Narrative Clinical Review. This page provides the verified citation, abstract, and full-text PDF for the journal article.
Clinical boundary: Persistent OCD should prompt confirmation of diagnosis, risk, comorbidity, prior-treatment adequacy, adherence, adverse effects, ERP fidelity, reassurance, and family accommodation. Medication changes and specialist procedures need to be discussed with a qualified prescriber and appropriately experienced multidisciplinary services.
Publication Details
- Author: Christian Jonathan Haverkampf
- Journal: The Journal of Psychiatry Psychotherapy and Communication
- Publication date: 2023-06-30
- Volume, issue, pages: 12(2), 41–50
- Article type: Narrative Clinical Review
Recommended citation: Haverkampf, C. J. (2023). Treatment-Resistant Obsessive-Compulsive Disorder: An Updated Clinical Review. The Journal of Psychiatry Psychotherapy and Communication, 12(2), 41–50.
Abstract
Obsessive-compulsive disorder (OCD) can remain severely impairing after treatment, but apparent resistance often reflects incomplete diagnosis, inadequate exposure and response prevention (ERP), an insufficient medication trial, poor adherence, family accommodation, adverse effects, or unrecognized comorbidity. This narrative clinical review updates earlier JPPC discussions using guidance and evidence available through 30 May 2023. Assessment should confirm OCD, impairment, risk, and differential diagnoses and reconstruct every prior treatment. Adequate first-line care consists of disorder-specific cognitive-behavioral therapy with ERP and/or a serotonin reuptake inhibitor (SRI), selected collaboratively. ERP requires repeated exposure to relevant triggers, prevention of overt and covert rituals, and attention to reassurance and accommodation; supportive discussion alone is not equivalent. Medication trials may require higher tolerated doses and longer evaluation than depression trials, under medical supervision. After limited response, options include optimizing or combining ERP and SRI treatment, switching SSRI or cautiously using clomipramine, and specialist augmentation. Evidence most consistently supports low-dose risperidone or aripiprazole augmentation for selected SRI nonresponders, with adverse-effect monitoring and discontinuation if ineffective. Deep transcranial magnetic stimulation may help selected adults; deep brain stimulation and ablative neurosurgery are reserved for extremely severe, chronic, refractory OCD after independent multidisciplinary review. Communication-focused work may supplement, but not replace, established care. Persistence should prompt a diagnosis and treatment-fidelity audit before greater complexity or invasiveness.
Keywords
obsessive-compulsive disorder; treatment resistance; ERP; SSRIs; antipsychotic augmentation; deep TMS; DBS
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