Overview of Obsessive-Compulsive Disorder, with Emphasis in Forensics Settings and Evaluations

Abstract

While research on the etiology and symptomology of obsessive-compulsive disorder (OCD) is plentiful, there remains a paucity of discussion about the disorder’s relevance in forensic settings. OCD is found to be underdiagnosed and often has high comorbidity rates with other psychiatric conditions (e.g., psychotic disorders and anxiety disorders), exposing a need for further analysis and a richer discussion. The current paper illustrates the disorder’s phenomenology, delineates clinical presentation, and highlights the impacts of OCD on an individual’s functionality within forensic contexts. Clinical discussion centers on differential diagnosis (comorbidity and diagnostic subtypes categories), neuroanatomy, neuropsychological limitations (e.g., diminished cognitive flexibility, and disinhibition), and a review of treatment options. The forensic discussion superimposes clinical aspects of OCD onto civil and criminal contexts that demand specific considerations based on the setting and the specific type of assessment being completed. Specific civil applications include the impacts of OCD on disability assessment, parental fitness, risk-assessment, and decisional capacities (e.g., testamentary capacity and medical decision-making). Criminal considerations center on OCD as a consideration for the insanity defense and mitigation, as well as its role in violence risk assessments at the time of community reintegration from a forensic hospital. Holistically, the current article provides a breadth of discussion points to assist forensics consultation, guide clinical practice, and proposes areas for future research.