Highlights in obsessive-compulsive and related disorders

Obsessive-compulsive disorder (OCD) and related disorders are often difficult to treat successfully. Converging evidence from neuroscience implicates structural and functional alterations in cortico-striato-thalamic neurocircuitry as interventional targets. Evolving from stereotactic neurosurgery for severe, refractory OCD, modern neuromodulation techniques exploit the developing neurocircuitry evidence base and require a multidisciplinary approach including neurosurgery, neurology, brain-imaging, electrophysiology, cognitive neuroscience, psychiatry and psychology, though are not yet universally approved as treatments for OCD.

This presentation highlights four recently published papers. The first [1] is a case-control study of structural brain imaging investigating a large unmedicated sample of adults with OCD. Structural differences associated with symptom severity, dimensionality and comorbidities were identified supporting a dimensional approach to neuroanatomical modelling of compulsive symptoms and disorders. The second [2] is a meta-analysis of sham-controlled trials showing efficacy for deep brain stimulation (DBS) in severe, treatment-refractory OCD. Considerable heterogeneity in DBS-targets and clinical outcomes was observed, suggesting scope for personalised approaches to improve effectiveness. The third [3] reviews techniques to identify those brain circuits producing the best OCD response. By synthesising tractography profiles across individual DBS studies and mapping them against clinical benefit, the authors propose an OCD response tract comprising cortico-thalamic projections originating in the prefrontal cortex with stimulation ‘sweet-spots’ in the anterior limb of the internal capsule and symptom-specific subdomains. The fourth (4) is a new international evidence-based clinical guideline devoted to the clinical management of OCD.

1. de Jood NT et al doi:10.1016/j.euroneuro.2026.112829
2. Cohen S et al doi:10.1038/s41380-025-03092-z
3. Horn A et al doi:10.1016/j.biopsych.2025.03.008
4. Van Ameringen M et al doi:10.1016/j.jpsychires.2025.12.039