Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2025 Mar 3:rs.3.rs-6090427.
doi: 10.21203/rs.3.rs-6090427/v1.

Obsessive-compulsive disorder in the World Mental Health surveys

Dan J Stein  1 , Ayelet Meron Ruscio  2 , Yasmin Altwaijri  3 , Wai Tat Chiu  4 , Nancy A Sampson  4 , Sergio Aguilar-Gaxiola  5 , Ali Al-Hamzawi  6 , Jordi Alonso  7 , Stephanie Chardoul  8 , Oye Gureje  9 , Chiyi Hu  10 , Elie G Karam  11 , John J McGrath  12 , Fernando Navarro-Mateu  13 , Kate M Scott  14 , Juan Carlos Stagnaro  15 , Yolanda Torres  16 , Cristian Vladescu  17 , Jacek Wciórka  18 , Miguel Xavier  19 , Ronald C Kessler  4
Affiliations

Obsessive-compulsive disorder in the World Mental Health surveys

Dan J Stein et al. Res Sq. .

Update in

  • Obsessive-compulsive disorder in the World Mental Health surveys.
    Stein DJ, Ruscio AM, Altwaijri Y, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Chardoul S, Gureje O, Hu C, Karam EG, McGrath JJ, Navarro-Mateu F, Scott KM, Stagnaro JC, Torres Y, Vladescu C, Wciórka J, Xavier M, Kessler RC; World Mental Health Survey collaborators. Stein DJ, et al. BMC Med. 2025 Jul 9;23(1):416. doi: 10.1186/s12916-025-04209-5. BMC Med. 2025. PMID: 40629326 Free PMC article.

Abstract

Background: National surveys have suggested that obsessive-compulsive disorder (OCD) is a prevalent and impairing condition. However, there are few cross-national data on OCD, with data particularly scarce in low- and middle-income countries. Here we employ data from the World Mental Health surveys to characterize the onset, course, severity, and treatment of OCD across a range of countries in different geographic regions of the world.

Methods: Data came from general population surveys carried out in 10 countries using a consistent research protocol and interview. A total of 26,136 adults were assessed for OCD in face-to-face interviews and were included in the present analyses. We examined lifetime and 12-month prevalence as well as age of onset, persistence, severity, and treatment of DSM-IV OCD in six high-income countries (HICs) and four low- or middle-income countries (LMICs). We also investigated socio-demographic variables and temporally prior mental disorders as predictors of OCD onset, persistence, severity, and treatment.

Results: Across the 10 countries surveyed, OCD has a combined lifetime prevalence of 4.1%. The 12-month prevalence (3.0%) is nearly as high, suggesting a highly persistent course of illness. Age of onset is early, with more than 80% of OCD cases beginning by early adulthood. Most OCD cases in the community are mild (47.0%) or very mild (27.5%), with a smaller percentage designated as moderate (22.9%) or severe (2.7%) by the Yale-Brown Obsessive-Compulsive Scale. Only 19.8% of respondents with OCD received any mental health treatment in the past year, with treatment rates much higher in HICs (40.5%) than LMICs (7.0%). Cross-nationally, OCD commonly emerges in adolescence or early adulthood against a backdrop of earlier-occurring mental disorders. With few exceptions (e.g., marital status, prior social phobia), the socio-demographic and psychopathological risk factors for OCD onset, persistence, severity, and treatment are distinct.

Conclusions: These cross-national data underscore clinical lessons regarding the importance of early diagnosis of OCD and comprehensive evaluation of comorbidity; draw attention to OCD as an undertreated disorder, particularly in LMIC contexts; and emphasize the public health significance of this often-overlooked condition.

Keywords: World Mental Health surveys; community epidemiology; global mental health; obsessive-compulsive disorder.

PubMed Disclaimer

Conflict of interest statement

Competing interests In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. Dr. Stein has received consultancy honoraria from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, Vistagen, and Wellcome. All other authors report no conflicts of interest related to this manuscript.

Figures

Figure 1
Figure 1. Age of onset of OCD by sex
Abbreviations: OCD, obsessive-compulsive disorder. Cumulative age-of-onset distributions for first obsession or compulsion, shown separately for female and male respondents with lifetime OCD.
See this image and copyright information in PMC

References

    1. Fontenelle LF, Mendlowicz MV, and Versiani M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(3):327–37. - PubMed
    1. Judd LL. Obsessive compulsive neurosis in children. Arch Gen Psychiatry. 1965;12(2): 136–43. - PubMed
    1. Karno M, Golding JM, Sorenson SB, and Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45(12):1094–9. - PubMed
    1. Horwath E and Weissman MM. The epidemiology and cross-national presentation of obsessive-compulsive disorder. Psychiatr Clin North Am. 2000;23(3):493–507. - PubMed
    1. Kessler RC and Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121. - PMC - PubMed

Publication types