强迫性障碍患者通常需要寻求 3 至 4 个医生治疗且花费 9 年后才能做出正确诊断。[8]Jenike MA. Clinical practice. Obsessive-compulsive disorder. N Engl J Med. 2004;350:259-265.http://www.ncbi.nlm.nih.gov/pubmed/14724305?tool=bestpractice.com 从症状首次出现到获得恰当治疗平均需要17年。[8]Jenike MA. Clinical practice. Obsessive-compulsive disorder. N Engl J Med. 2004;350:259-265.http://www.ncbi.nlm.nih.gov/pubmed/14724305?tool=bestpractice.com 虽然5-羟色胺再摄取抑制剂的对照试验证明了其对OCD疗效有选择性,高达40%到60%的患者并没有得到满意的效果。[101]The Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. The Clomipramine Collaborative Study Group. Arch Gen Psychiatry. 1991 Aug;48(8):730-8.http://www.ncbi.nlm.nih.gov/pubmed/1883256?tool=bestpractice.com[102]Goodman WK, McDougle CJ, Price LH. Pharmacotherapy of obsessive-compulsive disorder. J Clin Psychiatry. 1992 Apr;(suppl 53):29-37.http://www.ncbi.nlm.nih.gov/pubmed/1532962?tool=bestpractice.com[103]Jenike MA, Rauch SL. Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry. 1994 Mar;(suppl 55):11-7.http://www.ncbi.nlm.nih.gov/pubmed/7915709?tool=bestpractice.com[104]McDougle CJ, Goodman WK, Leckman JF, et al. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol. 1993 Oct;13(5):354-8.http://www.ncbi.nlm.nih.gov/pubmed/8227493?tool=bestpractice.com[105]McDougle CJ, Goodman WK, Leckman JF, et al. The psychopharmacology of obsessive compulsive disorder. Implications for treatment and pathogenesis. Psychiatr Clin North Am. 1993 Dec;16(4):749-66.http://www.ncbi.nlm.nih.gov/pubmed/8309811?tool=bestpractice.com[53]Piccinelli M, Pini S, Bellantuono C, et al. Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review. Br J Psychiatry. 1995;166:424-443.http://www.ncbi.nlm.nih.gov/pubmed/7795913?tool=bestpractice.com[106]Pigott TA, Seay SM. A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. J Clin Psychiatry. 1999 Feb;60(2):101-6.http://www.ncbi.nlm.nih.gov/pubmed/10084636?tool=bestpractice.com[107]Rasmussen SA, Eisen JL, Pato MT. Current issues in the pharmacologic management of obsessive compulsive disorder. J Clin Psychiatry. 1993 Jun;(suppl 54):4-9.http://www.ncbi.nlm.nih.gov/pubmed/8101187?tool=bestpractice.com 这些患者有明显的致残率和发病率。[160]Hollander E, Kwon JH, Stein DJ, et al. Obsessive-compulsive and spectrum disorders: overview and quality of life issues. J Clin Psychiatry. 1996;57:3-6.http://www.ncbi.nlm.nih.gov/pubmed/8698678?tool=bestpractice.com 自然病程是终生的，患者通常需要终生服药。
与治疗抵抗相关的特征包括：较高频率的强迫行为；发病的年龄早；既往因强迫性障碍住院治疗；慢性病程（疾病得不到治疗的时间越长，患者就越有可能表现出难治性症状）。[29]Ravizza L, Barzega G, Bellino S, et al. Predictors of drug treatment response in obsessive-compulsive disorder. J Clin Psychiatry. 1995;56:368-373.http://www.ncbi.nlm.nih.gov/pubmed/7635854?tool=bestpractice.com 男性与发病年龄更早和慢性病程相关，通常预示治疗反应较差。[28]Ruscio AM, Stein DJ, Chiu WT, et al. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15:53-63.http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/18725912/http://www.ncbi.nlm.nih.gov/pubmed/18725912?tool=bestpractice.com 伴有分裂型人格障碍被认为是疗效较差的预测因素，可能需要及早转诊至专科医生，调整治疗方案。[29]Ravizza L, Barzega G, Bellino S, et al. Predictors of drug treatment response in obsessive-compulsive disorder. J Clin Psychiatry. 1995;56:368-373.http://www.ncbi.nlm.nih.gov/pubmed/7635854?tool=bestpractice.com 抽动障碍的并发存在可能会导致更严重的强迫性障碍症状，发生治疗抵抗的可能性更大。[30]Coffey BJ, Miguel EC, Biederman J, et al. Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998;186:201-206.http://www.ncbi.nlm.nih.gov/pubmed/9569887?tool=bestpractice.com
