Three comorbidities (ASD, Bulimia nervosa and ASPD) had a GRADE score 5 out of 5; most other comorbidities (n = 21) scored a 4 out of 5, and the remaining (n = 12) scored a 3 out of 5. MDD and panic disorder also scored a 3 out of 5 for paediatric studies. Based on ratings on the GRADE criteria, we interpret a moderate to high confidence in the pooled prevalence rates for comorbidities in OCD from our meta-analysis.