33]</a> Although possible at times with triggers such as <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>, onset rarely occurs after age 35, and about 50% of patients experience detrimental effects to daily life before age 20.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-Symptoms_of_Obsessive-Compulsive_Di-16">[16]</a><a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-34">[34]</a> While OCD occurs worldwide,<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-DSM52-2">[2]</a> a recent meta-analysis showed that women are 1.6 times more likely to experience OCD.<a href="#cite_note-Women_Are_at_Greater_Risk_of_OCD_Th-35">[35]</a> Based on data from 34 studies, the worldwide prevalence rate is 1.5% in women and 1% in men.<a href="#cite_note-Women_Are_at_Greater_Risk_of_OCD_Th-35">[35]</a> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2></div> OCD can present with a wide variety of symptoms. Certain groups of symptoms usually occur together as dimensions or clusters, which may reflect an underlying process. The standard assessment tool for OCD, the <a href="/wiki/Yale%E2%80%93Brown_Obsessive_Compulsive_Scale" class="mw-redirect" title="Yale–Brown Obsessive Compulsive Scale">Yale–Brown Obsessive Compulsive Scale</a> (Y-BOCS), has 13 predefined categories of symptoms. These symptoms fit into three to five groupings.<a href="#cite_note-Leckman-36">[36]</a> A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analytic</a> review of symptom structures found a four-factor grouping structure to be most reliable: symmetry factor, forbidden thoughts factor, cleaning factor, and hoarding factor. The symmetry factor correlates highly with obsessions related to ordering, counting, and symmetry, as well as repeating compulsions. The forbidden thoughts factor correlates highly with intrusive thoughts of a violent, religious, or sexual nature. The cleaning factor correlates highly with obsessions about contamination and compulsions related to cleaning. The hoarding factor only involves hoarding-related obsessions and compulsions, and was identified as being distinct from other symptom groupings.<a href="#cite_note-37">[37]</a> When looking into the onset of OCD, one study suggests that there are differences in the age of onset between males and females, with the average age of onset of OCD being 9.6 for male children and 11.0 for female children.<a href="#cite_note-Obsessive-Compulsive_Disorder_in_Ch-38">[38]</a> Children with OCD often have other mental disorders, such as ADHD, depression, anxiety, and disruptive behavior disorder. Continually, children are more likely to struggle in school and experience difficulties in social situations (Lack 2012). When looking at both adults and children a study found the average ages of onset to be 21 and 24 for males and females respectively.<a href="#cite_note-39">[39]</a> While some studies have shown that OCD with earlier onset is associated with greater severity, other studies have not been able to validate this finding.<a href="#cite_note-40">[40]</a> Looking at women specifically, a different study suggested that 62% of participants found that their symptoms worsened at a premenstrual age. Across the board, all demographics and studies showed a mean age of onset of less than 25.<a href="#cite_note-:16-41">[41]</a> Some OCD subtypes have been associated with improvement in performance on certain tasks, such as <a href="/wiki/Pattern_recognition_(psychology)" title="Pattern recognition (psychology)">pattern recognition</a> (washing subtype) and <a href="/wiki/Spatial_working_memory" class="mw-redirect" title="Spatial working memory">spatial working memory</a> (obsessive thought subtype). Subgroups have also been distinguished by <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a> findings and treatment response, though neuroimaging studies have not been comprehensive enough to draw conclusions. Subtype-dependent treatment response has been studied, and the hoarding subtype has consistently been least responsive to treatment.<a href="#cite_note-42">[42]</a> While OCD is considered a <a href="/wiki/Homogeneous" class="mw-redirect" title="Homogeneous">homogeneous</a> disorder from a <a href="/wiki/Neuropsychology" title="Neuropsychology">neuropsychological</a> perspective, many of the symptoms may be the result of <a href="/wiki/Comorbidity" title="Comorbidity">comorbid</a> disorders. For example, adults with OCD have exhibited more symptoms of <a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">attention deficit hyperactivity disorder</a> (ADHD) and <a href="/wiki/Autism_spectrum" class="mw-redirect" title="Autism spectrum">autism spectrum disorder</a> (ASD) than adults without OCD.<a href="#cite_note-43">[43]</a> In regards to the cause of onset, researchers asked participants in one study<a href="#cite_note-:16-41">[41]</a> what they felt was responsible for triggering the initial onset of their illness. 29% of patients answered that there was an environmental factor in their life that did so. Specifically, the majority of participants who answered with that noted their environmental factor to be related to an increased responsibility. <div class="mw-heading mw-heading3"><h3 id="Obsessions">Obsessions</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Intrusive_thought" title="Intrusive thought">Intrusive thought</a></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Primarily_obsessional_obsessive%E2%80%93compulsive_disorder" title="Primarily obsessional obsessive–compulsive disorder">Primarily obsessional obsessive–compulsive disorder</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Hortus_Deliciarum_-_Hell.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Hortus_Deliciarum_-_Hell.jpg/220px-Hortus_Deliciarum_-_Hell.jpg" decoding="async" width="220" height="281" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Hortus_Deliciarum_-_Hell.jpg/330px-Hortus_Deliciarum_-_Hell.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Hortus_Deliciarum_-_Hell.jpg/440px-Hortus_Deliciarum_-_Hell.jpg 2x" data-file-width="1370" data-file-height="1749" /></a><figcaption>People with OCD may face intrusive thoughts, such as thoughts about the <a href="/wiki/Devil" title="Devil">devil</a> (shown is a painted interpretation of <a href="/wiki/Hell" title="Hell">Hell</a>).</figcaption></figure> Obsessions are stress-inducing thoughts that recur and persist, despite efforts to ignore or confront them.<a href="#cite_note-Review10-44">[44]</a> People with OCD frequently perform tasks, or <a href="/wiki/Compulsive_behavior" title="Compulsive behavior">compulsions</a>, to seek relief from obsession-related anxiety. Within and among individuals, initial obsessions vary in clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension, accompanied by a belief that life cannot proceed as normal while the imbalance remains. A more intense obsession could be a preoccupation with the thought or image of a close family member or friend dying, or intrusive thoughts related to <a href="/wiki/Relationship_obsessive%E2%80%93compulsive_disorder" title="Relationship obsessive–compulsive disorder">relationship rightness</a>.<a href="#cite_note-Doron2013-45">[45]</a><a href="#cite_note-46">[46]</a> Other obsessions concern the possibility that someone or something other than oneself—such as <a href="/wiki/God" title="God">God</a>, the <a href="/wiki/Devil" title="Devil">devil</a>, or <a href="/wiki/Disease" title="Disease">disease</a>—will harm either the patient or the people or things the patient cares about. Others with OCD may experience the sensation of invisible protrusions emanating from their bodies, or feel that <a href="/wiki/Animism" title="Animism">inanimate objects are ensouled</a>.<a href="#cite_note-Mash-47">[47]</a> Another common obsession is <a href="/wiki/Scrupulosity" title="Scrupulosity">scrupulosity</a>, the pathological guilt/anxiety about moral or religious issues. In scrupulosity, a person's obsessions focus on moral or religious fears, such as the fear of being an evil person or the fear of divine retribution for sin.<a href="#cite_note-48">[48]</a><a href="#cite_note-Huppert-49">[49]</a> <a href="/wiki/Mysophobia" title="Mysophobia">Mysophobia</a>, a <a href="/wiki/Pathological_fear" class="mw-redirect" title="Pathological fear">pathological fear</a> of contamination and <a href="/wiki/Microorganism" title="Microorganism">germs</a>, is another common obsession theme.<a href="#cite_note-:03-50">[50]</a><a href="#cite_note-51">[51]</a> Some people with OCD experience <a href="/wiki/Sexual_obsessions" title="Sexual obsessions">sexual obsessions</a> that may involve intrusive thoughts or images of "kissing, touching, fondling, <a href="/wiki/Oral_sex" title="Oral sex">oral sex</a>, <a href="/wiki/Anal_sex" title="Anal sex">anal sex</a>, <a href="/wiki/Sexual_intercourse" title="Sexual intercourse">intercourse</a>, <a href="/wiki/Incest" title="Incest">incest</a>, and <a href="/wiki/Rape" title="Rape">rape</a>" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals, and religious figures", and can include <a href="/wiki/Heterosexuality" title="Heterosexuality">heterosexual</a> or <a href="/wiki/Homosexuality" title="Homosexuality">homosexual</a> contact with people of any age.<a href="#cite_note-Osgood-52">[52]</a> Similar to other intrusive thoughts or images, some disquieting sexual thoughts are normal at times, but people with OCD may attach extraordinary significance to such thoughts. For example, obsessive fears about <a href="/wiki/Sexual_orientation" title="Sexual orientation">sexual orientation</a> can appear to the affected individual, and even to those around them, as a crisis of <a href="/wiki/Sexual_identity" title="Sexual identity">sexual identity</a>.<a href="#cite_note-hocd-53">[53]</a><a href="#cite_note-so-ocd-54">[54]</a> Furthermore, the doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or self-loathing.<a href="#cite_note-Osgood-52">[52]</a> Most people with OCD understand that their thoughts do not correspond with reality; however, they feel that they must act as though these ideas are correct or realistic. For example, someone who engages in <a href="/wiki/Compulsive_hoarding" class="mw-redirect" title="Compulsive hoarding">compulsive hoarding</a> might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, despite accepting that such behavior is irrational on an intellectual level. There is debate as to whether hoarding should be considered an independent syndrome from OCD.<a href="#cite_note-55">[55]</a> <div class="mw-heading mw-heading3"><h3 id="Compulsions">Compulsions</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Compulsive_behavior" title="Compulsive behavior">Compulsive behavior</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Derma_me.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fb/Derma_me.JPG/300px-Derma_me.JPG" decoding="async" width="300" height="232" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fb/Derma_me.JPG/450px-Derma_me.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fb/Derma_me.JPG/600px-Derma_me.JPG 2x" data-file-width="3349" data-file-height="2592" /></a><figcaption>A person exhibiting <a href="/wiki/Excoriation_disorder" title="Excoriation disorder">skin-picking disorder</a></figcaption></figure> Some people with OCD perform compulsive rituals because they inexplicably feel that they must do so, while others act compulsively to mitigate the anxiety that stems from obsessive thoughts. The affected individual might feel that these actions will either prevent a dreaded event from occurring, or push the event from their thoughts. In any case, their reasoning is so <a href="/wiki/Idiosyncrasy" title="Idiosyncrasy">idiosyncratic</a> or distorted that it results in significant distress, either personally, or for those around the affected individual. Excessive <a href="/wiki/Excoriation_disorder" title="Excoriation disorder">skin picking</a>, <a href="/wiki/Trichotillomania" title="Trichotillomania">hair pulling</a>, <a href="/wiki/Nail_biting" title="Nail biting">nail biting</a>, and other body-focused repetitive behavior disorders are all on the <a href="/wiki/Obsessive%E2%80%93compulsive_spectrum" title="Obsessive–compulsive spectrum">obsessive–compulsive spectrum</a>.<a href="#cite_note-DSM52-2">[2]</a> Some individuals with OCD are aware that their behaviors are not rational, but they feel compelled to follow through with them to fend off feelings of panic or dread.<a href="#cite_note-56">[56]</a> Furthermore, compulsions often stem from <a href="/wiki/Memory_distrust_syndrome" title="Memory distrust syndrome">memory distrust</a>, a symptom of OCD characterized by insecurity in one's skills in <a href="/wiki/Perception" title="Perception">perception</a>, <a href="/wiki/Attention" title="Attention">attention</a>, and <a href="/wiki/Memory" title="Memory">memory</a>, even in cases where there is no clear evidence of a deficit.<a href="#cite_note-57">[57]</a> Common compulsions may include hand washing, cleaning, checking things (such as locks on doors), repeating actions (such as repeatedly turning on and off switches), ordering items in a certain way, and requesting reassurance.<a href="#cite_note-58">[58]</a><a href="#cite_note-59">[59]</a> Although some individuals perform actions repeatedly, they do not necessarily perform these actions compulsively; for example, morning or nighttime routines and religious practices are not usually compulsions. Whether behaviors qualify as compulsions or mere habit depends on the context in which they are performed. For instance, arranging and ordering books for eight hours a day would be expected of someone who works in a library, but this routine would seem abnormal in other situations. In other words, habits tend to bring efficiency to one's life, while compulsions tend to disrupt it.<a href="#cite_note-60">[60]</a> Furthermore, compulsions are different from <a href="/wiki/Tics" class="mw-redirect" title="Tics">tics</a> (such as touching, tapping, rubbing, or blinking) and <a href="/wiki/Stereotypic_movement_disorder" title="Stereotypic movement disorder">stereotyped movements</a> (such as head banging, body rocking, or self-biting), which are usually not as complex and not precipitated by obsessions.<a href="#cite_note-61">[61]</a> It can sometimes be difficult to tell the difference between compulsions and complex tics, and about 10–40% of people with OCD also have a lifetime tic disorder.<a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-62">[62]</a> People with OCD rely on compulsions as an escape from their obsessive thoughts; however, they are aware that relief is only temporary, and that intrusive thoughts will return. Some affected individuals use compulsions to avoid situations that may trigger obsessions. Compulsions may be actions directly related to the obsession, such as someone obsessed with contamination compulsively washing their hands, but they can be unrelated as well.<a href="#cite_note-:4-9">[9]</a> In addition to experiencing the anxiety and fear that typically accompanies OCD, affected individuals may spend hours performing compulsions every day. In such situations, it can become difficult for the person to fulfill their work, familial, or social roles. These behaviors can also cause adverse physical symptoms; for example, people who obsessively wash their hands with <a href="/wiki/Antibacterial_soap" title="Antibacterial soap">antibacterial soap</a> and hot water can make their skin red and raw with <a href="/wiki/Dermatitis" title="Dermatitis">dermatitis</a>.<a href="#cite_note-63">[63]</a> Individuals with OCD often use <a href="/wiki/Rationalization_(psychology)" title="Rationalization (psychology)">rationalizations</a> to explain their behavior; however, these rationalizations do not apply to the behavioral pattern, but to each individual occurrence. For example, someone compulsively checking the front door may argue that the time and stress associated with one check is less than the time and stress associated with being robbed, and checking is consequently the better option. This reasoning often occurs in a cyclical manner, and can continue for as long as the affected person needs it to in order to feel safe.<a href="#cite_note-64">[64]</a> In <a href="/wiki/Cognitive_Behavioral_Therapy" class="mw-redirect" title="Cognitive Behavioral Therapy">cognitive behavioral therapy</a> (CBT), OCD patients are asked to overcome intrusive thoughts by not indulging in any compulsions. They are taught that rituals keep OCD strong, while not performing them causes OCD to become weaker.<a href="#cite_note-65">[65]</a> This position is supported by the pattern of memory distrust; the more often compulsions are repeated, the more weakened memory trust becomes, and this cycle continues as memory distrust increases compulsion frequency.<a href="#cite_note-66">[66]</a> For <a href="/wiki/Body-focused_repetitive_behavior" title="Body-focused repetitive behavior">body-focused repetitive behaviors</a> (BFRB) such as <a href="/wiki/Trichotillomania" title="Trichotillomania">trichotillomania</a> (hair pulling), <a href="/wiki/Excoriation_disorder" title="Excoriation disorder">skin picking</a>, and <a href="/wiki/Nail_biting" title="Nail biting">onychophagia</a> (nail biting), behavioral interventions such as <a href="/wiki/Habit_reversal_training" title="Habit reversal training">habit reversal training</a> and <a href="/wiki/Decoupling_for_body-focused_repetitive_behaviors" title="Decoupling for body-focused repetitive behaviors">decoupling</a> are recommended for the treatment of compulsive behaviors.<a href="#cite_note-:1-67">[67]</a><a href="#cite_note-:2-68">[68]</a> OCD sometimes manifests without overt compulsions, which may be termed "primarily obsessional OCD." OCD without overt compulsions could, by one estimate, characterize as many as 50–60% of OCD cases.<a href="#cite_note-69">[69]</a> <div class="mw-heading mw-heading3"><h3 id="Insight_and_overvalued_ideation">Insight and overvalued ideation</h3></div> The <a href="/wiki/DSM-5" title="DSM-5">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM-5), identifies a continuum for the level of insight in OCD, ranging from good insight (the least severe) to no insight (the most severe). Good or fair insight is characterized by the acknowledgment that obsessive–compulsive beliefs are not or may not be true, while poor insight, in the middle of the continuum, is characterized by the belief that obsessive–compulsive beliefs are probably true. The absence of insight altogether, in which the individual is completely convinced that their beliefs are true, is also identified as a <a href="/wiki/Delusion" title="Delusion">delusional</a> thought pattern, and occurs in about 4% of people with OCD.<a href="#cite_note-70">[70]</a><a href="#cite_note-Sadock-71">[71]</a> When cases of OCD with no insight become severe, affected individuals have an unshakable belief in the reality of their delusions, which can make their cases difficult to differentiate from <a href="/wiki/Psychosis" title="Psychosis">psychotic disorders</a>.<a href="#cite_note-pmid10755077-72">[72]</a> Some people with OCD exhibit what is known as overvalued ideas, ideas that are abnormal compared to affected individuals' respective cultures, and more treatment-resistant than most negative thoughts and obsessions.<a href="#cite_note-:8-73">[73]</a> After some discussion, it is possible to convince the individual that their fears are unfounded. It may be more difficult to practice <a href="/wiki/Exposure_therapy#Obsessive_compulsive_disorder" title="Exposure therapy">exposure and response prevention therapy</a> (ERP) on such people, as they may be unwilling to cooperate, at least initially.<a href="#cite_note-74">[74]</a> Similar to how insight is identified on a continuum, obsessive-compulsive beliefs are characterized on a spectrum, ranging from obsessive doubt to delusional conviction. In the <a href="/wiki/United_States" title="United States">United States</a>, overvalued ideation (OVI) is considered most akin to poor insight—especially when considering belief strength as one of an idea's key identifiers.<a href="#cite_note-75">[75]</a> Furthermore, severe and frequent overvalued ideas are considered similar to idealized values, which are so rigidly held by, and so important to affected individuals, that they end up becoming a defining identity.<a href="#cite_note-:8-73">[73]</a> In adolescent OCD patients, OVI is considered a severe symptom.<a href="#cite_note-:9-76">[76]</a> Historically, OVI has been thought to be linked to poorer treatment outcome in patients with OCD, but it is currently considered a poor indicator of prognosis.<a href="#cite_note-:9-76">[76]</a><a href="#cite_note-77">[77]</a> The Overvalued Ideas Scale (OVIS) has been developed as a reliable quantitative method of measuring levels of OVI in patients with OCD, and research has suggested that overvalued ideas are more stable for those with more extreme OVIS scores.<a href="#cite_note-78">[78]</a> <div class="mw-heading mw-heading3"><h3 id="Cognitive_performance">Cognitive performance</h3></div> Though OCD was once believed to be associated with above-average intelligence, this does not appear to necessarily be the case.<a href="#cite_note-79">[79]</a> A 2013 review reported that people with OCD may sometimes have mild but wide-ranging <a href="/wiki/Cognitive_deficit" class="mw-redirect" title="Cognitive deficit">cognitive deficits</a>, most significantly those affecting <a href="/wiki/Spatial_memory" title="Spatial memory">spatial memory</a> and to a lesser extent with <a href="/wiki/Verbal_memory" title="Verbal memory">verbal memory</a>, <a href="/wiki/Verbal_fluency_test" title="Verbal fluency test">fluency</a>, <a href="/wiki/Executive_functions" title="Executive functions">executive function</a>, and <a href="/wiki/Cognitive_processing_speed" class="mw-redirect" title="Cognitive processing speed">processing speed</a>, while auditory attention was not significantly affected.<a href="#cite_note-shin-80">[80]</a> People with OCD show impairment in formulating an organizational strategy for coding information, <a href="/wiki/Set-shifting" class="mw-redirect" title="Set-shifting">set-shifting</a>, and motor and <a href="/wiki/Cognitive_inhibition" title="Cognitive inhibition">cognitive inhibition</a>.<a href="#cite_note-Aydin-81">[81]</a> Specific subtypes of symptom dimensions in OCD have been associated with specific cognitive deficits.<a href="#cite_note-82">[82]</a> For example, the results of one <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> comparing washing and checking symptoms reported that washers outperformed checkers on eight out of ten cognitive tests.<a href="#cite_note-83">[83]</a> The symptom dimension of contamination and cleaning may be associated with higher scores on tests of inhibition and verbal memory.<a href="#cite_note-84">[84]</a> <div class="mw-heading mw-heading3"><h3 id="Video_game_addiction">Video game addiction</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Video_game_addiction" title="Video game addiction">Video game addiction</a></div> <div class="excerpt-block"><style data-mw-deduplicate="TemplateStyles:r1066933788">.mw-parser-output .excerpt-hat .mw-editsection-like{font-style:normal}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable dablink excerpt-hat selfref">This section is an excerpt from <a href="/wiki/Digital_media_use_and_mental_health#OCD" title="Digital media use and mental health">Digital media use and mental health § OCD</a>.[<a class="external text" href="https://en.wikipedia.org/w/index.php?title=Digital_media_use_and_mental_health&action=edit">edit</a>]</div><div class="excerpt"> In April 2018, the International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found a significant correlation between IGD and obsessive–compulsive disorder symptoms in 3 of 4 studies.<a href="#cite_note-Digital_media_use_and_mental_health_IJERPH_2018-85">[85]</a></div></div> <div class="mw-heading mw-heading3"><h3 id="Pediatric_OCD">Pediatric OCD</h3></div> Approximately 1–2% of children are affected by OCD.<a href="#cite_note-86">[86]</a> There is a lot of similarity between the clinical presentation of OCD in children and adults, and it is considered a highly familial disorder, with a phenotypic heritability of around 50%.<a href="#cite_note-Obsessive-Compulsive_Disorder_in_Ch-38">[38]</a><a href="#cite_note-87">[87]</a> Obsessive–compulsive disorder symptoms tend to develop more frequently in children 10–14 years of age, with males displaying symptoms at an earlier age, and at a more severe level than females.<a href="#cite_note-88">[88]</a> In children, symptoms can be grouped into at least four types, including sporadic and tic-related OCD.<a href="#cite_note-Leckman-36">[36]</a> The Children's Yale–Brown Obsessive–Compulsive Scale (CY-BOCS) is the gold standard measure for assessment of pediatric OCD.<a href="#cite_note-Evidence-Based_Assessment_of_Obsess-89">[89]</a> It follows the Y-BOCS format, but with a Symptom Checklist that is adapted for developmental appropriateness. Insight, avoidance, indecisiveness, responsibility, pervasive slowness, and doubting, are not included in a rating of overall severity. The CY-BOCS has demonstrated good convergent validity with clinician-rated OCD severity, and good to fair discriminant validity from measures of closely related anxiety, depression, and tic severity.<a href="#cite_note-Evidence-Based_Assessment_of_Obsess-89">[89]</a> The CY-BOCS Total Severity score is an important monitoring tool as it is responsive to pharmacotherapy and psychotherapy.<a href="#cite_note-90">[90]</a><a href="#cite_note-91">[91]</a> Positive treatment response is characterized by 25% reduction in CY-BOCS total score, and diagnostic remission is associated with a 45%-50% reduction in Total Severity score (or a score <15).<a href="#cite_note-Evidence-Based_Assessment_of_Obsess-89">[89]</a> CBT is the first line treatment for mild to moderate cases of OCD in children, while medication plus CBT is recommended for moderate to severe cases.<a href="#cite_note-92">[92]</a><a href="#cite_note-Cognitive-Behavior_Therapy,_Sertral-93">[93]</a><a href="#cite_note-94">[94]</a> Serotonin reuptake inhibitors (<a href="/wiki/SRIs" class="mw-redirect" title="SRIs">SRIs</a>) are first-line medications for OCD in children with established AACAP guidelines for dosing.<a href="#cite_note-Practice_Parameter_for_the_Assessme-95">[95]</a> <div class="mw-heading mw-heading3"><h3 id="Associated_conditions">Associated conditions</h3></div> People with OCD may be diagnosed with other conditions as well, such as obsessive–compulsive personality disorder, <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>, <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar disorder</a>, <a href="/wiki/Generalized_anxiety_disorder" title="Generalized anxiety disorder">generalized anxiety disorder</a>, <a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">anorexia nervosa</a>, <a href="/wiki/Social_anxiety_disorder" title="Social anxiety disorder">social anxiety disorder</a>, <a href="/wiki/Bulimia_nervosa" title="Bulimia nervosa">bulimia nervosa</a>, <a href="/wiki/Tourette_syndrome" title="Tourette syndrome">Tourette syndrome</a>, <a href="/wiki/Transformation_obsession" title="Transformation obsession">transformation obsession</a>, ASD, ADHD, <a href="/wiki/Dermatillomania" class="mw-redirect" title="Dermatillomania">dermatillomania</a>, <a href="/wiki/Body_dysmorphic_disorder" title="Body dysmorphic disorder">body dysmorphic disorder</a>, and <a href="/wiki/Trichotillomania" title="Trichotillomania">trichotillomania</a>.<a href="#cite_note-96">[96]</a> More than 50% of people with OCD experience suicidal tendencies, and 15% have attempted <a href="/wiki/Suicide" title="Suicide">suicide</a>.<a href="#cite_note-Fenske_2009-17">[17]</a> Depression, anxiety, and prior suicide attempts increase the risk of future suicide attempts.<a href="#cite_note-97">[97]</a> It has been found that between 18 and 34% of females currently experiencing OCD scored positively on an inventory measuring disordered eating.<a href="#cite_note-:12-98">[98]</a> Another study found that 7% are likely to have an eating disorder,<a href="#cite_note-:12-98">[98]</a> while another found that fewer than 5% of males have OCD and an eating disorder.<a href="#cite_note-99">[99]</a> Individuals with OCD have also been found to be affected by <a href="/wiki/Delayed_sleep_phase_disorder" title="Delayed sleep phase disorder">delayed sleep phase disorder</a> at a substantially higher rate than the general public.<a href="#cite_note-Turner_2007-100">[100]</a><a href="#cite_note-Paterson2013-101">[101]</a> Moreover, severe OCD symptoms are consistently associated with greater <a href="/wiki/Sleep_disturbance" class="mw-redirect" title="Sleep disturbance">sleep disturbance</a>. Reduced total sleep time and sleep efficiency have been observed in people with OCD, with delayed sleep onset and offset.<a href="#cite_note-Paterson2013-101">[101]</a> Some research has demonstrated a link between <a href="/wiki/Addiction" title="Addiction">drug addiction</a> and OCD. For example, there is a higher risk of drug addiction among those with any anxiety disorder, likely as a way of <a href="/wiki/Coping_(psychology)" class="mw-redirect" title="Coping (psychology)">coping</a> with the heightened levels of anxiety. However, drug addiction among people with OCD may be a compulsive behavior. Depression is also extremely prevalent among people with OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD, or any other anxiety disorder, may feel "out of control".<a href="#cite_note-comorbidity-102">[102]</a> Someone exhibiting OCD signs does not necessarily have OCD. Behaviors that present as obsessive–compulsive can also be found in a number of other conditions, including <a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">obsessive–compulsive personality disorder</a> (OCPD), autism spectrum disorder (ASD), or disorders in which <a href="/wiki/Perseveration" title="Perseveration">perseveration</a> is a possible feature (ADHD, <a href="/wiki/PTSD" class="mw-redirect" title="PTSD">PTSD</a>, bodily disorders, or <a href="/wiki/Stereotypy" title="Stereotypy">stereotyped behaviors</a>).<a href="#cite_note-differential-103">[103]</a> Some cases of OCD present symptoms typically associated with Tourette syndrome, such as compulsions that may appear to resemble <a href="/wiki/Tic#Motor_or_phonic" title="Tic">motor tics</a>; this has been termed tic-related OCD or Tourettic OCD.<a href="#cite_note-10.1176/appi.neuropsych.21.1.59-104">[104]</a><a href="#cite_note-OCD_and_T-105">[105]</a> OCD frequently occurs <a href="/wiki/Comorbidity" title="Comorbidity">comorbidly</a> with both <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar disorder</a> and <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>. Between 60 and 80% of those with OCD experience a major depressive episode in their lifetime. Comorbidity rates have been reported at between 19 and 90%, as a result of methodological differences. Between 9–35% of those with bipolar disorder also have OCD, compared to 1–2% in the general population. About 50% of those with OCD experience <a href="/wiki/Cyclothymia" title="Cyclothymia">cyclothymic</a> traits or <a href="/wiki/Hypomania" title="Hypomania">hypomanic</a> episodes. OCD is also associated with anxiety disorders. Lifetime comorbidity for OCD has been reported at 22% for <a href="/wiki/Specific_phobia" title="Specific phobia">specific phobia</a>, 18% for <a href="/wiki/Social_anxiety_disorder" title="Social anxiety disorder">social anxiety disorder</a>, 12% for <a href="/wiki/Panic_disorder" title="Panic disorder">panic disorder</a>, and 30% for <a href="/wiki/Generalized_anxiety_disorder" title="Generalized anxiety disorder">generalized anxiety disorder</a>. The comorbidity rate for OCD and ADHD has been reported to be as high as 51%.<a href="#cite_note-106">[106]</a> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Cause_of_obsessive-compulsive_disorder" class="mw-redirect" title="Cause of obsessive-compulsive disorder">Cause of obsessive-compulsive disorder</a></div> The cause of OCD is unknown.<a href="#cite_note-NIH20152-1">[1]</a> Both environmental and genetic factors are believed to play a role. Risk factors include a history of <a href="/wiki/Adverse_childhood_experiences" title="Adverse childhood experiences">adverse childhood experiences</a> or other <a href="/wiki/Stress_(psychological)" class="mw-redirect" title="Stress (psychological)">stress</a>-inducing events.<a href="#cite_note-DSM52-2">[2]</a><a href="#cite_note-107">[107]</a><a href="#cite_note-108">[108]</a> <div class="mw-heading mw-heading3"><h3 id="Drug-induced_OCD">Drug-induced OCD</h3></div> Some medications, toxin exposures, and drugs, such as <a href="/wiki/Methamphetamine" title="Methamphetamine">methamphetamine</a> or <a href="/wiki/Cocaine" title="Cocaine">cocaine</a>, can induce obsessive–compulsive symptoms in people without a history of OCD. <a href="/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">Atypical antipsychotics</a> such as <a href="/wiki/Olanzapine" title="Olanzapine">olanzapine</a> and <a href="/wiki/Clozapine" title="Clozapine">clozapine</a> can induce OCD in some people, particularly individuals with <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a>. The diagnostic criteria include: 1) General OCD symptoms (obsessions, compulsions, skin picking, hair pulling, etc.) that developed soon after exposure to the substance or medication which can produce such symptoms. 2) The onset of symptoms cannot be explained by an obsessive–compulsive and related disorder that is not substance/medication-induced and should last for a substantial period of time (about 1 month) 3) This disturbance does not only occur during <a href="/wiki/Delirium" title="Delirium">delirium</a>. 4) Clinically induces distress or impairment in social, occupational, or other important areas of functioning. <a href="#cite_note-109">[109]</a><a href="#cite_note-110">[110]</a><a href="#cite_note-111">[111]</a><a href="#cite_note-112">[112]</a><a href="#cite_note-113">[113]</a> <div class="mw-heading mw-heading3"><h3 id="Genetics">Genetics</h3></div> There appear to be some <a href="/wiki/Genetics" title="Genetics">genetic</a> components of OCD causation, with <a href="/wiki/Identical_twins" class="mw-redirect" title="Identical twins">identical twins</a> more often affected than fraternal twins.<a href="#cite_note-DSM52-2">[2]</a> Furthermore, individuals with OCD are more likely to have first-degree family members exhibiting the same disorders than <a href="/wiki/Matched_control" class="mw-redirect" title="Matched control">matched controls</a>. In cases in which OCD develops during childhood, there is a much stronger familial link in the disorder than with cases in which OCD develops later in adulthood. In general, genetic factors account for 45–65% of the variability in OCD symptoms in children diagnosed with the disorder.<a href="#cite_note-pmid19665647-114">[114]</a> A 2007 study found evidence supporting the possibility of a heritable risk for OCD.<a href="#cite_note-Menzies_et_al,_2007-115">[115]</a> Research has found there to be a genetic correlation between anorexia nervosa and OCD, suggesting a strong etiology.<a href="#cite_note-:13-116">[116]</a><a href="#cite_note-117">[117]</a><a href="#cite_note-118">[118]</a> First and second hand relatives of probands with OCD have a greater risk of developing anorexia nervosa as genetic relatedness increases.<a href="#cite_note-:13-116">[116]</a> A <a href="/wiki/Mutation" title="Mutation">mutation</a> has been found in the human <a href="/wiki/Serotonin" title="Serotonin">serotonin</a> transporter gene <a href="/wiki/HSERT" class="mw-redirect" title="HSERT">hSERT</a> in unrelated families with OCD.<a href="#cite_note-pmid14593431-119">[119]</a> A <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> found that while neither <a href="/wiki/Allele" title="Allele">allele</a> was associated with OCD overall, in <a href="/wiki/Caucasian_race" title="Caucasian race">Caucasians</a>, the L allele was associated with OCD.<a href="#cite_note-120">[120]</a> Another meta-analysis observed an increased risk in those with the <a href="/wiki/Zygosity" title="Zygosity">homozygous</a> S allele, but found the LS <a href="/wiki/Genotype" title="Genotype">genotype</a> to be inversely associated with OCD.<a href="#cite_note-121">[121]</a> A <a href="/wiki/Genome" title="Genome">genome</a>-wide association study found OCD to be linked with <a href="/wiki/Single-nucleotide_polymorphism" title="Single-nucleotide polymorphism">single-nucleotide polymorphisms</a> (SNPs) near <a href="/w/index.php?title=BTBD3&action=edit&redlink=1" class="new" title="BTBD3 (page does not exist)">BTBD3</a>, and two SNPs in <a href="/wiki/DLGAP1" title="DLGAP1">DLGAP1</a> in a trio-based analysis, but no SNP reached significance when analyzed with <a href="/wiki/Case_control" class="mw-redirect" title="Case control">case-control</a> data.<a href="#cite_note-122">[122]</a> One meta-analysis found a small but significant association between a polymorphism in <a href="/wiki/SLC1A1" class="mw-redirect" title="SLC1A1">SLC1A1</a> and OCD.<a href="#cite_note-123">[123]</a> The relationship between OCD and <a href="/wiki/Catechol-O-methyltransferase" title="Catechol-O-methyltransferase">Catechol-O-methyltransferase</a> (COMT) has been inconsistent, with one meta-analysis reporting a significant association, albeit only in men, and another meta analysis reporting no association.<a href="#cite_note-124">[124]</a><a href="#cite_note-125">[125]</a> It has been postulated by <a href="/wiki/Evolutionary_psychology" title="Evolutionary psychology">evolutionary psychologists</a> that moderate versions of compulsive behavior may have had evolutionary advantages. Examples would be moderate constant checking of hygiene, the <a href="/wiki/Hearth" title="Hearth">hearth</a>, or the environment for enemies. Similarly, <a href="/wiki/Hoarding" title="Hoarding">hoarding</a> may have had evolutionary advantages. In this view, OCD may be the extreme statistical tail of such behaviors, possibly the result of a high number of predisposing genes.<a href="#cite_note-126">[126]</a> <div class="mw-heading mw-heading3"><h3 id="Brain_structure_and_functioning">Brain structure and functioning</h3></div> <a href="/wiki/Medical_imaging" title="Medical imaging">Imaging</a> studies have shown differences in the <a href="/wiki/Frontal_lobe" title="Frontal lobe">frontal cortex</a> and <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">subcortical</a> structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but such a connection is not clear.<a href="#cite_note-:10-21">[21]</a> Some people with OCD have areas of unusually high activity in their brain, or low levels of the chemical <a href="/wiki/Serotonin" title="Serotonin">serotonin</a>,<a href="#cite_note-:11-127">[127]</a> which is a <a href="/wiki/Neurotransmitter" title="Neurotransmitter">neurotransmitter</a> that some <a href="/wiki/Nerve_cells" class="mw-redirect" title="Nerve cells">nerve cells</a> use to communicate with each other,<a href="#cite_note-128">[128]</a> and is thought to be involved in regulating many functions, influencing emotions, mood, memory, and sleep.<a href="#cite_note-How_SSRIs_work_{{!}}_OCD-UK-129">[129]</a> <div class="mw-heading mw-heading3"><h3 id="Autoimmune">Autoimmune</h3></div> A controversial hypothesis is that some cases of rapid onset of OCD in children and adolescents may be caused by a syndrome connected to <a href="/wiki/Group_A_streptococcal_infection" title="Group A streptococcal infection">Group A streptococcal infections</a> (GABHS), known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (<a href="/wiki/PANDAS" title="PANDAS">PANDAS</a>).<a href="#cite_note-Sigra2018-130">[130]</a><a href="#cite_note-Wilbur2019-131">[131]</a><a href="#cite_note-Boileau2011-132">[132]</a> OCD and tic disorders are hypothesized to arise in a subset of children as a result of a post-<a href="/wiki/Streptococcus" title="Streptococcus">streptococcal</a> autoimmune process.<a href="#cite_note-Dale2017-133">[133]</a><a href="#cite_note-Marazziti2018-134">[134]</a><a href="#cite_note-Zibordi2018-135">[135]</a> The PANDAS hypothesis is unconfirmed and unsupported by data, and two new categories have been proposed: <a href="/wiki/PANDAS" title="PANDAS">PANS</a> (pediatric acute-onset neuropsychiatric syndrome) and CANS (childhood acute neuropsychiatric syndrome).<a href="#cite_note-Marazziti2018-134">[134]</a><a href="#cite_note-Zibordi2018-135">[135]</a> The CANS and PANS hypotheses include different possible mechanisms underlying acute-onset neuropsychiatric conditions, but do not exclude GABHS infections as a cause in a subset of individuals.<a href="#cite_note-Marazziti2018-134">[134]</a><a href="#cite_note-Zibordi2018-135">[135]</a> PANDAS, PANS, and CANS are the focus of clinical and laboratory research, but remain unproven.<a href="#cite_note-Dale2017-133">[133]</a><a href="#cite_note-Marazziti2018-134">[134]</a><a href="#cite_note-Zibordi2018-135">[135]</a> Whether PANDAS is a distinct entity differing from other cases of tic disorders or OCD is debated.<a href="#cite_note-Shulman2009-136">[136]</a><a href="#cite_note-Maia2008-137">[137]</a><a href="#cite_note-Robertson2011-138">[138]</a><a href="#cite_note-Singer2011-139">[139]</a> A review of studies examining anti-basal ganglia <a href="/wiki/Antibody" title="Antibody">antibodies</a> in OCD found an increased risk of having anti-basal ganglia antibodies in those with OCD versus the general population.<a href="#cite_note-140">[140]</a> <div class="mw-heading mw-heading3"><h3 id="Environment">Environment</h3></div> OCD may be more common in people who have been bullied, abused, or neglected, and it sometimes starts after a significant life event, such as childbirth or <a href="/wiki/Bereavement" class="mw-redirect" title="Bereavement">bereavement</a>.<a href="#cite_note-:11-127">[127]</a> It has been reported in some studies that there is a connection between <a href="/wiki/Childhood_trauma" title="Childhood trauma">childhood trauma</a> and obsessive-compulsive symptoms. More research is needed to understand this relationship better.<a href="#cite_note-:10-21">[21]</a> <div class="mw-heading mw-heading2"><h2 id="Mechanisms">Mechanisms</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Biology_of_obsessive%E2%80%93compulsive_disorder" title="Biology of obsessive–compulsive disorder">Biology of obsessive–compulsive disorder</a></div> <div class="mw-heading mw-heading3"><h3 id="Neuroimaging">Neuroimaging</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/82/OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg/300px-OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg" decoding="async" width="300" height="242" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/82/OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg/450px-OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/82/OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg/600px-OCD_-_Obsessive%E2%80%93compulsive_disorder.jpg 2x" data-file-width="1031" data-file-height="832" /></a><figcaption>Some parts of the brain showing abnormal activity in OCD: Orbitofrontal cortex integrates rewards, emotions, and behaviors; anterior cingulate cortex is involved in error detection; amygdala is involved in emotional interpretation of reward</figcaption></figure> Functional neuroimaging during symptom provocation has observed abnormal activity in the <a href="/wiki/Orbitofrontal_cortex" title="Orbitofrontal cortex">orbitofrontal cortex</a> (OFC), left <a href="/wiki/Dorsolateral_prefrontal_cortex" title="Dorsolateral prefrontal cortex">dorsolateral prefrontal cortex</a> (dlPFC), right <a href="/wiki/Premotor_cortex" title="Premotor cortex">premotor cortex</a>, left superior <a href="/wiki/Superior_temporal_gyrus" title="Superior temporal gyrus">temporal gyrus</a>, <a href="/wiki/Globus_pallidus_externus" class="mw-redirect" title="Globus pallidus externus">globus pallidus externus</a>, <a href="/wiki/Hippocampus" title="Hippocampus">hippocampus</a>, and right <a href="/wiki/Uncus" title="Uncus">uncus</a>. Weaker foci of abnormal activity were found in the left <a href="/wiki/Caudate_nucleus" title="Caudate nucleus">caudate</a>, <a href="/wiki/Posterior_cingulate_cortex" title="Posterior cingulate cortex">posterior cingulate cortex</a>, and <a href="/wiki/Superior_parietal_lobule" title="Superior parietal lobule">superior parietal lobule</a>.<a href="#cite_note-141">[141]</a> However, an older meta-analysis of functional neuroimaging in OCD reported that the only consistent functional neuroimaging finding was increased activity in the <a href="/wiki/Orbital_gyri" title="Orbital gyri">orbital gyrus</a> and head of the <a href="/wiki/Caudate_nucleus" title="Caudate nucleus">caudate nucleus</a>, while <a href="/wiki/Anterior_cingulate_cortex" title="Anterior cingulate cortex">anterior cingulate cortex</a> (ACC) activation abnormalities were too inconsistent.<a href="#cite_note-142">[142]</a> A meta-analysis comparing affective and nonaffective tasks observed differences with controls in regions implicated in <a href="/wiki/Salience_(neuroscience)" title="Salience (neuroscience)">salience</a>, habit, goal-directed behavior, self-referential thinking, and cognitive control. For nonaffective tasks, hyperactivity was observed in the <a href="/wiki/Insular_cortex" title="Insular cortex">insula</a>, ACC, and head of the <a href="/wiki/Caudate_nucleus" title="Caudate nucleus">caudate</a>/<a href="/wiki/Putamen" title="Putamen">putamen</a>, while hypoactivity was observed in the <a href="/wiki/Medial_prefrontal_cortex" class="mw-redirect" title="Medial prefrontal cortex">medial prefrontal cortex</a> (mPFC) and posterior caudate. Affective tasks were observed to relate to increased activation in the <a href="/wiki/Precuneus" title="Precuneus">precuneus</a> and <a href="/wiki/Posterior_cingulate_cortex" title="Posterior cingulate cortex">posterior cingulate cortex</a>, while decreased activation was found in the <a href="/wiki/Globus_pallidus" title="Globus pallidus">pallidum</a>, ventral anterior thalamus, and posterior caudate.<a href="#cite_note-143">[143]</a> The involvement of the <a href="/wiki/Cortico-basal_ganglia-thalamo-cortical_loop" title="Cortico-basal ganglia-thalamo-cortical loop">cortico-striato-thalamo-cortical</a> loop in OCD, as well as the high rates of comorbidity between OCD and ADHD, have led some to draw a link in their mechanism. Observed similarities include dysfunction of the <a href="/wiki/Anterior_cingulate_cortex" title="Anterior cingulate cortex">anterior cingulate cortex</a> and <a href="/wiki/Prefrontal_cortex" title="Prefrontal cortex">prefrontal cortex</a>, as well as shared deficits in executive functions.<a href="#cite_note-144">[144]</a> The involvement of the orbitofrontal cortex and dorsolateral prefrontal cortex in OCD is shared with <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar disorder</a>, and may explain the high degree of comorbidity.<a href="#cite_note-radua2010-145">[145]</a> Decreased volumes of the dorsolateral prefrontal cortex related to executive function has also been observed in OCD.<a href="#cite_note-146">[146]</a> People with OCD evince increased <a href="/wiki/Grey_matter" title="Grey matter">grey matter</a> volumes in bilateral <a href="/wiki/Lenticular_nucleus" class="mw-redirect" title="Lenticular nucleus">lenticular nuclei</a>, extending to the caudate nuclei, with decreased grey matter volumes in bilateral dorsal <a href="/wiki/Medial_frontal_gyrus" title="Medial frontal gyrus">medial frontal</a>/<a href="/wiki/Anterior_cingulate_cortex" title="Anterior cingulate cortex">anterior cingulate</a> gyri.<a href="#cite_note-Radua_and_Mataix-Cols,_2009-147">[147]</a><a href="#cite_note-radua2010-145">[145]</a> These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) grey matter volumes in bilateral lenticular/caudate nuclei, as well as decreased grey matter volumes in bilateral dorsal <a href="/wiki/Medial_frontal_gyrus" title="Medial frontal gyrus">medial frontal</a>/<a href="/wiki/Anterior_cingulate_cortex" title="Anterior cingulate cortex">anterior cingulate</a> gyri.<a href="#cite_note-radua2010-145">[145]</a> Increased <a href="/wiki/White_matter" title="White matter">white matter</a> volume and decreased <a href="/wiki/Fractional_anisotropy" title="Fractional anisotropy">fractional anisotropy</a> in anterior midline tracts has been observed in OCD, possibly indicating increased fiber crossings.<a href="#cite_note-148">[148]</a> <div class="mw-heading mw-heading3"><h3 id="Cognitive_models">Cognitive models</h3></div> Generally, two categories of models for OCD have been postulated. The first category involves deficits in executive dysfunction and is based on the observed structural and functional abnormalities in the dlPFC, <a href="/wiki/Striatum" title="Striatum">striatum</a> and thalamus. The second category involves dysfunctional modulatory control and primarily relies on observed functional and structural differences in the ACC, mPFC, and OFC.<a href="#cite_note-149">[149]</a><a href="#cite_note-150">[150]</a> One proposed model suggests that dysfunction in the <a href="/wiki/Orbitofrontal_cortex" title="Orbitofrontal cortex">orbitalfrontal cortex</a> (OFC) leads to improper valuation of behaviors and decreased behavioral control, while the observed alterations in <a href="/wiki/Amygdala" title="Amygdala">amygdala</a> activations leads to exaggerated fears and representations of negative stimuli.<a href="#cite_note-Wood-151">[151]</a> Due to the <a href="/wiki/Homogeneity_and_heterogeneity" title="Homogeneity and heterogeneity">heterogeneity</a> of OCD symptoms, studies differentiating various symptoms have been performed. Symptom-specific neuroimaging abnormalities include the hyperactivity of caudate and ACC in checking rituals, while finding increased activity of cortical and <a href="/wiki/Cerebellum" title="Cerebellum">cerebellar</a> regions in contamination-related symptoms. Neuroimaging differentiating content of intrusive thoughts has found differences between aggressive as opposed to <a href="/wiki/Taboo" title="Taboo">taboo</a> thoughts, finding increased connectivity of the <a href="/wiki/Amygdala" title="Amygdala">amygdala</a>, <a href="/wiki/Ventral_striatum" class="mw-redirect" title="Ventral striatum">ventral striatum</a>, and <a href="/wiki/Ventromedial_prefrontal_cortex" title="Ventromedial prefrontal cortex">ventromedial prefrontal cortex</a> in aggressive symptoms, while observing increased connectivity between the ventral striatum and insula in sexual or religious intrusive thoughts.<a href="#cite_note-152">[152]</a> Another model proposes that affective dysregulation links excessive reliance on habit-based action selection<a href="#cite_note-153">[153]</a> with compulsions. This is supported by the observation that those with OCD demonstrate decreased activation of the ventral striatum when anticipating monetary reward, as well as increased functional connectivity between the VS and the OFC. Furthermore, those with OCD demonstrate reduced performance in <a href="/wiki/Classical_conditioning" title="Classical conditioning">Pavlovian</a> fear-extinction tasks, hyperresponsiveness in the amygdala to fearful stimuli, and hyporesponsiveness in the amygdala when exposed to positively valanced stimuli. Stimulation of the <a href="/wiki/Nucleus_accumbens" title="Nucleus accumbens">nucleus accumbens</a> has also been observed to effectively alleviate both obsessions and compulsions, supporting the role of affective dysregulation in generating both.<a href="#cite_note-Wood-151">[151]</a> <div class="mw-heading mw-heading3"><h3 id="Neurobiological">Neurobiological</h3></div> From the observation of the efficacy of antidepressants in OCD, a serotonin hypothesis of OCD has been formulated. Studies of peripheral markers of serotonin, as well as challenges with proserotonergic compounds have yielded inconsistent results, including evidence pointing towards basal hyperactivity of <a href="/wiki/Serotonin" title="Serotonin">serotonergic</a> systems.<a href="#cite_note-154">[154]</a> <a href="/wiki/Serotonin_receptor" class="mw-redirect" title="Serotonin receptor">Serotonin receptor</a> and transporter binding studies have yielded conflicting results, including higher and lower serotonin receptor <a href="/wiki/5-HT2A" class="mw-redirect" title="5-HT2A">5-HT2A</a> and <a href="/wiki/Serotonin_transporter" title="Serotonin transporter">serotonin transporter</a> binding potentials that were normalized by treatment with SSRIs. Despite inconsistencies in the types of abnormalities found, evidence points towards dysfunction of serotonergic systems in OCD.<a href="#cite_note-155">[155]</a> Orbitofrontal cortex overactivity is attenuated in people who have successfully responded to SSRI medication, a result believed to be caused by increased stimulation of serotonin receptors <a href="/wiki/5-HT2A_receptor" title="5-HT2A receptor">5-HT2A</a> and <a href="/wiki/5-HT_receptor" title="5-HT receptor">5-HT2C</a>.<a href="#cite_note-156">[156]</a> A complex relationship between <a href="/wiki/Dopamine" title="Dopamine">dopamine</a> and OCD has been observed. Although <a href="/wiki/Antipsychotics" class="mw-redirect" title="Antipsychotics">antipsychotics</a>, which act by <a href="/wiki/Dopamine_antagonist" title="Dopamine antagonist">antagonizing dopamine receptors</a>, may improve some cases of OCD, they frequently exacerbate others. Antipsychotics, in the low doses used to treat OCD, may actually increase the release of dopamine in the <a href="/wiki/Prefrontal_cortex" title="Prefrontal cortex">prefrontal cortex</a>, through inhibiting <a href="/wiki/Autoreceptors" class="mw-redirect" title="Autoreceptors">autoreceptors</a>. Further complicating things is the efficacy of <a href="/wiki/Amphetamine" title="Amphetamine">amphetamines</a>, decreased <a href="/wiki/Dopamine_transporter" title="Dopamine transporter">dopamine transporter</a> activity observed in OCD,<a href="#cite_note-157">[157]</a> and low levels of <a href="/wiki/Dopamine_receptor_D2" title="Dopamine receptor D2">D2</a> binding in the <a href="/wiki/Striatum" title="Striatum">striatum</a>.<a href="#cite_note-glutamate-158">[158]</a> Furthermore, increased dopamine release in the <a href="/wiki/Nucleus_accumbens" title="Nucleus accumbens">nucleus accumbens</a> after deep brain stimulation correlates with improvement in symptoms, pointing to reduced dopamine release in the striatum playing a role in generating symptoms.<a href="#cite_note-159">[159]</a> Abnormalities in <a href="/wiki/Glutamatergic" title="Glutamatergic">glutamatergic</a> <a href="/wiki/Neurotransmission" title="Neurotransmission">neurotransmission</a> have been implicated in OCD. Findings such as increased <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal</a> <a href="/wiki/Glutamic_acid" title="Glutamic acid">glutamate</a>, less consistent abnormalities observed in neuroimaging studies, and the efficacy of some glutamatergic drugs (such as the glutamate-inhibiting <a href="/wiki/Riluzole" title="Riluzole">riluzole</a>) have implicated glutamate in OCD.<a href="#cite_note-glutamate-158">[158]</a> OCD has been associated with reduced <a href="/wiki/N-Acetylaspartic_acid" title="N-Acetylaspartic acid">N-Acetylaspartic acid</a> in the mPFC, which is thought to reflect neuron density or functionality, although the exact interpretation has not been established.<a href="#cite_note-160">[160]</a> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div> Formal diagnosis may be performed by a <a href="/wiki/Psychologist" title="Psychologist">psychologist</a>, <a href="/wiki/Psychiatrist" title="Psychiatrist">psychiatrist</a>, clinical <a href="/wiki/Social_work" title="Social work">social worker</a>, or other licensed mental health professional. OCD, like other mental and behavioral health disorders, cannot be diagnosed by a medical exam,<a href="#cite_note-:14-7">[7]</a> nor are there any medical exams that can predict if one will fall victim to such illnesses. To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the <a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM). The DSM notes that there are multiple characteristics that can turn obsessions and compulsions from normalized behavior to "clinically significant." There has to be recurring and strong thoughts or impulsive that intrude on the day-to-day lives of the patients and cause noticeable levels of anxiousness.<a href="#cite_note-DSM52-2">[2]</a> These thoughts, impulses, or images are of a degree or type that lies outside the <a href="/wiki/Normality_(behavior)" title="Normality (behavior)">normal</a> range of worries about conventional problems.<a href="#cite_note-Quick-161">[161]</a> A person may attempt to ignore or <a href="/wiki/Thought_suppression" title="Thought suppression">suppress</a> such obsessions, neutralize them with another thought or action, or try to rationalize their anxiety away. People with OCD tend to recognize their obsessions as irrational. Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not have OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person with OCD must perform these actions to avoid significant psychological distress. These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or, they are excessive. Moreover, the obsessions or compulsions must be time-consuming, often taking up more than one hour per day, or cause impairment in social, occupational, or scholastic functioning.<a href="#cite_note-Quick-161">[161]</a> It is helpful to quantify the severity of symptoms and impairment before and during treatment for OCD. In addition to the person's estimate of the time spent each day harboring obsessive-compulsive thoughts or behaviors, concrete tools can be used to gauge the person's condition. This may be done with rating scales, such as the <a href="/wiki/Yale%E2%80%93Brown_Obsessive_Compulsive_Scale" class="mw-redirect" title="Yale–Brown Obsessive Compulsive Scale">Yale–Brown Obsessive Compulsive Scale</a> (Y-BOCS; expert rating)<a href="#cite_note-162">[162]</a> or the obsessive–compulsive inventory (OCI-R; self-rating).<a href="#cite_note-163">[163]</a> With measurements such as these, psychiatric consultation can be more appropriately determined, as it has been standardized.<a href="#cite_note-Fenske_2009-17">[17]</a> In regards to diagnosing, the health professional also looks to make sure that the signs of obsessions and compulsions are not the results of any drugs, prescription or recreational, that the patient may be taking.<a href="#cite_note-:15-164">[164]</a> There are several types of obsessive thoughts that are found commonly in those with OCD. Some of these include fear of germs, hurting loved ones, embarrassment, neatness, societally unacceptable sexual thoughts etc.<a href="#cite_note-:15-164">[164]</a> Within OCD, these specific categories are often diagnosed into their own type of OCD.<a href="#cite_note-DSM52-2">[2]</a> OCD is sometimes placed in a group of disorders called the <a href="/wiki/Obsessive%E2%80%93compulsive_spectrum" title="Obsessive–compulsive spectrum">obsessive–compulsive spectrum</a>.<a href="#cite_note-165">[165]</a> Another criterion in the DSM is that a person's mental illness does not fit one of the other categories of a mental disorder better. That is to say, if the obsessions and compulsions of a patient could be better described by <a href="/wiki/Trichotillomania" title="Trichotillomania">trichotillomania</a>, it would not be diagnosed as OCD.<a href="#cite_note-DSM52-2">[2]</a> That being said, OCD does often go hand in hand with other mental disorders. For this reason, one may be diagnosed with multiple mental disorders at once.<a href="#cite_note-166">[166]</a> A different aspect of the diagnoses is the degree of insight had by the individual in regards to the truth of the obsessions. There are three levels, good/fair, poor and absent/delusional. Good/fair indicated that the patient is aware that the obsessions they have are not true or probably not true.<a href="#cite_note-DSM52-2">[2]</a> Poor indicates that the patient believes their obsessional beliefs are probably true.<a href="#cite_note-DSM52-2">[2]</a> Absent/delusional indicates that they fully believe their obsessional thoughts to be true.<a href="#cite_note-DSM52-2">[2]</a> Approximately 4% or fewer individuals with OCD will be diagnosed as absent/delusional.<a href="#cite_note-DSM52-2">[2]</a> Additionally, as many as 30% of those with OCD also have a lifetime tic disorder, meaning they have been diagnosed with a tic disorder at some point in their life.<a href="#cite_note-DSM52-2">[2]</a> There are several different types of tics that have been observed in individuals with OCD. These include but are not limited to, "grunting", "jerking" or "shrugging" body parts, sniffling, and excessive blinking.<a href="#cite_note-:15-164">[164]</a> There has been a significant amount of progress over the last few decades, and as of 2022 there is statically significant improvement in the diagnostic process for individuals with OCD. One study found that of two groups of individuals, one with participants under the age of 27.25 and one with participants over that age, those in the younger group experienced a significantly faster time between the onset of OCD tendencies and their formal diagnoses.<a href="#cite_note-167">[167]</a> <div class="mw-heading mw-heading3"><h3 id="Differential_diagnosis">Differential diagnosis</h3></div> OCD is often confused with the separate condition <a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">obsessive–compulsive personality disorder</a> (OCPD). OCD is <a href="/wiki/Egosyntonic_and_egodystonic" title="Egosyntonic and egodystonic">egodystonic</a>, meaning that the disorder is incompatible with the individual's <a href="/wiki/Self-concept" title="Self-concept">self-concept</a>.<a href="#cite_note-Aardema,_F._2007-168">[168]</a><a href="#cite_note-Aardema-169">[169]</a> As egodystonic disorders go against a person's self-concept, they tend to cause much distress. OCPD, on the other hand, is <a href="/wiki/Egosyntonic_and_egodystonic" title="Egosyntonic and egodystonic">egosyntonic</a>, marked by the person's acceptance that the characteristics and behaviors displayed as a result are compatible with their <a href="/wiki/Self-image" title="Self-image">self-image</a>, or are otherwise appropriate, correct, or reasonable. As a result, people with OCD are often aware that their behavior is not rational, and are unhappy about their obsessions, but nevertheless feel compelled by them.<a href="#cite_note-carter-170">[170]</a> By contrast, people with OCPD are not aware of anything abnormal; they will readily explain why their actions are rational. It is usually impossible to convince them otherwise, and they tend to derive pleasure from their obsessions or compulsions.<a href="#cite_note-carter-170">[170]</a> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2></div> <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> (CBT) and <a href="/wiki/Psychotropic_medication" class="mw-redirect" title="Psychotropic medication">psychotropic medications</a> are the first-line treatments for OCD.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-NICE2005-171">[171]</a> <div class="mw-heading mw-heading3"><h3 id="Therapy">Therapy</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Pennsylvania_Capitol_front_door_keyhole.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/42/Pennsylvania_Capitol_front_door_keyhole.jpg/220px-Pennsylvania_Capitol_front_door_keyhole.jpg" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/42/Pennsylvania_Capitol_front_door_keyhole.jpg/330px-Pennsylvania_Capitol_front_door_keyhole.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/42/Pennsylvania_Capitol_front_door_keyhole.jpg/440px-Pennsylvania_Capitol_front_door_keyhole.jpg 2x" data-file-width="2449" data-file-height="3264" /></a><figcaption>One exposure and ritual prevention activity would be to check the lock only once and then leave.</figcaption></figure> One specific CBT technique used is called <a href="/wiki/Exposure_and_response_prevention" class="mw-redirect" title="Exposure and response prevention">exposure and response prevention</a> (ERP), which involves teaching the person to deliberately come into contact with situations that trigger obsessive thoughts and fears (exposure), without carrying out the usual compulsive acts associated with the obsession (response prevention). This technique causes patients to gradually learn to tolerate the discomfort and anxiety associated with not performing their compulsions. For many patients, ERP is the add-on treatment of choice when <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitors</a> (SSRIs) or <a href="/wiki/Serotonin%E2%80%93norepinephrine_reuptake_inhibitor" title="Serotonin–norepinephrine reuptake inhibitor">serotonin–norepinephrine reuptake inhibitors</a> (SNRIs) medication does not effectively treat OCD symptoms, or vice versa, for individuals who begin treatment with psychotherapy.<a href="#cite_note-:10-21">[21]</a> This technique is considered superior to others due to the lack of medication used. However, up to 25% of patients will discontinue treatment due to the severity of their tics. CBT normally lasts anywhere from 12-16 sessions, with <a href="/wiki/Cognitive_behavioral_training" title="Cognitive behavioral training">homework</a> assigned to the patient in between meetings with a therapist. (Lack 2012). Modalities differ in ERP treatment but both virtual reality based as well as unguided computer assisted treatment programs have shown effective results in treatment programs.<a href="#cite_note-172">[172]</a><a href="#cite_note-173">[173]</a> For example, a patient might be asked to touch something very mildly contaminated (exposure), and wash their hands only once afterward (response prevention). Another example might entail asking the patient to leave the house and check the lock only once (exposure), without going back to check again (response prevention). After succeeding at one stage of treatment, the patient's level of discomfort in the exposure phase can be increased. When this therapy is successful, the patient will quickly <a href="/wiki/Habituation" title="Habituation">habituate</a> to an anxiety-producing situation, discovering a considerable drop in anxiety level.<a href="#cite_note-baojournal.com-174">[174]</a> ERP has a strong evidence base, and is considered the most effective treatment for OCD.<a href="#cite_note-baojournal.com-174">[174]</a> However, this claim was doubted by some researchers in 2000, who criticized the quality of many studies.<a href="#cite_note-pmid10910778-175">[175]</a> While ERP can lead a majority of clients to improvements, many do not reach remission or become asymptomatic;<a href="#cite_note-176">[176]</a> some therapists are also hesitant to use this approach.<a href="#cite_note-177">[177]</a> The recent development of remotely technology-delivered CBT is increasing access to therapy options for those living with OCD and remote versions appear to equally as effective as in-person therapy options. The development of smartphone interventions for OCD that utilize CBT techniques are another alternative that is expanding access to therapy while allowing therapies to be personalized for each patient.<a href="#cite_note-178">[178]</a> <a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">Acceptance and commitment therapy</a> (ACT), a newer therapy also used to treat anxiety and depression, has also been found to be effective in treatment of OCD.<a href="#cite_note-179">[179]</a><a href="#cite_note-180">[180]</a> ACT uses <a href="/wiki/Acceptance" title="Acceptance">acceptance</a> and <a href="/wiki/Mindfulness" title="Mindfulness">mindfulness</a> strategies to teach patients not to overreact to or avoid unpleasant thoughts and feelings but rather "move toward valued behavior."<a href="#cite_note-181">[181]</a><a href="#cite_note-182">[182]</a> <a href="/wiki/Inference-based_therapy" title="Inference-based therapy">Inference-based therapy</a> (IBT) is a form of <a href="/wiki/Cognitive_therapy" title="Cognitive therapy">cognitive therapy</a> specifically developed for treating OCD.<a href="#cite_note-O'Connor,_K._2005-183">[183]</a> The therapy posits that individuals with OCD put a greater emphasis on an imagined possibility than on what can be perceived with the <a href="/wiki/Sense" title="Sense">senses</a>, and confuse the imagined possibility with reality, in a process called <a href="/wiki/Inferential_confusion" title="Inferential confusion">inferential confusion</a>.<a href="#cite_note-184">[184]</a> According to inference-based therapy, obsessional thinking occurs when the person replaces reality and real probabilities with imagined possibilities.<a href="#cite_note-185">[185]</a> The goal of inference-based therapy is to reorient clients towards trusting the senses and relating to reality in a normal, non-effortful way. Differences between normal and obsessional doubts are presented, and clients are encouraged to use their senses and reasoning as they do in non-obsessive–compulsive disorder situations.<a href="#cite_note-186">[186]</a><a href="#cite_note-O'Connor,_K._2005-183">[183]</a> Research on Inference-Based Cognitive-Behavior Therapy (I-CBT) suggests it can lead to improvements for those with OCD.<a href="#cite_note-187">[187]</a> A 2007 <a href="/wiki/Cochrane_(organisation)" title="Cochrane (organisation)">Cochrane review</a> found that psychological interventions derived from CBT models, such as ERP, ACT, and IBT, were more effective than non-CBT interventions.<a href="#cite_note-:17-26">[26]</a> Other forms of psychotherapy, such as <a href="/wiki/Psychodynamics" title="Psychodynamics">psychodynamics</a> and <a href="/wiki/Psychoanalysis" title="Psychoanalysis">psychoanalysis</a>, may help in managing some aspects of the disorder. However, in 2007, the <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> (APA) noted a lack of <a href="/wiki/Scientific_control" title="Scientific control">controlled studies</a> showing their efficacy, "in dealing with the core symptoms of OCD."<a href="#cite_note-APAguidelines-188">[188]</a> For <a href="/wiki/Body-focused_repetitive_behavior" title="Body-focused repetitive behavior">body-focused repetitive behaviors</a> (BFRB), behavioral interventions such as <a href="/wiki/Habit_reversal_training" title="Habit reversal training">habit-reversal training</a> and <a href="/wiki/Decoupling_for_body-focused_repetitive_behaviors" title="Decoupling for body-focused repetitive behaviors">decoupling</a> are recommended.<a href="#cite_note-:1-67">[67]</a><a href="#cite_note-:2-68">[68]</a> Psychotherapy in combination with psychiatric medication may be more effective than either option alone for individuals with severe OCD.<a href="#cite_note-189">[189]</a><a href="#cite_note-190">[190]</a><a href="#cite_note-191">[191]</a> ERP coupled with weight restoration and serotonin reuptake inhibitors has proven the most effective when treating OCD and an eating disorder simultaneously.<a href="#cite_note-192">[192]</a> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:JZoloft_JPN.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/JZoloft_JPN.jpg/220px-JZoloft_JPN.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/JZoloft_JPN.jpg/330px-JZoloft_JPN.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5e/JZoloft_JPN.jpg/440px-JZoloft_JPN.jpg 2x" data-file-width="1024" data-file-height="768" /></a><figcaption>A blister pack of sertraline under the brand name Zoloft</figcaption></figure> The medications most frequently used to treat OCD are antidepressants, including <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitors</a> (SSRIs) and <a href="/wiki/Serotonin%E2%80%93norepinephrine_reuptake_inhibitor" title="Serotonin–norepinephrine reuptake inhibitor">serotonin–norepinephrine reuptake inhibitors</a> (SNRIs).<a href="#cite_note-NEJM2014-4">[4]</a> <a href="/wiki/Sertraline" title="Sertraline">Sertraline</a> and <a href="/wiki/Fluoxetine" title="Fluoxetine">fluoxetine</a> are effective in treating OCD for children and adolescents.<a href="#cite_note-:02-193">[193]</a><a href="#cite_note-:42-194">[194]</a><a href="#cite_note-:52-195">[195]</a> SSRIs help people with OCD by inhibiting the reabsorption of serotonin by the nerve cells after they carry messages from neurons to <a href="/wiki/Synapse" title="Synapse">synapse</a>; thus, more serotonin is available to pass further messages between nearby nerve cells.<a href="#cite_note-How_SSRIs_work_{{!}}_OCD-UK-129">[129]</a>[<a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify">clarify</a>] SSRIs are a second-line treatment of adult OCD with mild functional impairment, and as first-line treatment for those with moderate or severe impairment. In children, SSRIs can be considered as a second-line therapy in those with moderate to severe impairment, with close monitoring for psychiatric adverse effects.<a href="#cite_note-NICE2005-171">[171]</a> Patients treated with SSRIs are about twice as likely to respond to treatment as are those treated with <a href="/wiki/Placebo" title="Placebo">placebo</a>, so this treatment is qualified as efficacious.<a href="#cite_note-196">[196]</a><a href="#cite_note-197">[197]</a> Efficacy has been demonstrated both in short-term (6–24 weeks) treatment trials, and in discontinuation trials with durations of 28–52 weeks.<a href="#cite_note-198">[198]</a><a href="#cite_note-199">[199]</a><a href="#cite_note-200">[200]</a> <a href="/wiki/Clomipramine" title="Clomipramine">Clomipramine</a>, a medication belonging to the class of <a href="/wiki/Tricyclic_antidepressant" title="Tricyclic antidepressant">tricyclic antidepressants</a>, appears to work as well as SSRIs, but has a higher rate of side effects.<a href="#cite_note-NEJM2014-4">[4]</a> In 2006, the <a href="/wiki/National_Institute_for_Health_and_Care_Excellence" title="National Institute for Health and Care Excellence">National Institute for Health and Care Excellence</a> (NICE) guidelines recommended augmentative second-generation (atypical) <a href="/wiki/Antipsychotic" title="Antipsychotic">antipsychotics</a> for treatment-resistant OCD.<a href="#cite_note-Ve2014-5">[5]</a> Atypical antipsychotics are not useful when used alone, and no evidence supports the use of first-generation antipsychotics.<a href="#cite_note-Dec2010-28">[28]</a><a href="#cite_note-201">[201]</a> For OCD treatment specifically, there is tentative evidence for <a href="/wiki/Risperidone" title="Risperidone">risperidone</a>, and insufficient evidence for <a href="/wiki/Olanzapine" title="Olanzapine">olanzapine</a>. <a href="/wiki/Quetiapine" title="Quetiapine">Quetiapine</a> is no better than placebo with regard to primary outcomes, but small effects were found in terms of Y-BOCS score. The efficacy of quetiapine and olanzapine are limited by an insufficient number of studies.<a href="#cite_note-202">[202]</a> A 2014 review article found two studies that indicated that <a href="/wiki/Aripiprazole" title="Aripiprazole">aripiprazole</a> was "effective in the short-term", and found that "[t]here was a small effect-size for risperidone or antipsychotics in general in the short-term"; however, the study authors found "no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo."<a href="#cite_note-Ve2014-5">[5]</a> While quetiapine may be useful when used in addition to an SSRI/SNRI in treatment-resistant OCD, these drugs are often poorly tolerated, and have metabolic side effects that limit their use. A guideline by the <a href="/wiki/American_Psychological_Association" title="American Psychological Association">American Psychological Association</a> suggested that <a href="/wiki/Dextroamphetamine" title="Dextroamphetamine">dextroamphetamine</a> may be considered by itself after more well-supported treatments have been attempted.<a href="#cite_note-APA-203">[203]</a> <div class="mw-heading mw-heading3"><h3 id="Procedures">Procedures</h3></div> <a href="/wiki/Electroconvulsive_therapy" title="Electroconvulsive therapy">Electroconvulsive therapy</a> (ECT) has been found to have effectiveness in some severe and refractory cases.<a href="#cite_note-204">[204]</a> <a href="/wiki/Transcranial_magnetic_stimulation" title="Transcranial magnetic stimulation">Transcranial magnetic stimulation</a> has shown to provide therapeutic benefits in alleviating symptoms.<a href="#cite_note-205">[205]</a> <a href="/wiki/Psychosurgery" title="Psychosurgery">Surgery</a> may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical <a href="/wiki/Lesion" title="Lesion">lesion</a> is made in an area of the brain (the <a href="/wiki/Cingulate_cortex" title="Cingulate cortex">cingulate cortex</a>). In one study, 30% of participants benefitted significantly from this procedure.<a href="#cite_note-Barlow-206">[206]</a> <a href="/wiki/Deep_brain_stimulation" title="Deep brain stimulation">Deep brain stimulation</a> and <a href="/wiki/Vagus_nerve_stimulation" title="Vagus nerve stimulation">vagus nerve stimulation</a> are possible surgical options that do not require destruction of <a href="/wiki/Brain_tissue" class="mw-redirect" title="Brain tissue">brain tissue</a>. However, because deep brain stimulation results in such an instant and intense change, individuals may experience identity challenges afterward.<a href="#cite_note-207">[207]</a> In the United States, the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA) approved deep brain stimulation for the treatment of OCD under a <a href="/wiki/Humanitarian_Device_Exemption" title="Humanitarian Device Exemption">humanitarian device exemption</a>, requiring that the procedure be performed only in a hospital with special qualifications to do so.<a href="#cite_note-208">[208]</a> In the United States, <a href="/wiki/Psychosurgery" title="Psychosurgery">psychosurgery</a> for OCD is a treatment of last resort, and will not be performed until the person has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive <a href="/wiki/Cognitive%E2%80%93behavioral_therapy" class="mw-redirect" title="Cognitive–behavioral therapy">cognitive behavioral therapy</a> with exposure and ritual/response prevention.<a href="#cite_note-209">[209]</a> Likewise, in the United Kingdom, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out. <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3></div> Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents.<a href="#cite_note-210">[210]</a> Similar to the treatment of adults with OCD, cognitive behavioral therapy stands as an effective and validated first line of treatment of OCD in children.<a href="#cite_note-Freeman2014-211">[211]</a> Family involvement, in the form of behavioral observations and reports, is a key component to the success of such treatments.<a href="#cite_note-Rapoport,_J._E._1989-212">[212]</a> Parental interventions also provide positive reinforcement for a child who exhibits appropriate behaviors as alternatives to compulsive responses. In a recent meta-analysis of evidenced-based treatment of OCD in children, family-focused individual CBT was labeled as "probably efficacious," establishing it as one of the leading psychosocial treatments for youth with OCD.<a href="#cite_note-Freeman2014-211">[211]</a> After one or two years of therapy, in which a child learns the nature of their obsession and acquires strategies for coping, they may acquire a larger circle of friends, exhibit less shyness, and become less self-critical.<a href="#cite_note-213">[213]</a> Trials have shown that children and adolescents with OCD should begin treatment with the combination of CBT with a selective serotonin reuptake inhibitor or CBT alone, rather than only an SSRI.<a href="#cite_note-Cognitive-Behavior_Therapy,_Sertral-93">[93]</a><a href="#cite_note-Practice_Parameter_for_the_Assessme-95">[95]</a> Although the known causes of OCD in younger age groups range from brain abnormalities to psychological preoccupations, life stress such as bullying and traumatic familial deaths may also contribute to childhood cases of OCD, and acknowledging these stressors can play a role in treating the disorder.<a href="#cite_note-pmid19378573-214">[214]</a> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2></div> <a href="/wiki/Quality_of_life" title="Quality of life">Quality of life</a> is reduced across all domains in OCD. While psychological or pharmacological treatment can lead to a reduction of OCD symptoms and an increase in reported quality of life, symptoms may persist at moderate levels even following adequate treatment courses, and completely symptom-free periods are uncommon.<a href="#cite_note-pmid15533282-215">[215]</a><a href="#cite_note-216">[216]</a> In pediatric OCD, around 40% still have the disorder in adulthood, and around 40% qualify for <a href="/wiki/Remission_(medicine)" title="Remission (medicine)">remission</a>.<a href="#cite_note-217">[217]</a> The risk of having at least one comorbid personality disorder in OCD is 52%, which is the highest among anxiety disorders and greatly impacts its management and prognosis.<a href="#cite_note-218">[218]</a> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Delayed-maturation_theory_of_obsessive%E2%80%93compulsive_disorder" title="Delayed-maturation theory of obsessive–compulsive disorder">Delayed-maturation theory of obsessive–compulsive disorder</a></div><figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/ce/Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg/300px-Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg.png" decoding="async" width="300" height="132" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/ce/Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg/450px-Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/ce/Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg/600px-Obsessive-compulsive_disorder_world_map_-_DALY_-_WHO2004.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption>Age-standardized <a href="/wiki/Disability-adjusted_life_year" title="Disability-adjusted life year">disability-adjusted life year</a> estimated rates for obsessive-compulsive disorder per 100,000 inhabitants in 2004<style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col div-col-small" style="column-width: 9em;"> <style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend">  no data</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  <45</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  45–52.5</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  52.5–60</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  60–67.5</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  67.5–75</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  75–82.5</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  82.5–90</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  90–97.5</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  97.5–105</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  105–112.5</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  112.5–120</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend">  >120</div> </div></figcaption></figure> Obsessive–compulsive disorder affects about 2.3% of people at some point in their life, with the yearly rate about 1.2%.<a href="#cite_note-Good2014-6">[6]</a> OCD occurs worldwide.<a href="#cite_note-DSM52-2">[2]</a> It is unusual for symptoms to begin after the age of 35 and half of people develop problems before 20.<a href="#cite_note-NIH20152-1">[1]</a><a href="#cite_note-DSM52-2">[2]</a> Males and females are affected about equally.<a href="#cite_note-NIH20152-1">[1]</a> However, there is an earlier age for onset for males than females.<a href="#cite_note-219">[219]</a> <div class="mw-heading mw-heading2"><h2 id="History">History</h2></div> <a href="/wiki/Plutarch" title="Plutarch">Plutarch</a>, an <a href="/wiki/Ancient_Greek_philosophy" title="Ancient Greek philosophy">ancient Greek philosopher</a> and <a href="/wiki/Hellenic_historiography" title="Hellenic historiography">historian</a>, <a href="/wiki/Mental_illness_in_ancient_Rome" title="Mental illness in ancient Rome">describes</a> an ancient Roman man who possibly had <a href="/wiki/Scrupulosity" title="Scrupulosity">scrupulosity</a>, which could be a symptom of OCD or <a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">OCPD</a>. This man is described as "turning pale under his <a href="/wiki/Wreath_(attire)" title="Wreath (attire)">crown of flowers</a>," praying with a "faltering voice," and scattering "incense with trembling hands."<a href="#cite_note-220">[220]</a><a href="#cite_note-221">[221]</a><a href="#cite_note-222">[222]</a> In the 7th century AD, <a href="/wiki/John_Climacus" title="John Climacus">John Climacus</a> records an instance of a young <a href="/wiki/Monk" title="Monk">monk</a> plagued by constant and overwhelming "temptations to <a href="/wiki/Blasphemy" title="Blasphemy">blasphemy</a>" consulting an older monk, who told him: "My son, I take upon myself all the sins which these temptations have led you, or may lead you, to commit. All I require of you is that for the future you pay no attention to them whatsoever."<a href="#cite_note-Osborn1998-223">[223]</a>: 212  <a href="/wiki/The_Cloud_of_Unknowing" title="The Cloud of Unknowing">The Cloud of Unknowing</a>, a <a href="/wiki/Christians" title="Christians">Christian</a> mystical text from the late 14th century, recommends dealing with recurring obsessions by attempting to ignore them, and, if that fails, to "cower under them like a poor wretch and a coward overcome in battle, and reckon it to be a waste of your time for you to strive any longer against them", a technique now known as <a href="/wiki/Emotional_flooding" title="Emotional flooding">emotional flooding</a>.<a href="#cite_note-Osborn1998-223">[223]</a>: 213  <a href="/wiki/Abu_Zayd_al-Balkhi" title="Abu Zayd al-Balkhi">Abu Zayd Al-Balkhi</a>, the 9th century Islamic polymath, was likely the first to classify OCD into different types and pioneer <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a>, in a fashion unique to his era and which was not popular in Greek medicine.<a href="#cite_note-:18-224">[224]</a> In his medical treatise entitled Sustenance of the Body and Soul, Al-Balkhi describes obsessions particular to the disorder as "Annoying thoughts that are not real. These intrusive thoughts prevent enjoying life, and performing daily activities. They affect concentration and interfere with ability to carry out different tasks."<a href="#cite_note-225">[225]</a> As treatment, Al-Balkhi suggests treating obsessive thoughts with positive thoughts and mind-based therapy.<a href="#cite_note-:18-224">[224]</a> From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual or other obsessive thoughts were <a href="/wiki/Spiritual_possession" class="mw-redirect" title="Spiritual possession">possessed</a> by the <a href="/wiki/Satan" title="Satan">devil</a>.<a href="#cite_note-Aardema,_F._2007-168">[168]</a><a href="#cite_note-Osborn1998-223">[223]</a>: 213  Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through <a href="/wiki/Exorcism" title="Exorcism">exorcism</a>.<a href="#cite_note-Jenike-226">[226]</a><a href="#cite_note-berrios-227">[227]</a> The vast majority of people who thought that they were possessed by the devil did not have hallucinations or other "spectacular symptoms" but "complained of anxiety, religious fears, and evil thoughts."<a href="#cite_note-Osborn1998-223">[223]</a>: 213  In 1584, a woman from <a href="/wiki/Kent" title="Kent">Kent</a>, <a href="/wiki/England" title="England">England</a>, named Mrs. Davie, described by a <a href="/wiki/Justice_of_the_peace" title="Justice of the peace">justice of the peace</a> as "a good wife", was nearly <a href="/wiki/Death_by_burning" title="Death by burning">burned at the stake</a> after she confessed that she experienced constant, unwanted urges to murder her family.<a href="#cite_note-Osborn1998-223">[223]</a>: 213  The English term obsessive–compulsive arose as a translation of <a href="/wiki/German_language" title="German language">German</a> Zwangsvorstellung (obsession) used in the first conceptions of OCD by <a href="/wiki/Karl_Friedrich_Otto_Westphal" title="Karl Friedrich Otto Westphal">Karl Westphal</a>. Westphal's description went on to influence <a href="/wiki/Pierre_Janet" title="Pierre Janet">Pierre Janet</a>, who further documented features of OCD.<a href="#cite_note-Sadock-71">[71]</a> In the early 1910s, <a href="/wiki/Sigmund_Freud" title="Sigmund Freud">Sigmund Freud</a> attributed obsessive–compulsive behavior to unconscious conflicts that manifest as symptoms.<a href="#cite_note-Jenike-226">[226]</a> Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious."<a href="#cite_note-228">[228]</a> Freudian <a href="/wiki/Psychoanalysis" title="Psychoanalysis">psychoanalysis</a> remained the dominant treatment for OCD until the mid-1980s, even though medicinal and therapeutic treatments were known and available, because it was widely thought that these treatments would be detrimental to the effectiveness of the <a href="/wiki/Psychotherapy" title="Psychotherapy">psychotherapy</a>.<a href="#cite_note-Osborn1998-223">[223]</a>: 210–211  In the mid-1980s, this approach changed, and practitioners began treating OCD primarily with medicine and practical therapy rather than through psychoanalysis.<a href="#cite_note-Osborn1998-223">[223]</a>: 210  One of the first successful treatments of OCD, <a href="/wiki/Exposure_therapy" title="Exposure therapy">exposure and response prevention</a>, emerged during the 1960s, when psychologist <a href="/wiki/Vic_Meyer" title="Vic Meyer">Vic Meyer</a> exposed two hospitalized patients to anxiety-inducing situations while preventing them from performing any compulsions. Eventually, both patients' anxiety level dropped to manageable levels. Meyer devised this procedure from his analysis of <a href="/wiki/Extinction_(psychology)" title="Extinction (psychology)">fear extinguishment</a> in animals via <a href="/wiki/Flooding_(psychology)" title="Flooding (psychology)">flooding</a>.<a href="#cite_note-229">[229]</a> The success of ERP clinically and scientifically has been summarized as "spectacular" by prominent OCD researcher <a href="/wiki/Stanley_Rachman" title="Stanley Rachman">Stanley Rachman</a> decades following Meyer's creation of the method.<a href="#cite_note-:22-230">[230]</a> In 1967, psychiatrist <a href="/wiki/Juan_Jos%C3%A9_L%C3%B3pez-Ibor" title="Juan José López-Ibor">Juan José López-Ibor</a> reported that the drug <a href="/wiki/Clomipramine" title="Clomipramine">clomipramine</a> was effective in treating OCD. Many reports of its success in treatment followed, and several studies had confirmed its effectiveness by the 1980s.<a href="#cite_note-231">[231]</a><a href="#cite_note-ocdhistory.net-232">[232]</a> However, clomipramine was subsequently displaced by new <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">SSRIs</a> developed in the 1970s, such as <a href="/wiki/Fluoxetine" title="Fluoxetine">fluoxetine</a> and <a href="/wiki/Sertraline" title="Sertraline">sertraline</a>, which were shown to have fewer side effects.<a href="#cite_note-NEJM2014-4">[4]</a><a href="#cite_note-ocdhistory.net-232">[232]</a> Obsessive–compulsive symptoms worsened during the early stages of the <a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a>, particularly for individuals with contamination-related OCD.<a href="#cite_note-233">[233]</a> <div class="mw-heading mw-heading3"><h3 id="Notable_cases">Notable cases</h3></div> <a href="/wiki/John_Bunyan" title="John Bunyan">John Bunyan</a> (1628–1688), the author of <a href="/wiki/The_Pilgrim%27s_Progress" title="The Pilgrim's Progress">The Pilgrim's Progress</a>, displayed symptoms of OCD (which had not yet been named). During the most severe period of his condition, he would mutter the same phrase over and over again to himself while rocking back and forth.<a href="#cite_note-Osborn1998-223">[223]</a>: 53–54  He later described his obsessions in his autobiography <a href="/wiki/Grace_Abounding_to_the_Chief_of_Sinners" title="Grace Abounding to the Chief of Sinners">Grace Abounding to the Chief of Sinners</a>, stating, "These things may seem ridiculous to others, even as ridiculous as they were in themselves, but to me they were the most tormenting cogitations."<a href="#cite_note-Osborn1998-223">[223]</a>: 53–54  He wrote two pamphlets advising those with similar anxieties.<a href="#cite_note-Osborn1998-223">[223]</a>: 217–218  In one of them, he warns against indulging in compulsions: "Have care of putting off your trouble of spirit in the wrong way: by promising to reform yourself and lead a new life, by your performances or duties".<a href="#cite_note-Osborn1998-223">[223]</a>: 217–218  British poet, essayist and <a href="/wiki/Lexicography" title="Lexicography">lexicographer</a> <a href="/wiki/Samuel_Johnson" title="Samuel Johnson">Samuel Johnson</a> (1709–1784) also had OCD. He had elaborate rituals for crossing the thresholds of doorways, and repeatedly walked up and down staircases counting the steps.<a href="#cite_note-234">[234]</a><a href="#cite_note-Osborn1998-223">[223]</a>: 54–55  He would touch every post on the street as he walked past, only step in the middle of paving stones, and repeatedly perform tasks as though they had not been done properly the first time.<a href="#cite_note-Osborn1998-223">[223]</a>: 55  The "<a href="/wiki/Rat_Man" title="Rat Man">Rat Man</a>", real name Ernst Lanzer, a patient of <a href="/wiki/Sigmund_Freud" title="Sigmund Freud">Sigmund Freud</a>, suffered from what was then called "obsessional neurosis". Lanzer's illness was characterised most famously by a pattern of distressing intrusive thoughts in which he feared that his father or a female friend would be subjected to a purported Chinese method of <a href="/wiki/Torture" title="Torture">torture</a> in which rats would be encouraged to gnaw their way out of a victim's body by a hot poker.<a href="#cite_note-235">[235]</a> American aviator and filmmaker <a href="/wiki/Howard_Hughes" title="Howard Hughes">Howard Hughes</a> is known to have had OCD, primarily an obsessive fear of germs and contamination.<a href="#cite_note-236">[236]</a> Friends of Hughes have also mentioned his obsession with minor flaws in clothing.<a href="#cite_note-237">[237]</a> This was conveyed in <a href="/wiki/The_Aviator_(2004_film)" title="The Aviator (2004 film)">The Aviator</a> (2004), a film biography of Hughes.<a href="#cite_note-MGHOCD-238">[238]</a> English singer-songwriter <a href="/wiki/George_Ezra" title="George Ezra">George Ezra</a> has openly spoken about his life-long struggle with OCD, particularly <a href="/wiki/Primarily_obsessional_obsessive%E2%80%93compulsive_disorder" title="Primarily obsessional obsessive–compulsive disorder">primarily obsessional obsessive–compulsive disorder</a> (Pure O).<a href="#cite_note-239">[239]</a> Swedish climate activist <a href="/wiki/Greta_Thunberg" title="Greta Thunberg">Greta Thunberg</a> is also known to have OCD, among other mental health conditions.<a href="#cite_note-240">[240]</a> American actor <a href="/wiki/James_Spader" title="James Spader">James Spader</a> has also spoken about his OCD. In 2014, when interviewed for <a href="/wiki/Rolling_Stone" title="Rolling Stone">Rolling Stone</a> he said: "I'm obsessive-compulsive. I have very, very strong obsessive-compulsive issues. I'm very particular. ... It's very hard for me, you know? It makes you very addictive in behavior, because routine and ritual become entrenched. But in work, it manifests itself in obsessive attention to detail and fixation. It serves my work very well: Things don't slip by. But I'm not very easygoing.<a href="#cite_note-241">[241]</a> In 2022 the president of Chile <a href="/wiki/Gabriel_Boric" title="Gabriel Boric">Gabriel Boric</a> stated that he had OCD, saying: "I have an obsessive–compulsive disorder that's completely under control. Thank God I've been able to undergo treatment and it doesn't make me unable to carry out my responsibilities as the President of the Republic."<a href="#cite_note-242">[242]</a> In a documentary released in 2023, <a href="/wiki/David_Beckham" title="David Beckham">David Beckham</a> shared details about his compelling cleaning rituals, need for symmetry in the fridge, and the impact of OCD on his life.<a href="#cite_note-243">[243]</a> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:BFRB.Ribbbon.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e6/BFRB.Ribbbon.jpg/180px-BFRB.Ribbbon.jpg" decoding="async" width="180" height="295" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e6/BFRB.Ribbbon.jpg/270px-BFRB.Ribbbon.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e6/BFRB.Ribbbon.jpg/360px-BFRB.Ribbbon.jpg 2x" data-file-width="388" data-file-height="636" /></a><figcaption>This <a href="/wiki/Awareness_ribbon" title="Awareness ribbon">ribbon</a> represents <a href="/wiki/Trichotillomania" title="Trichotillomania">trichotillomania</a> and other body-focused repetitive behaviors.</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Art,_entertainment_and_media">Art, entertainment and media</h3></div> Movies and television shows may portray idealized or incomplete representations of disorders such as OCD.<a href="#cite_note-244">[244]</a> Compassionate and accurate literary and on-screen depictions may help counteract the potential <a href="/wiki/Social_stigma_against_mental_disorders" class="mw-redirect" title="Social stigma against mental disorders">stigma</a> associated with an OCD diagnosis, and lead to increased public awareness, understanding and sympathy for such disorders.<a href="#cite_note-245">[245]</a><a href="#cite_note-Goldberg-246">[246]</a> <ul><li>The play and film adaptations of <a href="/wiki/The_Odd_Couple_(film)" title="The Odd Couple (film)">The Odd Couple</a> based around the character of Felix, who shows some of the common symptoms of OCD.<a href="#cite_note-247">[247]</a></li> <li>In the film <a href="/wiki/As_Good_as_It_Gets" title="As Good as It Gets">As Good as It Gets</a> (1997), actor <a href="/wiki/Jack_Nicholson" title="Jack Nicholson">Jack Nicholson</a> portrays a man with OCD who performs ritualistic behaviors that disrupt his life.<a href="#cite_note-mghocd.org-248">[248]</a></li> <li>The film <a href="/wiki/Matchstick_Men" title="Matchstick Men">Matchstick Men</a> (2003) portrays a con man named Roy (<a href="/wiki/Nicolas_Cage" title="Nicolas Cage">Nicolas Cage</a>) with OCD who opens and closes doors three times while counting aloud before he can walk through them.<a href="#cite_note-249">[249]</a></li> <li>In the television series <a href="/wiki/Monk_(TV_series)" title="Monk (TV series)">Monk</a> (2002–2009), the titular character <a href="/wiki/Adrian_Monk" title="Adrian Monk">Adrian Monk</a> fears both human contact and dirt.<a href="#cite_note-250">[250]</a><a href="#cite_note-251">[251]</a></li> <li>The one-man show <a href="/wiki/The_Life_and_Slimes_of_Marc_Summers" title="The Life and Slimes of Marc Summers">The Life and Slimes of Marc Summers</a> (2016), a stage adaptation of <a href="/wiki/Marc_Summers" title="Marc Summers">Marc Summers</a>' 1999 memoir which recounts how OCD affected his entertainment career.<a href="#cite_note-Gioia_2016_n498-252">[252]</a></li> <li>In the novel <a href="/wiki/Turtles_All_the_Way_Down_(novel)" title="Turtles All the Way Down (novel)">Turtles All the Way Down</a> (2017) by <a href="/wiki/John_Green" title="John Green">John Green</a>, teenage main character Aza Holmes struggles with OCD that manifests as a fear of the human microbiome. Throughout the story, Aza repeatedly opens an unhealed <a href="/wiki/Callus" title="Callus">callus</a> on her finger to drain out what she believes are pathogens. The novel is based on Green's own experiences with OCD. He explained that Turtles All the Way Down is intended to show how "most people with chronic mental illnesses also live long, fulfilling lives".<a href="#cite_note-253">[253]</a></li> <li>The British TV series <a href="/wiki/Pure_(British_TV_series)" title="Pure (British TV series)">Pure</a> (2019) stars <a href="/wiki/Charly_Clive" title="Charly Clive">Charly Clive</a> as a 24-year-old Marnie who is plagued by disturbing sexual thoughts, as a kind of <a href="/wiki/Primarily_obsessional_obsessive_compulsive_disorder" class="mw-redirect" title="Primarily obsessional obsessive compulsive disorder">primarily obsessional obsessive compulsive disorder</a>.<a href="#cite_note-254">[254]</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2></div> The naturally occurring sugar <a href="/wiki/Inositol" title="Inositol">inositol</a> has been suggested as a treatment for OCD.<a href="#cite_note-255">[255]</a> <a href="/wiki/%CE%9C-opioid_receptor" title="Μ-opioid receptor">μ-Opioid receptor</a> agonists, such as <a href="/wiki/Hydrocodone" title="Hydrocodone">hydrocodone</a> and <a href="/wiki/Tramadol" title="Tramadol">tramadol</a>, may improve OCD symptoms.<a href="#cite_note-Davidson‌_03-256">[256]</a> Administration of opioids may be contraindicated in individuals concurrently taking <a href="/wiki/CYP2D6" title="CYP2D6">CYP2D6</a> inhibitors such as <a href="/wiki/Fluoxetine" title="Fluoxetine">fluoxetine</a> and <a href="/wiki/Paroxetine" title="Paroxetine">paroxetine</a>.<a href="#cite_note-Focus_07-257">[257]</a> Much research is devoted to the therapeutic potential of the agents that affect the release of the neurotransmitter <a href="/wiki/Glutamate" class="mw-redirect" title="Glutamate">glutamate</a> or the binding to its receptors. These include <a href="/wiki/Riluzole" title="Riluzole">riluzole</a>, <a href="/wiki/Memantine" title="Memantine">memantine</a>, <a href="/wiki/Gabapentin" title="Gabapentin">gabapentin</a>, <a href="/wiki/N-acetylcysteine" class="mw-redirect" title="N-acetylcysteine">N-acetylcysteine</a> (NAC), <a href="/wiki/Topiramate" title="Topiramate">topiramate</a>, and <a href="/wiki/Lamotrigine" title="Lamotrigine">lamotrigine</a>.<a href="#cite_note-Wu2012-258">[258]</a> Research on the potential for other supplements, such as <a href="/wiki/Milk_thistle" class="mw-redirect" title="Milk thistle">milk thistle</a>, to help with OCD and various neurological disorders, is ongoing.<a href="#cite_note-259">[259]</a> Researchers have identified over 600 genes related to cortical thickness, a factor that impacts OCD expression. "Notably, the enrichment of genes involved in ion transport regulation, responses to environmental stimuli, and metal ion transport regulation suggests the roles of these processes in OCD pathophysiology." <a href="#cite_note-260">[260]</a> Research indicates that people with OCD have a lower amplitude of low-frequency fluctuation in both the left and right putamen. The right putamen also displays decreased functional connectivity with the left putamen which extends to the left inferior frontal gyrus (IFG), bilateral precuneus extending to calcarine, right middle occipital cortex extending to the right middle temporal cortex, and left middle occipital gyrus. In addition, the decreased connectivity between the right putamen and the left putamen is negatively correlated with Y-BOCS scores. <a href="#cite_note-261">[261]</a> In a study exploring the correlation between neural biomarkers and response to transcranial Direct Current Stimulation (tDCS) in people with OCD, researchers found thicker precentral and paracentral areas in people with OCD compared to controls. A significant associated was found between a thinner precentral area and reduced YBOCS scores. <a href="#cite_note-262">[262]</a> <div class="mw-heading mw-heading2"><h2 id="Other_animals">Other animals</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Animal_psychopathology#Obsessive_compulsive_disorder_(OCD)" title="Animal psychopathology">Animal psychopathology § Obsessive compulsive disorder (OCD)</a></div> <div class="mw-heading mw-heading2"><h2 id="Advocacy">Advocacy</h2></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Unreferenced_section plainlinks metadata ambox ambox-content ambox-Unreferenced" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></div></td><td class="mbox-text"><div class="mbox-text-span">This section does not <a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources">cite</a> any <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">sources</a>. Please help <a href="/wiki/Special:EditPage/Obsessive%E2%80%93compulsive_disorder" title="Special:EditPage/Obsessive–compulsive disorder">improve this section</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a>. Unsourced material may be challenged and <a href="/wiki/Wikipedia:Verifiability#Burden_of_evidence" title="Wikipedia:Verifiability">removed</a>. (September 2024) (<a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a>)</div></td></tr></tbody></table> Many organizations and charities around the world advocate for the wellbeing of people with OCD, stigma reduction, research, and awareness. The <a rel="nofollow" class="external text" href="https://iocdf.org/">International OCD Foundation</a> (IOCDF) is the largest 501(c)3 nonprofit organization dedicated to serving a broad community of individuals with OCD and related disorders, their family members and loved ones, and mental health professionals and researchers around the world. Since 1986, the IOCDF provides up-to-date education and resources, strengthens community engagement worldwide, delivers quality professional training to clinicians, and funds groundbreaking research. <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2></div> <ul><li><a href="/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety disorder</a></li> <li><a href="/wiki/Bipolar_disorder" title="Bipolar disorder">Bipolar disorder</a></li> <li><a href="/wiki/Body_dysmorphic_disorder" title="Body dysmorphic disorder">Body dysmorphic disorder</a></li> <li><a href="/wiki/Compulsive_hoarder" class="mw-redirect" title="Compulsive hoarder">Compulsive hoarding</a></li> <li><a href="/wiki/Delusional_disorder" title="Delusional disorder">Delusional disorder</a></li> <li><a href="/wiki/Hypochondriasis" title="Hypochondriasis">Hypochondriasis</a></li> <li><a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">Major depressive disorder</a></li> <li><a href="/wiki/Obsessive%E2%80%93compulsive_spectrum" title="Obsessive–compulsive spectrum">Obsessive–compulsive spectrum</a></li> <li><a href="/wiki/Tic_disorder" title="Tic disorder">Tic disorder</a></li> <li><a href="/wiki/Body-focused_repetitive_behavior" title="Body-focused repetitive behavior">Body-focused repetitive behavior</a> <ul><li><a href="/wiki/Trichotillomania" title="Trichotillomania">Trichotillomania</a></li></ul></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-NIH20152-1">^ <a href="#cite_ref-NIH20152_1-0">a</a> <a href="#cite_ref-NIH20152_1-1">b</a> <a href="#cite_ref-NIH20152_1-2">c</a> <a href="#cite_ref-NIH20152_1-3">d</a> <a href="#cite_ref-NIH20152_1-4">e</a> <a href="#cite_ref-NIH20152_1-5">f</a> <a href="#cite_ref-NIH20152_1-6">g</a> <a href="#cite_ref-NIH20152_1-7">h</a> <a href="#cite_ref-NIH20152_1-8">i</a> <a href="#cite_ref-NIH20152_1-9">j</a> <a 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University of Chicago Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-226-13782-7" title="Special:BookSources/978-0-226-13782-7"><bdi>978-0-226-13782-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Obsession%3A+A+History&rft.pub=University+of+Chicago+Press&rft.date=2008&rft.isbn=978-0-226-13782-7&rft.aulast=Davis&rft.aufirst=LJ&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fobsessionhistory00davi_0&rfr_id=info%3Asid%2Fen.wikipedia.org%3AObsessive%E2%80%93compulsive+disorder" class="Z3988"></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output 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dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q178190" class="extiw" title="d:Q178190">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#1582741816">6B20</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/F42">F42</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=300.3">300.3</a></li><li><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a>: <a rel="nofollow" class="external text" href="https://omim.org/entry/164230">164230</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D009771">D009771</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb33766.htm">33766</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000929.htm">000929</a></li><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/287681-overview">article/287681</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Mental_disorders_(Classification)" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Mental_disorders" title="Template:Mental disorders"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Mental_disorders" title="Template talk:Mental disorders"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Mental_disorders" title="Special:EditPage/Template:Mental disorders"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Mental_disorders_(Classification)" style="font-size:114%;margin:0 4em"><a href="/wiki/Mental_disorder" title="Mental disorder">Mental disorders</a> (<a href="/wiki/Classification_of_mental_disorders" title="Classification of mental disorders">Classification</a>)</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Adult_personality_and_behavior" style="font-size:114%;margin:0 4em">Adult personality and behavior</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Sexual</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ego-dystonic_sexual_orientation" title="Ego-dystonic sexual orientation">Ego-dystonic sexual orientation</a></li> <li><a href="/wiki/Paraphilia" title="Paraphilia">Paraphilia</a> <ul><li><a href="/wiki/Sexual_fetishism" title="Sexual fetishism">Fetishism</a></li> <li><a href="/wiki/Voyeurism" title="Voyeurism">Voyeurism</a></li></ul></li> <li><a href="/wiki/Sexual_anhedonia" title="Sexual anhedonia">Sexual anhedonia</a></li> <li><a href="/wiki/Sexual_anorexia" title="Sexual anorexia">Sexual anorexia</a></li> <li><a href="/wiki/Sexual_maturation_disorder" title="Sexual maturation disorder">Sexual maturation disorder</a></li> <li><a href="/wiki/Sexual_relationship_disorder" title="Sexual relationship disorder">Sexual relationship disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Factitious_disorder" title="Factitious disorder">Factitious disorder</a> <ul><li><a href="/wiki/Factitious_disorder_imposed_on_self" title="Factitious disorder imposed on self">Munchausen syndrome</a></li></ul></li> <li><a href="/wiki/Fear_of_intimacy" title="Fear of intimacy">Fear of intimacy</a></li> <li><a href="/wiki/Gender_dysphoria" title="Gender dysphoria">Gender dysphoria</a></li> <li><a href="/wiki/Intermittent_explosive_disorder" title="Intermittent explosive disorder">Intermittent explosive disorder</a></li> <li><a href="/wiki/Excoriation_disorder" title="Excoriation disorder">Dermatillomania</a></li> <li><a href="/wiki/Kleptomania" title="Kleptomania">Kleptomania</a></li> <li><a href="/wiki/Pyromania" title="Pyromania">Pyromania</a></li> <li><a href="/wiki/Trichotillomania" title="Trichotillomania">Trichotillomania</a></li> <li><a href="/wiki/Personality_disorder" title="Personality disorder">Personality disorder</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Childhood_and_learning" style="font-size:114%;margin:0 4em"><a href="/wiki/Mental_disorders_diagnosed_in_childhood" title="Mental disorders diagnosed in childhood">Childhood and learning</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Emotional_and_behavioral_disorders" title="Emotional and behavioral disorders">Emotional and behavioral</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">ADHD</a></li> <li><a href="/wiki/Conduct_disorder" title="Conduct disorder">Conduct disorder</a> <ul><li><a href="/wiki/Oppositional_defiant_disorder" title="Oppositional defiant disorder">ODD</a></li></ul></li> <li><a href="/wiki/Emotional_and_behavioral_disorders" title="Emotional and behavioral disorders">Emotional and behavioral disorders</a> <ul><li><a href="/wiki/Separation_anxiety_disorder" title="Separation anxiety disorder">Separation anxiety disorder</a></li></ul></li> <li><a href="/wiki/Movement_disorders" class="mw-redirect" title="Movement disorders">Movement disorders</a> <ul><li><a href="/wiki/Stereotypic_movement_disorder" title="Stereotypic movement disorder">Stereotypic</a></li></ul></li> <li>Social functioning <ul><li><a href="/wiki/Disinhibited_attachment_disorder" title="Disinhibited attachment disorder">DAD</a></li> <li><a href="/wiki/Reactive_attachment_disorder" title="Reactive attachment disorder">RAD</a></li> <li><a href="/wiki/Selective_mutism" title="Selective mutism">Selective mutism</a></li></ul></li> <li><a href="/wiki/Speech_disorder" title="Speech disorder">Speech</a> <ul><li><a href="/wiki/Cluttering" title="Cluttering">Cluttering</a></li> <li><a href="/wiki/Stuttering" title="Stuttering">Stuttering</a></li></ul></li> <li><a href="/wiki/Tic_disorder" title="Tic disorder">Tic disorder</a> <ul><li><a href="/wiki/Tourette_syndrome" title="Tourette syndrome">Tourette syndrome</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Intellectual_disability" title="Intellectual disability">Intellectual disability</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/X-linked_intellectual_disability" title="X-linked intellectual disability">X-linked intellectual disability</a> <ul><li><a href="/wiki/Lujan%E2%80%93Fryns_syndrome" title="Lujan–Fryns syndrome">Lujan–Fryns syndrome</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Psychological development (<a href="/wiki/Developmental_disability" title="Developmental disability">developmental disabilities</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pervasive_developmental_disorder" title="Pervasive developmental disorder">Pervasive</a></li> <li><a href="/wiki/Specific_developmental_disorder" title="Specific developmental disorder">Specific</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Mood_(affective)" style="font-size:114%;margin:0 4em"><a href="/wiki/Mood_disorder" title="Mood disorder">Mood</a> (affective)</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bipolar_disorder" title="Bipolar disorder">Bipolar</a> <ul><li><a href="/wiki/Bipolar_I_disorder" title="Bipolar I disorder">Bipolar I</a></li> <li><a href="/wiki/Bipolar_II_disorder" title="Bipolar II disorder">Bipolar II</a></li> <li><a href="/wiki/Bipolar_disorder_not_otherwise_specified" title="Bipolar disorder not otherwise specified">Bipolar NOS</a></li> <li><a href="/wiki/Cyclothymia" title="Cyclothymia">Cyclothymia</a></li></ul></li> <li><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depression</a> <ul><li><a href="/wiki/Atypical_depression" title="Atypical depression">Atypical depression</a></li> <li><a href="/wiki/Dysthymia" title="Dysthymia">Dysthymia</a></li> <li><a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">Major depressive disorder</a></li> <li><a href="/wiki/Melancholic_depression" class="mw-redirect" title="Melancholic depression">Melancholic depression</a></li> <li><a href="/wiki/Seasonal_affective_disorder" title="Seasonal affective disorder">Seasonal affective disorder</a></li></ul></li> <li><a href="/wiki/Mania" title="Mania">Mania</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Neurological_and_symptomatic" style="font-size:114%;margin:0 4em">Neurological and symptomatic</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Autism_spectrum" class="mw-redirect" title="Autism spectrum">Autism spectrum</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Autism" title="Autism">Autism</a></li> <li><a href="/wiki/Asperger_syndrome" title="Asperger syndrome">Asperger syndrome</a></li> <li><a href="/wiki/High-functioning_autism" title="High-functioning autism">High-functioning autism</a></li> <li><a href="/wiki/Pervasive_developmental_disorder_not_otherwise_specified" title="Pervasive developmental disorder not otherwise specified">PDD-NOS</a></li> <li><a href="/wiki/Savant_syndrome" title="Savant syndrome">Savant syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dementia" title="Dementia">Dementia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV-associated_neurocognitive_disorder" title="HIV-associated neurocognitive disorder">AIDS dementia complex</a></li> <li><a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's disease</a></li> <li><a href="/wiki/Creutzfeldt%E2%80%93Jakob_disease" title="Creutzfeldt–Jakob disease">Creutzfeldt–Jakob disease</a></li> <li><a href="/wiki/Frontotemporal_dementia" title="Frontotemporal dementia">Frontotemporal dementia</a></li> <li><a href="/wiki/Huntington%27s_disease" title="Huntington's disease">Huntington's disease</a></li> <li><a href="/wiki/Mild_cognitive_impairment" title="Mild cognitive impairment">Mild cognitive impairment</a></li> <li><a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">Parkinson's disease</a></li> <li><a href="/wiki/Pick%27s_disease" class="mw-redirect" title="Pick's disease">Pick's disease</a></li> <li><a href="/wiki/Sundowning" title="Sundowning">Sundowning</a></li> <li><a href="/wiki/Vascular_dementia" title="Vascular dementia">Vascular dementia</a></li> <li><a href="/wiki/Wandering_(dementia)" title="Wandering (dementia)">Wandering</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Delirium" title="Delirium">Delirium</a></li> <li><a href="/wiki/Organic_brain_syndrome" title="Organic brain syndrome">Organic brain syndrome</a></li> <li><a href="/wiki/Post-concussion_syndrome" title="Post-concussion syndrome">Post-concussion syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible uncollapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Neurotic,_stress-related_and_somatoform" style="font-size:114%;margin:0 4em"><a href="/wiki/Neurosis" title="Neurosis">Neurotic</a>, <a href="/wiki/Stress_(biology)" title="Stress (biology)">stress</a>-related and <a href="/wiki/Somatic_symptom_disorder" title="Somatic symptom disorder">somatoform</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adjustment_disorder" title="Adjustment disorder">Adjustment</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adjustment_disorder" title="Adjustment disorder">Adjustment disorder</a> with depressed mood</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Phobia" title="Phobia">Phobia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Agoraphobia" title="Agoraphobia">Agoraphobia</a></li> <li><a href="/wiki/Childhood_phobia" title="Childhood phobia">Childhood phobia</a></li> <li><a href="/wiki/Social_anxiety" title="Social anxiety">Social anxiety</a></li> <li><a href="/wiki/Social_anxiety_disorder" title="Social anxiety disorder">Social phobia</a> <ul><li><a href="/wiki/Anthropophobia" class="mw-redirect" title="Anthropophobia">Anthropophobia</a></li> <li><a href="/wiki/Specific_social_phobia" title="Specific social phobia">Specific social phobia</a></li></ul></li> <li><a href="/wiki/Specific_phobia" title="Specific phobia">Specific phobia</a> <ul><li><a href="/wiki/Claustrophobia" title="Claustrophobia">Claustrophobia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Generalized_anxiety_disorder" title="Generalized anxiety disorder">Generalized anxiety disorder</a></li> <li><a class="mw-selflink selflink">OCD</a></li> <li><a href="/wiki/Panic_attack" title="Panic attack">Panic attack</a></li> <li><a href="/wiki/Panic_disorder" title="Panic disorder">Panic disorder</a></li> <li><a href="/wiki/Psychological_stress" title="Psychological stress">Stress</a> <ul><li><a href="/wiki/Acute_stress_reaction" title="Acute stress reaction">Acute stress reaction</a></li> <li><a href="/wiki/Post-traumatic_stress_disorder" title="Post-traumatic stress disorder">PTSD</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dissociative_disorder" class="mw-redirect" title="Dissociative disorder">Dissociative</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Depersonalization-derealization_disorder" title="Depersonalization-derealization disorder">Depersonalization-derealization disorder</a></li> <li><a href="/wiki/Dissociative_identity_disorder" title="Dissociative identity disorder">Dissociative identity disorder</a></li> <li><a href="/wiki/Dissociative_fugue" title="Dissociative fugue">Dissociative fugue</a></li> <li><a href="/wiki/Psychogenic_amnesia" class="mw-redirect" title="Psychogenic amnesia">Psychogenic amnesia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Somatic_symptom_disorder" title="Somatic symptom disorder">Somatic symptom</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Body_dysmorphic_disorder" title="Body dysmorphic disorder">Body dysmorphic disorder</a></li> <li><a href="/wiki/Conversion_disorder" title="Conversion disorder">Conversion disorder</a> <ul><li><a href="/wiki/Ganser_syndrome" title="Ganser syndrome">Ganser syndrome</a></li> <li><a href="/wiki/Globus_pharyngis" title="Globus pharyngis">Globus pharyngis</a></li> <li><a href="/wiki/Psychogenic_non-epileptic_seizure" title="Psychogenic non-epileptic seizure">Psychogenic non-epileptic seizures</a></li></ul></li> <li><a href="/wiki/False_pregnancy" title="False pregnancy">False pregnancy</a></li> <li><a href="/wiki/Hypochondriasis" title="Hypochondriasis">Hypochondriasis</a></li> <li><a href="/wiki/Mass_psychogenic_illness" title="Mass psychogenic illness">Mass psychogenic illness</a></li> <li><a href="/wiki/Nosophobia" title="Nosophobia">Nosophobia</a></li> <li><a href="/wiki/Psychogenic_pain" title="Psychogenic pain">Psychogenic pain</a></li> <li><a href="/wiki/Somatization_disorder" class="mw-redirect" title="Somatization disorder">Somatization disorder</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Physiological_and_physical_behavior" style="font-size:114%;margin:0 4em">Physiological and physical behavior</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Eating_disorder" title="Eating disorder">Eating</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">Anorexia nervosa</a></li> <li><a href="/wiki/Bulimia_nervosa" title="Bulimia nervosa">Bulimia nervosa</a></li> <li><a href="/wiki/Rumination_syndrome" title="Rumination syndrome">Rumination syndrome</a></li> <li><a href="/wiki/Other_specified_feeding_or_eating_disorder" title="Other specified feeding or eating disorder">Other specified feeding or eating disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonorganic <a href="/wiki/Sleep_disorder" title="Sleep disorder">sleep</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypersomnia" title="Hypersomnia">Hypersomnia</a></li> <li><a href="/wiki/Insomnia" title="Insomnia">Insomnia</a></li> <li><a href="/wiki/Parasomnia" title="Parasomnia">Parasomnia</a> <ul><li><a href="/wiki/Night_terror" title="Night terror">Night terror</a></li> <li><a href="/wiki/Nightmare" title="Nightmare">Nightmare</a></li> <li><a href="/wiki/Rapid_eye_movement_sleep_behavior_disorder" title="Rapid eye movement sleep behavior disorder">REM sleep behavior disorder</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Psychiatric_disorders_of_childbirth" title="Psychiatric disorders of childbirth">Postnatal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Postpartum_depression" title="Postpartum depression">Postpartum depression</a></li> <li><a href="/wiki/Postpartum_psychosis" title="Postpartum psychosis">Postpartum psychosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sexual_dysfunction#Sexual_desire_disorders" title="Sexual dysfunction">Sexual desire</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypersexuality" title="Hypersexuality">Hypersexuality</a></li> <li><a href="/wiki/Hypoactive_sexual_desire_disorder" title="Hypoactive sexual desire disorder">Hypoactive sexual desire disorder</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Psychoactive_substances,_substance_abuse_and_substance-related" style="font-size:114%;margin:0 4em"><a href="/wiki/Psychoactive_drug" title="Psychoactive drug">Psychoactive</a> substances, <a href="/wiki/Substance_abuse" title="Substance abuse">substance abuse</a> and substance-related</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_overdose" title="Drug overdose">Drug overdose</a></li> <li><a href="/wiki/Substance_intoxication" title="Substance intoxication">Intoxication</a></li> <li><a href="/wiki/Physical_dependence" title="Physical dependence">Physical dependence</a></li> <li><a href="/wiki/Rebound_effect" title="Rebound effect">Rebound effect</a></li> <li><a href="/wiki/Stimulant_psychosis" title="Stimulant psychosis">Stimulant psychosis</a></li> <li><a href="/wiki/Substance_dependence" title="Substance dependence">Substance dependence</a></li> <li><a href="/wiki/Drug_withdrawal" title="Drug withdrawal">Withdrawal</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Schizophrenia,_schizotypal_and_delusional" style="font-size:114%;margin:0 4em"><a href="/wiki/Schizophrenia" title="Schizophrenia">Schizophrenia</a>, <a href="/wiki/Schizotypal_personality_disorder" title="Schizotypal personality disorder">schizotypal</a> and <a href="/wiki/Delusional_disorder" title="Delusional disorder">delusional</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Delusional</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Delusional_disorder" title="Delusional disorder">Delusional disorder</a></li> <li><a href="/wiki/Folie_%C3%A0_deux" title="Folie à deux">Folie à deux</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Psychosis" title="Psychosis">Psychosis</a> and schizophrenia-like</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Brief_reactive_psychosis" class="mw-redirect" title="Brief reactive psychosis">Brief reactive psychosis</a></li> <li><a href="/wiki/Schizoaffective_disorder" title="Schizoaffective disorder">Schizoaffective disorder</a></li> <li><a href="/wiki/Schizophreniform_disorder" title="Schizophreniform disorder">Schizophreniform disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Schizophrenia</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Childhood_schizophrenia" title="Childhood schizophrenia">Childhood schizophrenia</a></li> <li><a href="/wiki/Disorganized_schizophrenia" title="Disorganized schizophrenia">Disorganized (hebephrenic) schizophrenia</a></li> <li><a href="/wiki/Pseudoneurotic_schizophrenia" title="Pseudoneurotic schizophrenia">Pseudoneurotic schizophrenia</a></li> <li><a href="/wiki/Simple-type_schizophrenia" title="Simple-type schizophrenia">Simple-type schizophrenia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Catatonia" title="Catatonia">Catatonia</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks mw-collapsible mw-collapsed navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Symptoms_and_uncategorized" style="font-size:114%;margin:0 4em">Symptoms and uncategorized</div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Impulse-control_disorder" title="Impulse-control disorder">Impulse-control disorder</a></li> <li><a href="/wiki/Kl%C3%BCver%E2%80%93Bucy_syndrome" title="Klüver–Bucy syndrome">Klüver–Bucy syndrome</a></li> <li><a href="/wiki/Psychomotor_agitation" title="Psychomotor agitation">Psychomotor agitation</a></li> <li><a href="/wiki/Stereotypy" title="Stereotypy">Stereotypy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Obsessive–compulsive_disorder" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Obsessive%E2%80%93compulsive_disorder" title="Template:Obsessive–compulsive disorder"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Obsessive%E2%80%93compulsive_disorder" title="Template talk:Obsessive–compulsive disorder"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Obsessive%E2%80%93compulsive_disorder" title="Special:EditPage/Template:Obsessive–compulsive disorder"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Obsessive–compulsive_disorder" style="font-size:114%;margin:0 4em"><a class="mw-selflink selflink">Obsessive–compulsive disorder</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">History</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dimensional_Obsessive-Compulsive_Scale" title="Dimensional Obsessive-Compulsive Scale">Dimensional Obsessive-Compulsive Scale</a></li> <li><a href="/wiki/Yale%E2%80%93Brown_Obsessive_Compulsive_Scale" class="mw-redirect" title="Yale–Brown Obsessive Compulsive Scale">Yale–Brown Obsessive Compulsive Scale</a></li> <li><a href="/wiki/OCD_Awareness_Week" title="OCD Awareness Week">OCD Awareness Week</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Biology_of_obsessive%E2%80%93compulsive_disorder" title="Biology of obsessive–compulsive disorder">Biology</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Neuroanatomy" scope="row" class="navbox-group" style="width:1%">Neuroanatomy</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Basal_ganglia" title="Basal ganglia">Basal ganglia</a> (<a href="/wiki/Striatum" title="Striatum">striatum</a>)</li> <li><a href="/wiki/Orbitofrontal_cortex" title="Orbitofrontal cortex">Orbitofrontal cortex</a></li> <li><a href="/wiki/Cingulate_cortex" title="Cingulate cortex">Cingulate cortex</a></li> <li><a href="/wiki/Brain-derived_neurotrophic_factor" title="Brain-derived neurotrophic factor">Brain-derived neurotrophic factor</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Receptors</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/5-HT1D_receptor" title="5-HT1D receptor">5-HT1Dβ</a></li> <li><a href="/wiki/5-HT2A_receptor" title="5-HT2A receptor">5-HT2A</a></li> <li><a href="/wiki/5-HT2C_receptor" title="5-HT2C receptor">5-HT2C</a></li> <li><a href="/wiki/%CE%9C-opioid_receptor" title="Μ-opioid receptor">μ Opioid</a></li> <li><a href="/wiki/Histamine_H2_receptor" title="Histamine H2 receptor">H2</a></li> <li><a href="/wiki/Tachykinin_receptor_1" title="Tachykinin receptor 1">NK1</a></li> <li><a href="/wiki/Muscarinic_acetylcholine_receptor_M4" title="Muscarinic acetylcholine receptor M4">M4</a></li> <li><a href="/wiki/NMDA_receptor" title="NMDA receptor">NMDA</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Symptoms</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intrusive_thoughts" class="mw-redirect" title="Intrusive thoughts">Obsessions</a> (<a href="/wiki/Magical_thinking" title="Magical thinking">associative</a></li> <li><a href="/wiki/Hypochondriasis" title="Hypochondriasis">diagnostic</a></li> <li><a href="/wiki/Self-harm" title="Self-harm">injurious</a></li> <li><a href="/wiki/Mysophobia" title="Mysophobia">pathogenic</a></li> <li><a href="/wiki/Sexual_obsessions" title="Sexual obsessions">sexual</a></li> <li><a href="/wiki/Scrupulosity" title="Scrupulosity">scrupulous</a></li> <li><a href="/wiki/Symmetry" title="Symmetry">symmetry</a>)</li> <li><a href="/wiki/Compulsive_behavior" title="Compulsive behavior">Compulsions</a> (<a href="/wiki/Impulse_(psychology)" class="mw-redirect" title="Impulse (psychology)">impulses</a></li> <li><a href="/wiki/Ritual" title="Ritual">rituals</a></li> <li><a href="/wiki/Tic" title="Tic">tics</a>)</li> <li><a href="/wiki/Thought_suppression" title="Thought suppression">Thought suppression</a> (<a href="/wiki/Experiential_avoidance" title="Experiential avoidance">Experiential avoidance</a>)</li> <li><a href="/wiki/Hoarding" title="Hoarding">Hoarding</a> (<a href="/wiki/Animal_hoarding" title="Animal hoarding">animals</a></li> <li><a href="/wiki/Bibliomania" title="Bibliomania">books</a></li> <li><a href="/wiki/Digital_hoarding" title="Digital hoarding">data</a></li> <li><a href="/wiki/Hoarding_disorder" title="Hoarding disorder">possessions</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Treatment</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Serotonergics" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Serotonin" title="Serotonin">Serotonergics</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Selective_serotonin_reuptake_inhibitors" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">Selective serotonin reuptake inhibitors</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Escitalopram" title="Escitalopram">Escitalopram</a></li> <li><a href="/wiki/Fluoxetine" title="Fluoxetine">Fluoxetine</a></li> <li><a href="/wiki/Fluvoxamine" title="Fluvoxamine">Fluvoxamine</a></li> <li><a href="/wiki/Paroxetine" title="Paroxetine">Paroxetine</a></li> <li><a href="/wiki/Sertraline" title="Sertraline">Sertraline</a></li> <li><a href="/wiki/Citalopram" title="Citalopram">Citalopram</a></li> <li><a href="/wiki/Nefazodone" title="Nefazodone">Nefazodone</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Monoamine_oxidase_inhibitor" title="Monoamine oxidase inhibitor">Monoamine oxidase inhibitors</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Phenelzine" title="Phenelzine">Phenelzine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Tricyclic_antidepressant" title="Tricyclic antidepressant">Tricyclic antidepressants</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clomipramine" title="Clomipramine">Clomipramine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">Atypical antipsychotics</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aripiprazole" title="Aripiprazole">Aripiprazole</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Inositol" title="Inositol">Inositol</a></li> <li><a href="/wiki/Deep_brain_stimulation" title="Deep brain stimulation">Deep brain stimulation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Behavioral</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">Acceptance and commitment therapy</a></li> <li><a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> (<a href="/wiki/Exposure_and_response_prevention" class="mw-redirect" title="Exposure and response prevention">Exposure and response prevention</a>)</li> <li><a href="/wiki/Inference-based_therapy" title="Inference-based therapy">Inference-based therapy</a></li> <li><a href="/wiki/Metacognitive_therapy" title="Metacognitive therapy">Metacognitive therapy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Popular culture</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Literature</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Fictional</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Matchstick_Men" title="Matchstick Men">Matchstick Men</a></li> <li><a href="/wiki/Plyushkin" title="Plyushkin">Plyushkin</a></li> <li><a href="/wiki/Xenocide" title="Xenocide">Xenocide</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Nonfiction</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Everything_in_Its_Place" class="mw-redirect" title="Everything in Its Place">Everything in Its Place</a></li> <li><a href="/wiki/Just_Checking:_Scenes_From_the_Life_of_an_Obsessive-Compulsive" title="Just Checking: Scenes From the Life of an Obsessive-Compulsive">Just Checking</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Media</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/As_Good_as_It_Gets" title="As Good as It Gets">As Good as It Gets</a></li> <li><a href="/wiki/The_Aviator_(2004_film)" title="The Aviator (2004 film)">The Aviator</a></li> <li><a href="/wiki/Matchstick_Men" title="Matchstick Men">Matchstick Men</a></li> <li><a href="/wiki/Adrian_Monk" title="Adrian Monk">Adrian Monk</a></li> <li><a href="/wiki/Pure_(British_TV_series)" title="Pure (British TV series)">Pure</a></li> <li>"<a href="/wiki/$pringfield_(or,_How_I_Learned_to_Stop_Worrying_and_Love_Legalized_Gambling)" title="$pringfield (or, How I Learned to Stop Worrying and Love Legalized Gambling)">$pringfield</a>"</li> <li><a href="/wiki/Straight_Up_(2019_film)" title="Straight Up (2019 film)">Straight Up</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Category:Obsessive%E2%80%93compulsive_disorder" title="Category:Obsessive–compulsive disorder">Related</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Guilt_(emotion)" title="Guilt (emotion)">Guilt (emotion)</a></li> <li><a href="/wiki/Illusion_of_control" title="Illusion of control">Illusion of control</a></li> <li><a href="/wiki/Obsessive%E2%80%93compulsive_personality_disorder" title="Obsessive–compulsive personality disorder">Obsessive–compulsive personality disorder</a></li> <li><a href="/wiki/Obsessional_jealousy" title="Obsessional jealousy">Obsessional jealousy</a></li> <li><a href="/wiki/PANDAS" title="PANDAS">PANDAS</a></li> <li><a href="/wiki/Primarily_Obsessional_OCD" class="mw-redirect" title="Primarily Obsessional OCD">Primarily Obsessional OCD</a></li> <li><a href="/wiki/Questionable_cause" title="Questionable cause">Questionable cause</a></li> <li><a href="/wiki/Relationship_obsessive%E2%80%93compulsive_disorder" title="Relationship obsessive–compulsive disorder">Relationship obsessive–compulsive disorder</a></li> <li><a href="/wiki/Social_anxiety_disorder" title="Social anxiety disorder">Social anxiety disorder</a></li> <li><a href="/wiki/Superstition" title="Superstition">Superstition</a></li> <li><a href="/wiki/Tourette_syndrome" title="Tourette syndrome">Tourette syndrome</a></li> <li><a href="/wiki/University_of_Florida_Obsessive%E2%80%93Compulsive_Disorder_Program" title="University of Florida Obsessive–Compulsive Disorder Program">University of Florida Obsessive–Compulsive Disorder Program</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="OCD_pharmacotherapies" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:OCD_pharmacotherapies" title="Template:OCD pharmacotherapies"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:OCD_pharmacotherapies" title="Template talk:OCD pharmacotherapies"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:OCD_pharmacotherapies" title="Special:EditPage/Template:OCD pharmacotherapies"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="OCD_pharmacotherapies" style="font-size:114%;margin:0 4em"><a class="mw-selflink-fragment" href="#Medication"><abbr title="Obsessive-compulsive disorder">OCD</abbr> pharmacotherapies</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Selective_serotonin_reuptake_inhibitors" class="mw-redirect" title="Selective serotonin reuptake inhibitors"><abbr title="Selective serotonin reuptake inhibitors">SSRIs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Selective serotonin reuptake inhibitors (<a href="/wiki/Citalopram" title="Citalopram">citalopram</a>, <a href="/wiki/Escitalopram" title="Escitalopram">escitalopram</a>, <a href="/wiki/Fluoxetine" title="Fluoxetine">fluoxetine</a>, <a href="/wiki/Fluvoxamine" title="Fluvoxamine">fluvoxamine</a>, <a href="/wiki/Paroxetine" title="Paroxetine">paroxetine</a>, <a href="/wiki/Sertraline" title="Sertraline">sertraline</a>)</li> <li><a href="/wiki/Serotonin-norepinephrine_reuptake_inhibitors" class="mw-redirect" title="Serotonin-norepinephrine reuptake inhibitors"><abbr title="Serotonin-norepinephrine reuptake inhibitors">SNRIs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Serotonin-norepinephrine reuptake inhibitors (<a href="/wiki/Venlafaxine" title="Venlafaxine">venlafaxine</a>)</li> <li><a href="/wiki/Tricyclic_antidepressants" class="mw-redirect" title="Tricyclic antidepressants"><abbr title="Tricyclic antidepressants">TCAs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Tricyclic antidepressants (<a href="/wiki/Clomipramine" title="Clomipramine">clomipramine</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Others</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Typical_antipsychotic" title="Typical antipsychotic">Typical antipsychotics</a> (<a href="/wiki/Haloperidol" title="Haloperidol">haloperidol</a>)</li> <li><a href="/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">Atypical antipsychotics</a> (<a href="/wiki/Aripiprazole" title="Aripiprazole">aripiprazole</a>, <a href="/wiki/Olanzapine" title="Olanzapine">olanzapine</a>, <a href="/wiki/Quetiapine" title="Quetiapine">quetiapine</a>, <a href="/wiki/Risperidone" title="Risperidone">risperidone</a>)</li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Digital_media_use_and_mental_health" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Digital_media_use_and_mental_health" title="Template:Digital media use and mental health"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Digital_media_use_and_mental_health" title="Template talk:Digital media use and mental health"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Digital_media_use_and_mental_health" title="Special:EditPage/Template:Digital media use and mental health"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Digital_media_use_and_mental_health" style="font-size:114%;margin:0 4em"><a href="/wiki/Digital_media_use_and_mental_health" title="Digital media use and mental health">Digital media use and mental health</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Proposed or recognised diagnostic categories</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Computer_addiction" title="Computer addiction">Computer addiction</a></li> <li><a href="/wiki/Internet_addiction_disorder" title="Internet addiction disorder">Internet addiction disorder</a></li> <li><a href="/wiki/Internet_sex_addiction" title="Internet sex addiction">Internet sex addiction</a></li> <li><a href="/wiki/Online_gambling" title="Online gambling">Online problem gambling</a></li> <li><a href="/wiki/Problematic_smartphone_use" title="Problematic smartphone use">Problematic smartphone use</a> <ul><li><a href="/wiki/Nomophobia" title="Nomophobia">Nomophobia</a></li></ul></li> <li><a href="/wiki/Problematic_social_media_use" title="Problematic social media use">Problematic social media use</a></li> <li><a href="/wiki/Television_addiction" title="Television addiction">Television addiction</a></li> <li><a href="/wiki/Video_game_addiction" title="Video game addiction">Video game addiction</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Disciplines involved</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Digital_anthropology" title="Digital anthropology">Digital anthropology</a></li> <li><a href="/wiki/Digital_sociology" class="mw-redirect" title="Digital sociology">Digital sociology</a></li> <li><a href="/wiki/Ergonomics" title="Ergonomics">Ergonomics</a> <ul><li><a href="/wiki/Cognitive_ergonomics" title="Cognitive ergonomics">Cognitive ergonomics</a></li> <li><a href="/wiki/Computer-mediated_communication" title="Computer-mediated communication">Computer-mediated communication</a></li> <li><a href="/wiki/Cyberpsychology" title="Cyberpsychology">Cyberpsychology</a></li> <li><a href="/wiki/Engineering_psychology" title="Engineering psychology">Engineering psychology</a></li> <li><a href="/wiki/Human%E2%80%93computer_interaction" title="Human–computer interaction">Human–computer interaction</a></li> <li><a href="/wiki/Media_naturalness_theory" title="Media naturalness theory">Media naturalness theory</a></li> <li><a href="/wiki/Neuroergonomics" title="Neuroergonomics">Neuroergonomics</a></li></ul></li> <li><a href="/wiki/Neuroscience" title="Neuroscience">Neuroscience</a></li> <li><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a> <ul><li><a href="/wiki/Evolutionary_psychiatry" title="Evolutionary psychiatry">Evolutionary</a></li></ul></li> <li><a href="/wiki/Psychology" title="Psychology">Psychology</a> <ul><li><a href="/wiki/Clinical_psychology" title="Clinical psychology">Clinical</a></li> <li><a href="/wiki/Cognitive_psychology" title="Cognitive psychology">Cognitive</a></li> <li><a href="/wiki/Evolutionary_psychology" title="Evolutionary psychology">Evolutionary</a></li> <li><a href="/wiki/Social_psychology" title="Social psychology">Social</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Associated psychiatric conditions</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety disorder</a> <ul><li><a href="/wiki/Generalized_anxiety_disorder" title="Generalized anxiety disorder">Generalized anxiety disorder</a></li> <li><a class="mw-selflink selflink">Obsessive–compulsive disorder</a></li> <li><a href="/wiki/Social_anxiety_disorder" title="Social anxiety disorder">Social anxiety disorder</a></li></ul></li> <li><a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">Attention deficit hyperactivity disorder</a></li> <li><a href="/wiki/Autism" title="Autism">Autism</a></li> <li><a href="/wiki/Bipolar_disorder" title="Bipolar disorder">Bipolar disorder</a></li> <li><a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">Depression</a></li> <li><a href="/wiki/Eating_disorder" title="Eating disorder">Eating disorder</a> <ul><li><a href="/wiki/Anorexia_nervosa" title="Anorexia nervosa">Anorexia nervosa</a></li> <li><a href="/wiki/Body_image_disturbance" title="Body image disturbance">Body image disturbance</a></li></ul></li> <li><a href="/wiki/Insomnia" title="Insomnia">Insomnia</a></li> <li><a href="/wiki/Narcissistic_personality_disorder" title="Narcissistic personality disorder">Narcissistic personality disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Behavioral_addiction" title="Behavioral addiction">Behavioral addiction</a></li> <li><a href="/wiki/Behavioral_modernity" title="Behavioral modernity">Behavioral modernity</a></li> <li><a href="/wiki/Body_image" title="Body image">Body image</a></li> <li><a href="/wiki/Criticism_of_Facebook" title="Criticism of Facebook">Criticism of Facebook</a> <ul><li><a href="/wiki/2021_Facebook_leak" title="2021 Facebook leak">2021 Facebook company files leak</a></li></ul></li> <li><a href="/wiki/Cyberbullying" title="Cyberbullying">Cyberbullying</a></li> <li><a href="/wiki/Cyberpathology" title="Cyberpathology">Cyberpathology</a></li> <li><a href="/wiki/Digital_detox" title="Digital detox">Digital detox</a></li> <li><a href="/wiki/Digital_zombie" title="Digital zombie">Digital zombie</a></li> <li><a href="/wiki/Evolution_of_cognition" title="Evolution of cognition">Evolution of cognition</a></li> <li><a href="/wiki/Evolutionary_mismatch" title="Evolutionary mismatch">Evolutionary mismatch</a></li> <li><a href="/wiki/Fear_of_missing_out" title="Fear of missing out">Fear of missing out</a></li> <li><a href="/wiki/Mobile_phones_and_driving_safety" title="Mobile phones and driving safety">Mobile phones and driving safety</a></li> <li><a href="/wiki/Promotion_of_anorexia" class="mw-redirect" title="Promotion of anorexia">Promotion of anorexia</a></li> <li><a href="/wiki/Psychological_effects_of_Internet_use" title="Psychological effects of Internet use">Psychological effects of Internet use</a></li> <li><a href="/wiki/Screen_time" title="Screen time">Screen time</a> <ul><li><a href="/wiki/Binge-watching" title="Binge-watching">Binge-watching</a></li> <li><a href="/wiki/Social_aspects_of_television" title="Social aspects of television">Social aspects of television</a></li> <li><a href="/wiki/Television_consumption" title="Television consumption">Television consumption</a></li></ul></li> <li><a href="/wiki/Smartphones_and_pedestrian_safety" title="Smartphones and pedestrian safety">Smartphones and pedestrian safety</a></li> <li><a href="/wiki/Social_media_and_suicide" title="Social media and suicide">Social media and suicide</a></li> <li><a href="/wiki/Social_media_restrictions_on_children_in_Australia" title="Social media restrictions on children in Australia">Social media restrictions on children in Australia</a></li> <li><a href="/wiki/Spaving" title="Spaving">Spaving</a></li> <li><a href="/wiki/Suicide_and_the_Internet" title="Suicide and the Internet">Suicide and the Internet</a></li> <li><a href="/wiki/Technophilia" title="Technophilia">Technophilia</a> <ul><li><a href="/wiki/Technophobia" title="Technophobia">Technophobia</a></li></ul></li> <li><a href="/wiki/Technostress" title="Technostress">Technostress</a></li> <li><a href="/wiki/Texting_while_driving" title="Texting while driving">Texting while driving</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" 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