A 21-year old presents with symptoms of obsessive-compulsive disorder. Which factor is the best predictor for positive prognosis?

Choice A reason: Early onset of OCD, such as starting at age 11, is typically associated with a more severe clinical course, higher rates of comorbidity (such as tic disorders), and a poorer long-term prognosis. Adult-onset OCD generally has a more favorable outlook compared to the pediatric-onset subtype, which often reflects a more ingrained neurodevelopmental pathology. Choice B reason: Acting on compulsions is a defining characteristic of the disorder, but the presence of compulsions themselves does not predict a positive outcome. In fact, more complex or time-consuming compulsions often indicate greater severity and functional impairment, which can complicate the treatment process and lead to a more chronic course of illness. Choice C reason: Good prognostic factors for OCD include good social and occupational adjustment, the presence of a precipitating event, and an episodic or intermittent nature of symptoms. Clients who experience periods of symptom remission or intermittency have a better overall prognosis than those with a continuous, chronic, or deteriorating course of obsessions and compulsions. Choice D reason: The presence of comorbid major depressive disorder is a negative prognostic indicator. Comorbid depression often increases the level of functional disability, reduces the client's motivation or ability to engage in demanding treatments like Exposure and Response Prevention (ERP), and is associated with a higher risk of treatment resistance and relapse.