One recent Canadian study investigated the quality of life in OCD. This study showed that individuals with OCD were mainly affected by the severity of obsessive thoughts rather than by compulsive rituals. Co-occurrence of depression was the most important predictor for poor quality of life.

Maybe the enviroment (family or friends) are more concerned by the occurrence of compulsive behaviour (and this might interfere with normal living!), but for the OCD patient this might be less stressing (at least compared to the obsessive thoughts).

Any treatment should also consider a secondary or simultaneous depressive disorder. The pharmacotherapy option with serotonin re-uptake inhibitors (SSRI) is a very good choice for most patients with ocd because it has a positive effect on symptoms of ocd and depression. Additional cognitive behavioural therapy (exposure and response prevention) can achieve better results if this comorbidity is considered.