OCD

A mental health disorder involving unwanted thoughts (obsessions) that drive repetitive behaviors (compulsions), causing distress and consuming significant time in daily life.

What is Obsessive–Compulsive Disorder (OCD)?

OCD is a mental health condition characterized by obsessions (intrusive, distressing thoughts, images, or urges) and/or compulsions (repetitive behaviors or mental rituals performed to reduce distress or prevent a feared outcome). Symptoms are time-consuming, difficult to control, and cause significant distress or impairment at school, work, home, or socially. Onset can occur at any age but most often emerges between late childhood and young adulthood. Co-occurring anxiety, depressive, or tic disorders are common.

Causes and Risk Factors of OCD

OCD arises from a mix of genetic, neurobiological, and environmental factors.
Family history: Higher risk with a first-degree relative, especially with childhood-onset OCD.
Brain circuitry: Differences in cortico-striato-thalamo-cortical networks have been observed.
Trauma/stress: Childhood adversity can increase vulnerability.
Infections/immune: A subset of children develop sudden onset OCD/tics after streptococcal infection (PANDAS) or other immune triggers (PANS).
Boys often present earlier than girls during childhood.

Other Conditions

You are not defined by what you've been through; your future is yours to create.

We treat root causes and underlying triggers of mental health conditions.

Symptoms of OCD

People with OCD may experience obsessions, compulsions, or both. Common themes include:
Obsessions (intrusive thoughts/urges/images)
Contamination or illness fears
Harm (accidentally or intentionally hurting self/others)
“Forbidden” or taboo content (sexual, aggressive, or religious)
Symmetry/“just right” sensations; need for exactness
Fear of losing items, making mistakes, or moral transgression

Compulsions (repetitive behaviors/mental rituals)
Washing/cleaning; decontamination rituals
Checking (locks, appliances, safety)
Ordering/arranging; repeating; counting; mental neutralizing/praying
Reassurance seeking; avoiding triggers
Not everyone with habits or intrusive thoughts has OCD. In OCD, the person feels driven to perform rituals, spends ≥1 hour/day on symptoms (or is markedly impaired), gains little or no pleasure from rituals (brief relief only), and finds symptoms hard to control.
Tics and Tourette syndrome can co-occur. Tics are sudden, repetitive movements or sounds outside of one’s control.

Types of Anxiety Disorders

Generalized Anxiety Disorder (GAD): Ongoing, hard-to-control worry about multiple areas of life, often with restlessness, fatigue, and tension.
Panic Disorder: Recurrent, unexpected panic attacks and worry about having more attacks; may lead to avoidance.
Agoraphobia: Anxiety about situations where escape may be difficult (e.g., crowds, public transport), often avoided.
Social Anxiety Disorder (Social Phobia): Intense fear of being judged or embarrassed in social or performance situations.
Specific Phobias: Marked fear of a particular object or situation (e.g., heights, flying, needles).
Separation Anxiety Disorder & Selective Mutism: More common in childhood but can occur at any age.
Note: Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) are closely related conditions but are classified separately from anxiety disorders. They can still involve significant anxiety.

15+

Years of experience

Diagnosis of OCD

OCD is a clinical diagnosis made by a qualified clinician.
Assessment: Medical and psychiatric history; mental status exam; safety assessment; review of medications/substances; screening for comorbidities (depression, bipolar spectrum, anxiety, tics, autism spectrum, ADHD, eating and sleep disorders).
Rule-outs: Other causes of intrusive thoughts or repetitive behaviors, including psychosis, generalized anxiety, body dysmorphic disorder, illness anxiety, autism spectrum, and obsessive–compulsive personality disorder (OCPD) (a distinct, personality-based pattern of perfectionism and rigidity without true obsessions/compulsions).
Specifiers: Level of insight (good/poor/absent-delusional) and tic-related.
Measures (to quantify severity/track change; not diagnostic):

- Yale–Brown Obsessive Compulsive Scale (Y-BOCS / CY-BOCS for children)
- Obsessive–Compulsive Inventory–Revised (OCI-R) or Dimensional Obsessive–Compulsive Scale (DOCS)
- Screening tools can flag possible OCD but do not confirm diagnosis.

Clinical Dimensions to Note (useful for care planning)

Treatment

Effective, evidence-based treatments help most people reduce symptoms and reclaim function. Care is individualized and often combines psychotherapy with medication.

First-Line Psychotherapy

1. Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT-ERP)

Gradual, planned exposure to feared thoughts/situations while resisting rituals or avoidance.
Teaches new learning that anxiety can decline without compulsions and feared outcomes are unlikely.
Typically 12–20 sessions (may be more for severe/complex presentations).
Can be adapted for children/teens (includes parent involvement) and for perinatal/postpartum OCD.

2. Medications

Serotonergic antidepressants (high-dose, longer trials than for depression):

SSRIs (e.g., fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram/escitalopram).
Clomipramine (a TCA) is effective; often used after or alongside SSRIs with careful monitoring.
Augmentation for partial response: low-dose antipsychotics (e.g., risperidone, aripiprazole), especially in tic-related OCD.
Medication typically requires 10–12 weeks at therapeutic dose to judge response; many benefit from longer-term maintenance.
Benzodiazepines are not first-line for core OCD symptoms.

Neuromodulation / Advanced Options (for severe, treatment-resistant OCD)

Deep Transcranial Magnetic Stimulation (TMS) protocols (often adjunctive to ERP).
Deep Brain Stimulation (DBS) under specialized programs.
Ablative procedures (e.g., capsulotomy) in highly selected cases at tertiary centers.

These options are reserved for patients who have not improved with optimized ERP and multiple medication trials.

3.Lifestyle & Supports

Sleep regularity, exercise, stress-reduction, and mindfulness can support (not replace) ERP/medication.
Family education to reduce accommodation/reassurance that can inadvertently maintain symptoms.
School/work accommodations (structured routines, reduced reassurance cycles) when needed.

When to Seek an Evaluation

Vivabest Psychiatry PLLC: Our Approach

Comprehensive evaluation with validated measures (e.g., Y-BOCS/CY-BOCS), attention to insight, tic-related features, and perinatal/postpartum presentations.
CBT-ERP delivered directly or through trusted specialists; coaching to reduce family accommodation.
Medication management using evidence-based SSRI/clomipramine strategies and augmentation when indicated, with careful monitoring of benefits and side effects.
Collaborative care plan combining psychotherapy, skills training, and lifestyle interventions, with measurement-based follow-up to track progress.

OCD