Objective: To review the treatment options for obsessive–compulsive disorder (OCD), with particular reference to treatment resistance, and provide a guideline for clinicians managing these patients, drawing upon evidence from clinical trials and expert consensus.
Conclusions: The behavioural technique of exposure and ritual prevention (EX/RP) and serotonergic medications have emerged as effective standard treatments of OCD, although full symptom remission is rare. Predictors of poor and partial response to these treatments may reflect substantial underlying heterogeneity in OCD. Clinicians can now begin to apply psychological and pharmacological augmenting strategies that specifically target these heterogenous subgroups in an attempt to improve response. We offer a treatment algorithm for OCD derived from this understanding.
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