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Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive ideas, impulses, or urges (obsessions) along with overt or covert behaviors (compulsions) aimed at reducing the distress (DSM-IV-TR). Patients have either obsessions, compulsions, or, most commonly, both. Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause anxiety. The obsessions are not simply excessive worries about real-life problems and the affected individual usually recognizes that these thoughts, impulses or images are excessive, unreasonable and a product of their own mind (DSM-IV-TR). In order to naturalize the obsessions, other thoughts or actions are performed (compulsions). Examples of obsessions include, among others, contamination (concern with dirt or germs, fear of blood) symmetry (concern about order, exactness), obsessions about safety and harm (fear of harm due to carelessness, fear of being responsible for terrible events) hoarding, pathological doubt (after completing a routine activity the affected individual wonders whether he or she performed it correctly or did it at all), numbers with special significance, etc. Compulsions are repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that patients with OCD feel compelled to do in response to an obsession, or according to rules which must be applied rigidly (e.g. checking that a light switch is turned off by switching it on and off without any interruption). The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors are either not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly unreasonable or excessive. Examples of compulsive activities are washing hands until they are raw, repeatedly checking the locked door, arranging and rearranging items in a set order, counting, asking, repeating reassurance questions etc. The diagnosis is made by clinical interview, with a specific and detailed focus on OCD. To diagnose the disorder according to the DSM-IV criteria, the patient must suffer from either obsessions or compulsions that cause great distress, are time-consuming (more then 1 hour

The Treatment of Obsessive-Compulsive Disorder and the Approaches to Treatment Resistance