About 2 to 4% of the population suffers from obsessive-compulsive disorder (OCD) at some time in their lives (lifetime prevalence; Stein et al., 2025; Ruscio et al., 2010).
It can lead to significant impairments—work, school, relationships, and so on— in many patients who suffer from it.
Although many effective treatment options, including medications and cognitive-behavior therapy, are available, we have to face some shocking facts about how poorly we are doing with the diagnosis and treatment of OCD.
Missed or delayed diagnosis
Many patients are not correctly diagnosed with OCD (IOCDF, 2025).
In those who do get diagnosed, there is typically a considerable delay from the onset of symptoms to getting diagnosed and treated. The duration of untreated illness varies widely across studies, typically between 7 and 21 years (Perris et al., 2023; Pellegrini et al., 2025; Ziegler et al., 2021).
This is a HUGE problem because this delay—during the critical periods of adolescence and young adulthood—has harmful effects on various aspects of the person’s life, and could affect treatment-responsiveness of the illness (Pellegrini et al., 2025).
Before we can decide what needs to be done about this problem, we need to understand why the diagnosis of OCD is so commonly missed or delayed.
Illness/ Clinician factors
– Screening for OCD is not easy, partly due to the many different types of symptoms with which it can manifest (Brakoulias et al., 2026).
– Commonly, OCD is misdiagnosed as something else because the symptoms are wrongly thought to be due to other conditions like psychosis, post-traumatic stress disorder (PTSD), generalized anxiety disorder, and so on (Brakoulias et al., 2026).
Patient factors
The reasons why patients delay seeking medical attention include (Poyraz et al., 2015):
– Spontaneous fluctuation of symptoms over time
– Believing that OCD symptoms were not due to an illness
– Believing that the patient can overcome the symptoms by him/herself
Also, patients with OCD may delay seeking care due to:
– Shame or embarrassment about their symptoms.
Inappropriate/inadequate treatment
Even when a correct diagnosis of OCD is made:
– A substantial percentage of patients don’t receive a serotonin reuptake inhibitor (Brakoulias et al., 2026)
– The doses of medications are commonly lower than those that are recommended (IOCDF, 2025)
– Only a minority of patients receive the specific, evidence-based psychotherapy that is known to be effective for OCD—exposure and response prevention (ERP) therapy or other cognitive-behavior therapy (Brakoulias et al., 2026).
It has been noted that exposure and response prevention therapy (ERP) is not widely available in most countries (Brakoulias et al., 2019). But what about in resource-rich countries like the United States?
In the United States (IOCDF, 2025; Senter et al., 2021):
– Only 2% of patients with OCD receive formal exposure and response prevention (ERP) therapy
– Only about 20% of patients receive any form of evidence-based therapy, including exposure and response prevention and other cognitive-behavior therapy
– More than 70% of patients diagnosed with OCD were not even referred for evidence-based therapy, including exposure and response prevention or other cognitive-behavior therapy
As the International OCD Foundation (IOCDF) notes (source):
“People with OCD are being failed at every step: screening, diagnosis, referral, and treatment.”
On this website, we will continue to provide detailed and specific recommendations about what mental health clinicians and others can and should do to address these serious problems related to the diagnosis and treatment of obsessive-compulsive disorder that were discussed in the article on this page.
These include, among other topics, how to:
- Screen all patients for possible OCD
- Correctly diagnose it, differentiating it from other conditions with which it is commonly confused
- Educate and guide patients with OCD and their families
- Refer patients, as needed, for specific evidence-based therapies for OCD—exposure and response prevention (ERP) therapy or other cognitive-behavior therapy for OCD
- Treat adequately with medications, first-line and second-line
- Evaluate progress systematically
- Treat refractory OCD
Related Pages
Obsessive-Compulsive and Related Disorders (Main Menu)
OCD—Rating Scales
Self-rating scales for OCD: Why? How? Which ones?
The Obsessive-Compulsive Inventory-Revised (OCI-R)
OCD—Management
See: Obsessive-Compulsive and Related Disorders (Main Menu)
OCD—Resources
BEST books about OCD for patients and families
Practice guidelines for obsessive-compulsive disorders (OCD)
References
Brakoulias V, Pampaloni I, Fineberg NA. Obsessive-compulsive disorder (OCD): often a missed diagnosis and misdiagnosed. Br J Psychiatry. 2026 Feb 16:1-3. doi: 10.1192/bjp.2026.10542. Epub ahead of print. PMID: 41693596.
Brakoulias V, Starcevic V, Albert U, Arumugham SS, Bailey BE, Belloch A, Borda T, Dell’Osso L, Elias JA, Falkenstein MJ, Ferrao YA, Fontenelle LF, Jelinek L, Kalogeraki L, Kay B, Laurito LD, Lochner C, Maina G, Marazziti D, Martin A, Matsunaga H, Miguel EC, Morgado P, Mourikis I, Pasquini M, Perez Rivera R, Potluri S, Reddy JYC, Riemann BC, do Rosario MC, Shavitt RG, Stein DJ, Viswasam K, Wang Z, Fineberg NA. Treatments used for obsessive-compulsive disorder-An international perspective. Hum Psychopharmacol. 2019 Jan;34(1):e2686. doi: 10.1002/hup.2686. Epub 2019 Jan 10. PMID: 30628745.
International OCD Foundation (2025). America’s OCD Care Crisis: National Findings on the Failure of Effective OCD Treatment to Reach Patients. Available at https://iocdf.org/wp-content/uploads/2025/12/Full-Report-Americas-OCD-Care-Crisis-12-9-2025.pdf. Accessed on March 11, 2026.
Pellegrini L, Giobelli S, Burato S, di Salvo G, Maina G, Albert U. Meta-analysis of age at help-seeking and duration of untreated illness (DUI) in obsessive-compulsive disorder (OCD): The need for early interventions. J Affect Disord. 2025 Jul 1;380:212-225. doi: 10.1016/j.jad.2025.03.090. Epub 2025 Mar 19. PMID: 40118279.
Perris F, Cipolla S, Catapano P, Sampogna G, Luciano M, Giallonardo V, Del Vecchio V, Fabrazzo M, Fiorillo A, Catapano F. Duration of Untreated Illness in Patients with Obsessive-Compulsive Disorder and Its Impact on Long-Term Outcome: A Systematic Review. J Pers Med. 2023 Sep 29;13(10):1453. doi: 10.3390/jpm13101453. PMID: 37888064; PMCID: PMC10608019.
Poyraz CA, Turan Ş, Sağlam NG, Batun GÇ, Yassa A, Duran A. Factors associated with the duration of untreated illness among patients with obsessive compulsive disorder. Compr Psychiatry. 2015 Apr;58:88-93. doi: 10.1016/j.comppsych.2014.12.019. Epub 2014 Dec 31. PMID: 25596625. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010 Jan;15(1):53-63. doi: 10.1038/mp.2008.94. Epub 2008 Aug 26. PMID: 18725912; PMCID: PMC2797569.
Senter MS, Patel SR, Dixon LB, Myers RW, Simpson HB. Defining and Addressing Gaps in Care for Obsessive-Compulsive Disorder in the United States. Psychiatr Serv. 2021 Jul 1;72(7):784-793. doi: 10.1176/appi.ps.202000296. Epub 2021 May 7. PMID: 33957763.
Stein DJ, Ruscio AM, Altwaijri Y, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Chardoul S, Gureje O, Hu C, Karam EG, McGrath JJ, Navarro-Mateu F, Scott KM, Stagnaro JC, Torres Y, Vladescu C, Wciórka J, Xavier M, Kessler RC; World Mental Health Survey collaborators. Obsessive-compulsive disorder in the World Mental Health surveys. BMC Med. 2025 Jul 9;23(1):416. doi: 10.1186/s12916-025-04209-5. PMID: 40629326; PMCID: PMC12239380.
Wongbusarakum K, Schug E, Visher TC, Sulivan-Pascual K, Mirkis M, Rhee P, Frank AC. Factors associated with delays in assessment and treatment of obsessive-compulsive disorder: A scoping review. J Obsessive Compuls Relat Disord. 2025 Oct;47:100982. doi: 10.1016/j.jocrd.2025.100982. Epub 2025 Oct 27. PMID: 41384033; PMCID: PMC12691969.
Ziegler S, Bednasch K, Baldofski S, Rummel-Kluge C. Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLoS One. 2021 Dec 13;16(12):e0261169. doi: 10.1371/journal.pone.0261169. PMID: 34898630; PMCID: PMC8668120.
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