OCD Doctor

Obsessive compulsive disorder, commonly called OCD, can be much more complicated than simply being neat, organized, or particular. People with OCD experience unwanted thoughts, fears, images, or urges that repeatedly enter their minds. These are called obsessions. They may also feel driven to perform certain behaviors or mental rituals to reduce their anxiety. These are called compulsions.

OCD can become time consuming and interfere with school, work, relationships, sleep, and everyday activities. Fortunately, OCD is treatable. Finding a doctor who understands how to recognize and treat OCD is an important first step.

Why See a Psychiatrist for OCD?

A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. This medical training can be particularly helpful when evaluating OCD because symptoms do not always occur by themselves.

Someone with OCD may also have depression, anxiety, ADHD, a tic disorder, an eating disorder, or another psychiatric condition. Some medical conditions and medications can also contribute to changes in thoughts, anxiety, or behavior. A psychiatrist can look at the entire picture rather than focusing only on one symptom.
Psychiatrists can also provide medication treatment when it is appropriate. This is important because OCD medication treatment can be different from the treatment of ordinary anxiety or depression. Medication doses and the amount of time needed to determine whether a medication is working may be different for OCD.

Psychiatrists are not the only professionals who treat OCD. Psychologists, counselors, social workers, and other therapists can develop significant expertise in OCD, particularly in a therapy called exposure and response prevention. For many patients, excellent OCD care involves a psychiatrist working together with a therapist who has specific experience providing this treatment.

How Does a Psychiatrist Evaluate OCD?

There is no blood test or brain scan that diagnoses OCD. Diagnosis usually begins with a detailed conversation about the person's symptoms.

An OCD doctor will want to understand the thoughts or fears that repeatedly bother the patient. Some people worry excessively about germs or contamination. Others become consumed by doubts about whether they locked a door, turned something off, or made a mistake.

OCD can also involve disturbing thoughts about harming someone, sexual thoughts, religious concerns, or fears about doing something completely out of character. Having an unwanted thought does not mean that a person wants to act on it. In OCD, these thoughts are often upsetting precisely because they conflict with the person's values.

The psychiatrist will also look for compulsions. Some are easy to recognize, such as excessive washing, checking, arranging, or repeating an activity. Others happen entirely inside a person's mind. A patient might repeatedly review an event, count, pray, replace a frightening thought with a good thought, or mentally check whether something feels right.

Reassurance seeking can also become part of OCD. A person may repeatedly ask a spouse, parent, friend, or doctor whether something is safe or whether they did something wrong.

An evaluation looks at how much time these symptoms consume, how much distress they cause, and how much they interfere with everyday life. A psychiatrist will also evaluate whether another psychiatric or medical condition could better explain the symptoms.

OCD Can Look Different From Person to Person

One reason OCD can be missed is that there is no single type of OCD.

A person who repeatedly washes their hands because of contamination fears may recognize that something is wrong. You can learn more about contamination OCD here.

Someone who spends hours mentally reviewing conversations because they are terrified they accidentally offended someone may not realize that the problem could also be OCD.

Some people hide their symptoms because they are embarrassed by their thoughts. Others have lived with OCD for so long that their rituals seem normal to them.
This is one reason an experienced OCD clinician asks specific questions rather than simply asking, "Do you have obsessive thoughts?"

Exposure and Response Prevention

One of the most important treatments for OCD is exposure and response prevention, usually shortened to ERP. ERP is a specialized form of cognitive behavioral therapy and is considered a first line psychological treatment for OCD.

During ERP, patients gradually practice facing situations, thoughts, or feelings that trigger their OCD while learning not to perform the usual compulsion.

For example, someone with contamination OCD might gradually practice touching something they consider dirty without immediately washing their hands. Someone with checking OCD might practice checking a door once and then leaving rather than returning several times.

The goal is not simply to make someone anxious. The goal is to teach the brain that anxiety and uncertainty can be tolerated without performing a ritual. With repeated practice, the connection between the obsession and the compulsion can become weaker.

Medication Treatment for OCD

Medication can also be an important part of OCD treatment.

Selective serotonin reuptake inhibitors, commonly called SSRIs, are the most frequently used first line medications for OCD. These medications are also used for depression and anxiety, but treating OCD often requires a different approach.

One important treatment pearl is patience. Someone taking an antidepressant for depression may notice improvement relatively quickly. OCD often takes longer to respond. The National Institute of Mental Health notes that antidepressant treatment for OCD may take 8 to 12+ weeks before symptoms begin to improve and that higher doses may sometimes be required than those typically used for depression.

This means that a medication should not necessarily be labeled a failure simply because OCD symptoms have not disappeared after a few weeks.

Medication selection also needs to be individualized. A psychiatrist considers previous medication responses, side effects, other medications, medical conditions, age, and other psychiatric symptoms before recommending treatment.

Treatment Usually Aims for Improvement, Not Perfect Thoughts

A common misunderstanding about OCD treatment is that successful treatment should eliminate every unwanted thought. Everyone experiences strange, uncomfortable, or unwanted thoughts from time to time. The problem in OCD is often what happens after the thought appears.

A person may analyze it, fight it, seek reassurance about it, or perform a ritual to make the anxiety disappear. Those responses can unintentionally keep the OCD cycle going.

Treatment therefore focuses not only on reducing symptoms but also on changing how a person responds when an obsession appears.

Family Members Can Accidentally Reinforce OCD

OCD frequently involves other members of the household.

A child might repeatedly ask a parent whether something is contaminated. An adult might ask a spouse dozens of times whether the stove was turned off. Family members naturally want to reduce the person's distress, so they provide reassurance or participate in rituals.

Although well intended, repeatedly helping with compulsions can sometimes strengthen the OCD cycle. Part of treatment may involve teaching family members how to remain supportive without becoming part of the rituals.

Finding the Right OCD Specialist

OCD is a condition in which specialized experience matters.

When looking for an OCD doctor or therapist, patients can ask how frequently the clinician treats OCD, whether they use ERP, how they determine whether medication has received an adequate trial, and how they approach OCD that has not improved with initial treatment.

Traditional supportive therapy can be helpful for many emotional problems, but simply talking about fears is not the same as ERP. The International OCD Foundation recommends looking for clinicians who have specific experience treating OCD and providing evidence based treatment.

For some patients, the best approach is a team. A psychiatrist can manage the medical and medication portions of treatment while an ERP trained therapist provides specialized psychotherapy.

OCD can be frustrating because people often recognize that their fears or rituals are excessive yet still feel unable to stop them. That does not mean treatment will not work. Effective treatments are available, and even people with significant OCD symptoms can improve with appropriate care.