King's College London

A subset of patients with obsessive-compulsive disorder (OCD) present with symptoms that indicate risk. In some cases of OCD, risk is only apparent, merely reflecting the content of obsessional fears which are never acted upon (e.g. intrusive thoughts of harming others). In contrast, genuine risk can arise in OCD as an unintended consequence of engaging in compulsions or avoidance (e.g. skin damage caused by washing with bleach). In both situations, risk can cause confusion among clinicians regarding diagnosis and /or hinder access to appropriate treatment. The current article adds to the small existing literature on risk in OCD by presenting case examples illustrating different types of risk in the context of pediatric OCD, along with a discussion of their implications for management. The cases highlight that it is crucial that risk in OCD is considered carefully within the context of the phenomenology of the disorder. In many cases, treatment should follow the usual OCD treatment protocols and both apparent and genuine risk resolve with successful treatment of the OCD. In some cases, there may be a need to actively manage genuine risk. In these instances, it is essential that risk management is carefully integrated into a program of evidence-based treatment for OCD.