The OCD Evidence Map.
What we know about obsessive-compulsive disorder, what we're still figuring out, and what the data can't tell us.
OCD is the disorder where the gap between the evidence and what reaches patients is widest. Exposure and response prevention is one of the most effective treatments in psychiatry, and most people who meet criteria for OCD haven't gotten it. SSRIs at doses higher than the antidepressant range help a meaningful minority. Combination is standard for severe cases. The map below shows where the evidence is settled, where the augmentation literature is moving, and where the clinical reality keeps outrunning the trials.
Evidence nodes
What the map shows
OCD's evidence base has a clean center and a messier edge. The center is ERP plus SSRIs at higher doses than depression dosing. That's been settled for decades. The edge is what to do for the patients who don't respond. Augmentation with low-dose antipsychotics is supported. Glutamate modulators have signal but not consensus. Deep brain stimulation is reserved for severe, treatment-refractory cases and is still an active research area. The map shows the center and the edge in one view, and points to the relevant summary for each node.
What the map doesn't show
- ·Subtype matters and most prevalence figures don't break it out. Contamination, harm, symmetry, and hoarding subtypes have different treatment responses and different course.
- ·Hoarding now sits in its own DSM category, but a lot of the older OCD literature still includes it, which makes effect size comparisons tricky.
- ·Pediatric OCD has a different evidence base than adult OCD. The map calls that out but doesn't fully map it.
- ·The dissemination gap, the difference between what works in trials and who actually gets it, is large for ERP and shows up in workforce data rather than treatment-outcome data.
Sources
How to cite this map
The OCD Evidence Map, AnxietyResearch.org. Built from NIMH and epidemiologic OCD prevalence data, exposure and response prevention meta-analyses, SSRI dosing literature for OCD, and the augmentation pharmacology literature. Accessed [date]. https://anxietyresearch.org/evidence-maps/ocd/
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