The Prognosis

Obsessive-compulsive disorder (OCD) is a long-term condition that often starts in childhood. Researchers estimate that between 0.5-4% of children and teenagers develop the condition and between 30-50% of adults with OCD say their symptoms first started when they were children. However, there have been few long-term studies into how children with OCD get on in later life. Researchers from the Institute of Psychiatry, King's College London studied 142 children who had been treated for OCD over a nine-year period. 41% still had OCD by the end of the study and 40% had another mental-health problem instead of, or as well as, OCD. People who had been ill for longer when they first started treatment were more likely to still have OCD nine years later. Around half the participants were still receiving and/or felt a need for further treatment by the end of the study.

Obsessive Compulsive Disorder (OCD) may follow an acute, episodic, chronic unremitting, deteriorating or relapsing course. For some people the symptom type will remain unchanged, but for others the symptoms change over time. Intermittent, episodic disorder is more common in the early stages of the disorder whereas chronic illness is more common in the later stages.

The response to treatment is usually good. For example, Exposure and Response Prevention (ERP) has response rates of up to 85% in people who complete the treatment, but this may take several months. The response to drug treatment increases gradually over weeks and months and the benefits continue to accrue for at least six months and have been shown for up to 2 years. Resistant cases that require different types of treatment may take a year or more to achieve functional improvement.

A recent study of people with severe OCD showed that 6 to 8 years after treatment, approximately:

27% no longer met the criteria for the diagnosis of OCD (i.e. were effectively “cured”)

17% had mild symptoms

34% had moderate symptoms

24% had severe symptoms

Worse outcome was associated with longer duration of illness before treatment.

Therefore for people who are undergoing treatment, a short term award of 2 years is recommended, in order to give time to assess the response to treatment. For people who have received treatment but have responded poorly, a longer term award of 10 years is recommended, as it is possible that further treatments may be instituted in the future.