Prognosis

OCD patients tend to seek treatment from 3 to 4 doctors and spend 9 years in treatment before a correct diagnosis is made.[12] The average amount of time that lapses between onset of symptoms and appropriate treatment is 17 years.[12] While 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.[95][96][97][98][99]​​​​​​​[100][101]​​​​[102]​ These patients have significant disability and morbidity.[163] The natural course is lifelong, and patients generally require lifelong treatment.

Features associated with treatment resistance include: higher frequency of compulsions; early age of onset; previous hospitalizations for OCD; and chronic course (the longer the disorder goes untreated, the more likely patients are to exhibit resistant symptoms).[32] Male gender is associated with an earlier onset and chronic course, and often predicts poorer response to treatment.[5] Concomitant schizotypal personality disorder is considered a predictor of worse response and may warrant early referral to specialist to tailor therapy.[32] The presence of a concurrent tic disorder, which is more common in males, may be associated with more severe OCD symptoms and greater likelihood of treatment resistance.[33]

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