Prognosis

Patients with OCD tend to seek treatment from three to four doctors and spend 9 years in treatment before a correct diagnosis is made.[12] The average amount of time that lapses between the onset of symptoms and appropriate treatment is 17 years.[12] Although controlled trials with serotonin reuptake inhibitors have demonstrated a selective efficacy in OCD, up to 40% to 60% of patients do not have a satisfactory outcome.[111][112][113][114][115]​​​​​​​​[116][117]​​​​​[118]​ These patients have significant disability and morbidity.[180] The natural course is lifelong, and patients generally require lifelong treatment.

Features associated with treatment resistance include a higher frequency of compulsions, an early age of onset, previous hospitalizations for OCD, and a more chronic course (the longer the disorder goes untreated, the more likely patients are to exhibit resistant symptoms).[38] Male gender is associated with an earlier onset and a more chronic course, and often predicts a poorer response to treatment.[5] Concomitant schizotypal personality disorder is considered a predictor of worse response and may warrant early referral to a specialist to tailor therapy.[38] The presence of a concurrent tic disorder, which is more common in males, may be associated with more severe OCD symptoms and a greater likelihood of treatment resistance.[39]

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