OCD Treatment: Therapy & Medication Options

How Is OCD Diagnosed?

OCD is diagnosed when someone experiences the recurrence of obsessive thoughts and repetitive behaviors, and when these thoughts and behaviors significantly impair their life and ability to function. A psychiatrist or psychologist will diagnose OCD after a period of analyzing someone’s current symptoms and health history.

Why Is OCD Often Misdiagnosed?

OCD is often misdiagnosed because there is so much overlap in symptoms with complex trauma, anxiety, depression, and sometimes even ADHD. It can also be more complicated when someone has a comorbid disorder with their OCD.

What Is the Most Effective Treatment for OCD?

Generally, exposure and response prevention is the most effective type of treatment used to address OCD; however, the length of one’s illness, severity of symptoms, and treatment history all play a role in determining the best options.³ Other patients may choose to add medication management to their treatment plan to achieve greater impact on their progress.

OCD Therapy

Most often, OCD is treated with outpatient therapy, most commonly exposure and response prevention (ERP). Positive results can be seen as soon as four to six months. There are instances in which clients will require longer outpatient treatment or a more intensive treatment setting depending on the severity of their condition.

Therapy techniques used to manage OCD are:^3,4

Exposure & Response Prevention (ERP)

ERP is the gold-standard treatment for OCD. In ERP for OCD, the client and therapist formulate a list of feared items (hierarchy of fears), then gradually expose the individual while avoiding the usual compulsive responses. This continues until they can manage the stimuli without the need to engage in the usual, ritualized behaviors.^3,4

Habit Reversal Training

Habit reversal training (HRT) was originally used to help people manage symptoms of tic disorders and Tourette Syndrome. More recently, the treatment has been successful with OCD. HRT works to have the person challenge and end their compulsive behaviors through recording, awareness training, competing-response training, and habit-control motivation.⁹

Mindfulness-Based CBT

Mindfulness-based CBT trains people to have an observational instead of judgmental stance regarding thoughts, feelings, urges, and physical sensations. People with OCD are taught that the uncomfortable sensations are not the problem, but rather their reactions to them, they are encouraged to practice experiencing these sensations without engaging in rituals, avoidance, and reassurance-seeking behaviors.^3,4

Acceptance and Commitment Therapy (ACT)

ACT is an approach to therapy that asks clients to be open to their negative feelings and accept them without judgment. ACT for OCD involves radical self-acceptance of all feelings and understanding that each emotion serves a purpose.

Psychodynamic Therapy

The use of psychodynamic therapy with OCD is a controversial subject with limited evidence-based psychodynamic therapy options. More recently, experts pointed to a specific form of psychodynamic therapy called short-term psychodynamic therapy (STPP) as a helpful option. This form of therapy uses 12 modules of treatment to address OCD symptoms.¹⁰

Medication for OCD

If necessary, your therapist will refer you or your loved one to a psychiatrist or psychiatric nurse practitioner who can prescribe appropriate OCD medications, typically SSRIs. People may make the decision to add medications due to continued struggles after several months of therapy with only moderate progress. Most people can self-refer to a PCP or psychiatrist to discuss medication. If not, your therapist or PCP can make a referral.

Medications that can be used to treat OCD include:⁶

• Clomipramine (Anafranil)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Sertraline (Zoloft)
• Citalopram (Celexa)

*This is not a comprehensive list. You should talk with your doctor or psychiatrist about any medications you are prescribed or interested in taking.

OCD Medication Side Effects

SSRIs have side effects, but they are generally more manageable than clomipramine. Although all SSRIs appear to be equally effective, some people may respond well to one and not another. In choosing among the SSRIs, the prescriber will consider the pros and cons, past treatment responses, and the presence of any other conditions.

OCD Medication for Children & Teens

The use of medication in children with OCD and adolescents with OCD is dependent upon the age of the child, the severity of their condition, and whether there are any comorbidities along with their OCD, such as depression, that require treatment with a selective serotonin reuptake inhibitor (SSRI) as well. If the child or adolescent has no other conditions and is young, CBT is suggested as the first option prior to utilizing medication. Medication is only added after a trial of CBT has been attempted with less than desirable results.⁸

Additional Treatments for OCD

For the patients who do not respond to the more traditional therapeutic approaches, there are several less common methods, including repetitive transcranial magnetic stimulation. Some of these approaches do not have as much evidence to support their success rates, but some people and their teams may find them helpful for more severe symptoms.

Other types of treatment plans for OCD include:⁵

• TMS for OCD: A non-invasive type of deep brain stimulation that is used to treat OCD and depression.
• Electroconvulsive therapy (ECT): A brief electrical stimulation of the brain while the patient is under anesthesia.
• Deep brain stimulation: First used for Parkinson’s disease, deep brain stimulation (DBS) places electrodes in the brain that are controlled by a generator in the chest. The stimulation is constant with frequencies tailored to the individual.¹¹
• Cingulotomy: A type of brain surgery that is a last resort for those with OCD.¹²

Treatment for Severe OCD

Occasionally a patient will require more intensive outpatient or inpatient treatment due to the severity of their condition or the presence of unmanageable co-occurring disorders. Intensive outpatient treatment consists of up to 10 hours of care each week. Inpatient care is usually reserved for the most severe cases.³

Intensive Outpatient Care

In intensive outpatient care, people usually meet with therapists, psychiatrists, and medical providers such as medical doctors or nurse practitioners who monitor their medications and health status. They will also participate in several hours of group therapy each week with other patients who have OCD. This allows them to hear from others dealing with the same condition. Family members may also participate in either group meetings or therapy appointments to learn how to support their loved ones.

Inpatient Hospitalization

In an inpatient setting, someone receives care from medical professionals 24 hours a day, seven days a week. One example for when this is necessary would be for someone with OCD who is so afraid of germs and contamination that they refuse to eat and require medical intervention. OCD can also exacerbate conditions such as anxiety and depression to the point that a person may become suicidal. Other times, the condition may be interfering with functioning to the point that intensive treatment is needed to break the OCD cycle.

Can OCD Support Groups Help?

Support groups utilize aspects of socialization and fellowship to help a person manage a challenging issue. Although OCD support groups lack professional clinicians and guidance, they may foster a sense of community and understanding that reduces loneliness and isolation linked to OCD. Support groups will generally not help reduce OCD symptoms, but they can improve other aspects of life. Online OCD resources can be a great place to start when looking for a support group. Remember, it is not recommended that you treat OCD on your own, so support groups should simply be one aspect of a holistic treatment approach.

Can OCD be Cured?

OCD cannot be cured. While OCD is likely genetic in origin, currently, we are not able to treat OCD at the genetic level to cure it.⁷ Consequently, the best option is therapy and/or medication for effectively managing the symptoms and achieving OCD recovery and symptom management. OCD is a chronic condition, which means that without intervention the condition will not likely go away on its own. The severity of OCD varies greatly, yet with professional intervention, treatment outcomes are positive in most cases.⁸

Although OCD can lead to increased distress and anxiety, some OCD traits can be helpful and result in people achieving higher than average levels of success, as evidenced by several famous people with OCD.