A guideline by the American Psychological Association suggested that dextroamphetamine may be considered by itself after more well-supported treatments have been attempted. Procedures
Electroconvulsive therapy (ECT) has been found to have effectiveness in some severe and refractory cases.Surgery may be used as a last resort in people who do not improve with other treatments. In this procedure, a surgical lesion is made in an area of the brain (the cingulate cortex). In one study, 30% of participants benefitted significantly from this procedure. Deep brain stimulation and vagus nerve stimulation are possible surgical options that do not require destruction of brain tissue. In the United States, the Food and Drug Administration approved deep-brain stimulation for the treatment of OCD under a humanitarian device exemption, requiring that the procedure be performed only in a hospital with special qualifications to do so.In the United States, psychosurgery for OCD is a treatment of last resort, and will not be performed until the person has failed several attempts at medication (at the full dosage) with augmentation, and many months of intensive cognitive–behavioral therapy with exposure and ritual/response prevention. Likewise, in the United Kingdom, psychosurgery cannot be performed unless a course of treatment from a suitably qualified cognitive–behavioral therapist has been carried out. Children
Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents. Similar to the treatment of adults with OCD, cognitive behavioral therapy stands as an effective and validated first line of treatment of OCD in children.
Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general function. As indicated by the disorders name, the primary symptoms of OCD are obsessions and compulsions. Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of anxiety, disgust, or discomfort. Common obsessions include fear of contamination, obsession with symmetry, and intrusive thoughts about religion, sex, and harm. Compulsions are repeated actions or routines that occur in response to obsessions. Common compulsions include excessive hand washing, cleaning, counting, ordering, hoarding, neutralizing, seeking assurance, and checking things. Washing is in response to the fear of contamination. Ordering is the preference for tasks to be completed a specific way (e.g., organizing clothes a specific way). Hoarding is the collecting of unnecessary objects (e.g., collecting food wrappers). Neutralizing is the act of engaging in a ritual to make up for supposedly "bad behavior". Checking is the compulsion to check particular objects/places to ensure they are a certain way (e.g., checking to ensure the water is turned off). People with OCD tend to be overly cleanly, repeatedly count objects, and seek reassurance to avoid making a mistake. Many adults with OCD are aware that their compulsions do not make sense, but they perform them anyway to relieve the distress caused by obsessions.