The Compulsive Obsessive Disorder: many clues, still little evidence

The Obsessive-Compulsive Disorder (OCD) is a debilitating psychiatric condition characterized by intrusive, distressing obsessions and repetitive, ritualistic compulsions. Despite its relatively high prevalence, elucidating its pathogenesis remains a significant challenge. The present study aims to review the current understanding of OCD's pathophysiological mechanisms focusing on the role of cortical and subcortical structures and their connections, proposing that obsessions may be a consequence, rather than a trigger, of compulsions. For this reason, the syndrome might be rebadged as the Compulsive Obsessive Disorder (COD). This will be explored, from a neurocognitive point of view, as an imbalance between goal-directed and habitual behaviour. Moreover, the issue of refractoriness will be addressed - with emphasis on the complex mechanisms that underlie refractory OCD and the cruciality of developing targeted interventions. This review discusses the potential contributors to treatment resistance, including neurobiological alterations, comorbid psychiatric conditions and the duration of untreated illness, a potential modifiable parameter which influences clinical outcomes. Innovative interventions offer hope for individuals with refractory OCD. The evolving landscape of OCD treatment will be overviewed, ranging from pharmacology to neurostimulation and novel psychotherapeutic techniques tailored to refractory cases which have shown promise in ameliorating symptoms when traditional approaches fall short.