Abstract Objective and Method: Despite the existence of effective therapeutic alternatives for obsessive-compulsive disorder, a significant number of patients does not achieve or does not maintain remission after adequate treatment. The relief of these patients’ suffering with the available treatments is a clinical challenge related to many unanswered questions. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness, to describe the intrinsic and extrinsic factors of obsessive-compulsive disorder’s phenomenology that might influence treatment response to conventional treatment, and to present a flowchart of therapeutic alternatives for resistant or refractory obsessive-compulsive disorder patients. Conclusion: The literature demonstrates that intrinsic and/or extrinsic phenomenological aspects of obsessive-compulsive disorder may collaborate to the fact that, at least 30% of obsessive-compulsive disorder patients do not respond to conventional treatment. Several therapeutic or augmentation alternatives, psychopharmacological, biological or even psychotherapeutic alternatives exist, but more studies are necessary to evince the correct way to symptom remission.

Descriptors: Obsessive-compulsive disorder; Combined modality therapy; Biological psychiatry; Psychopharmacology; Behavior therapy