Clinical Focus
Obsessive-Compulsive Disorder
Comprehensive evaluation and evidence-based treatment coordinated with specialized OCD therapists.
What is it?
Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by obsessions (intrusive, unwanted thoughts, images, or urges that cause significant distress) and compulsions (repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions). OCD affects approximately 2% to 3% of adults.
OCD is profoundly misunderstood. Popular culture trivializes it as a preference for neatness. In clinical reality, OCD is a severely disabling condition that can consume hours of a patient's day. The World Health Organization has ranked it among the top 10 most disabling illnesses worldwide in terms of lost income and diminished quality of life.
Clinical Presentation
OCD obsessions cluster around common themes: contamination fears, harm obsessions (intrusive thoughts about harming oneself or others that the patient finds deeply distressing), symmetry and exactness, and religious or moral scrupulosity. Compulsions may be visible behaviors (handwashing, checking, ordering) or mental rituals (silent praying, mental reviewing).
Many patients with primarily mental compulsions are misdiagnosed because their rituals are invisible. "Pure O" involves primarily mental obsessions and covert compulsions without obvious behavioral rituals. The shame associated with certain obsession content, particularly violent or sexual intrusive thoughts, further delays help-seeking.
Our Approach
Depression is present in 60% to 70% of individuals with OCD. Anxiety disorders co-occur in approximately 75%. The relationship between OCD and ADHD is clinically important: both involve executive function difficulties, but the underlying mechanisms differ. When both are present, stimulants can sometimes worsen OCD symptoms, requiring careful treatment sequencing.
Diagnostic accuracy matters because OCD requires specific treatment. OCD typically requires significantly higher SSRI doses and longer duration before response (8 to 12 weeks vs. 4 to 6 weeks for depression). A patient treated with standard depression dosing may be mislabeled treatment-resistant.
Treatment Approach
The gold standard is the combination of medication and exposure and response prevention (ERP) therapy. We coordinate with therapists specifically trained in ERP, which is distinct from general CBT.
First-line medication is an SSRI at higher doses than used for depression. Sertraline, fluoxetine, and fluvoxamine have the strongest evidence. Clomipramine remains the most effective single medication but carries a higher side-effect burden. For treatment-resistant OCD, augmentation with low-dose atypical antipsychotics may be considered.
Why This Is Different at Our Practice
OCD requires higher medication doses and longer treatment timelines than depression, and many patients are undertreated because their providers use standard depression dosing. Our 60 to 90 minute evaluation identifies the comorbidities that complicate treatment, and we maintain referral relationships with ERP-trained therapists because general CBT therapists without ERP training are not substitutes.
Psychiatrist: Dr. Lodhi, Dr. Patel, and Dr. Staley
Frequently Asked Questions
How is OCD different from being a perfectionist?+
Perfectionism is a personality trait. OCD is a medical condition driven by intrusive, unwanted thoughts. People with OCD do not enjoy their rituals. They perform them because the anxiety of not performing them is unbearable.
What is ERP therapy for OCD?+
Exposure and response prevention is the gold-standard psychotherapy for OCD. It involves gradual exposure to triggers while refraining from compulsions. It requires a therapist with specific ERP training.
Why does OCD require higher medication doses?+
OCD involves different serotonergic pathways and typically requires higher SSRI doses. Response also takes 8 to 12 weeks rather than 4 to 6. Patients treated with standard depression doses who do not improve may be mislabeled as treatment-resistant.
Can intrusive thoughts be about anything?+
Yes. The content does not reflect the patient's desires or character. It reflects the condition's tendency to target whatever the individual values most. Patients with violent intrusive thoughts are distressed precisely because those thoughts contradict their values.