Obsessive-Compulsive Disorder: Diagnosis and Management with an Osteopathic Component

Abstract

Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects about one in 40 American adults and one in 100 American children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the patient must have the presence of obsessions, compulsions or both. OCD can be covert in presentation and therefore requires physician vigilance with the diagnosis. The efficacy of the physician’s interviewing style is extremely important in OCD treatment because typically, long delays in diagnosis often occur and the shame associated with the disorder may inhibit discussion of the symptoms and treatment plans. In addition to serotonin-regulating medications, deciphering the etiology of the patient’s obsessions or compulsions is important. Thus, cognitive behavioral therapy supplemented with SSRIs is the true first-line therapy for OCD because it provides a synergistic approach of life discussions, habit training and medication. Because of the inseparability of physical and mental health, osteopathic medicine offers an effective model for treatment through osteopathic manipulative treatment (OMT). In the holistic view of OMT, somatic, visceral and psychological dysfunctions are united. Thus, physicians who incorporate OMT into their practice can aid in the treatment of psychopathology, such as OCD. In this article, we will discuss the epidemiology of OCD, the DSM-5 criteria for OCD, the current OCD treatments, the osteopathic approach and how it pertains to OCD treatment, and lastly, OMT and its possible role in treating OCD. Due to a lack of research on osteopathic manipulative medicine (OMM) treatments in OCD, we will also propose a possible study design for further investigation.