Psychiatric Care for OCD

Obsessive-compulsive disorder involves unwanted, intrusive thoughts, images or urges (obsessions) and repetitive behaviors or mental acts (compulsions) done to relieve the distress they cause. Common examples include checking, cleaning, counting, seeking reassurance or mentally going over past events. The cycle can take up hours of the day and cause real distress.

How our physicians help

Our physicians start with a careful diagnosis, since OCD can overlap with anxiety, tics or other conditions. Treatment often includes exposure and response prevention (ERP), a form of cognitive behavioral therapy, and medication when appropriate, monitored by the same physician. We coordinate with ERP specialists when that helps.

Signs of OCD that are easy to miss

OCD tends to attach itself to what a person values most, such as the safety of loved ones, morals, faith or health.

• Unwanted thoughts or images about harm, sex or religion that horrify you and go against who you are.
• Driving back to make sure you did not hit someone, or rereading an email many times before sending it.
• Hours online searching for proof that you are not sick or not a bad person.
• Staying away from babies, driving or public restrooms because of the fears they set off.

OCD in children and teens

Adults can mistake OCD for defiance, and teens may hide it completely.

• Bedtime or getting dressed takes far longer because steps must be redone until they feel just right.
• Repeated questions about whether something bad will happen.
• Needing parents to say or do things a certain way, with great distress if they do not.
• Schoolwork that takes hours because of rewriting, erasing or rereading.

What an OCD evaluation covers

An OCD evaluation often touches on thoughts a person has never said out loud. Our physicians ask about them directly, because thoughts like these are a common part of OCD. We also ask about mood and safety, since depression often comes along with OCD.

Several conditions can look like OCD. Generalized anxiety involves worry about real-life problems, while OCD thoughts feel intrusive and lead to rituals. Autism can involve repetitive routines that usually feel comforting. Obsessive-compulsive personality disorder is a lasting preference for order and control that feels right to the person, while OCD feels unwanted.

Therapy, medication and what comes next

Exposure and response prevention (ERP) is the main therapy for OCD. With a trained therapist, you list feared situations from mild to hard and work up the list while holding off on the ritual. Someone with contamination fears might touch a doorknob and not wash. Someone with harm thoughts might write the thought down and leave it unanswered. Distress usually rises before it falls, so pacing matters. Talk therapy built around reassurance can feed the cycle.

SSRIs, a class of antidepressants, are the first-choice medicines. They often take longer to help in OCD than in depression, and a fair trial can take a few months. Many people improve without every symptom going away. For people under age 25, antidepressants carry a warning about suicidal thoughts that appear or worsen, so we monitor closely.

If first steps do not help enough, we can coordinate referrals to intensive OCD programs or to transcranial magnetic stimulation (TMS), a magnetic pulse treatment we do not provide ourselves.

Helping a family member, and getting help yourself

Families often get pulled into OCD out of love. They answer the same question, wash extra laundry or change plans to avoid a trigger. This is called accommodation. It brings quick relief, but it tells the brain the ritual was needed. Pulling back all at once can backfire, so ask for guidance and agree on small changes together.

Reach out if rituals or mental reviewing cost you time every day, strain a relationship or keep you from things you used to do. You do not have to be sure it is OCD first.

OCD can be exhausting, and some people reach a point of despair. Fear of acting on an unwanted thought is common in OCD and is a reason to call us. If thoughts of suicide have appeared, or a thought of hurting someone has started to feel like something you want to do, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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