OCD
Intrusive thoughts and rituals that take over — and respond well to targeted treatment.
Obsessive-compulsive disorder is characterized by unwanted, intrusive thoughts (obsessions) that generate intense anxiety, and repetitive behaviors or mental acts (compulsions) performed to neutralize that anxiety. OCD is not about being a 'neat freak' — the obsessions are often disturbing and ego-dystonic, meaning the person knows they don't make sense but can't stop them.
Signs and symptoms
Common obsessions
- Fear of contamination — germs, illness, or spreading harm to others
- Intrusive thoughts about harming oneself or loved ones (harm OCD)
- Need for symmetry, exactness, or things to 'feel right'
- Unwanted sexual or religious intrusive thoughts
- Fear of acting on violent impulses despite having no desire to do so
Common compulsions
- Excessive handwashing, cleaning, or avoiding contamination triggers
- Checking behaviors — locks, appliances, physical sensations
- Counting, ordering, or arranging objects until they feel 'right'
- Seeking reassurance repeatedly from others
- Mental rituals — praying, reviewing, or replacing bad thoughts with good ones
Dr. Patil's approach
How this condition is treated here.
OCD responds best to a combination of medication (typically higher-dose SSRIs) and exposure and response prevention (ERP) therapy — a specialized form of CBT that is very different from standard talk therapy. Dr. Patil manages the medication component and refers patients to ERP-trained therapists in the area when appropriate.
SSRIs at therapeutic doses
OCD typically requires higher SSRI doses than depression. Common choices include fluvoxamine, fluoxetine, sertraline, and clomipramine. It can take 8–12 weeks to see full effect.
Augmentation
If SSRIs alone aren't sufficient, adding a low-dose antipsychotic (risperidone or aripiprazole) can improve response in treatment-resistant OCD.
ERP therapy referral
Exposure and response prevention is the gold standard psychotherapy for OCD. It involves graded exposure to feared triggers while resisting compulsions. It requires a therapist specifically trained in OCD treatment.
What to expect at your first visit
The first visit involves a thorough assessment of obsession and compulsion type, severity, and impact on daily functioning. Dr. Patil will ask about how many hours per day OCD symptoms take up, what triggers them, and what prior treatments have been tried.
- Discussion of specific obsession and compulsion patterns — being specific helps
- Assessment of OCD severity and its impact on work, relationships, and daily tasks
- Explanation of why higher medication doses are typically needed for OCD
- A referral plan for ERP therapy alongside medication management
Common misconceptions
Myth
"OCD means being very organized or clean."
Fact
This is one of the most harmful misconceptions about OCD. Many people with OCD have obsessions that are profoundly disturbing — about violence, sexuality, or religion — and feel horrified by their own thoughts. Organization is rarely the primary presentation.
Myth
"If you have intrusive violent thoughts, you might act on them."
Fact
Intrusive thoughts in OCD are ego-dystonic — the person is distressed by them precisely because they go against their values. Having the thought does not predict behavior.
Frequently asked questions
Is OCD curable?
OCD is highly treatable but is generally considered a chronic condition that can be managed very effectively. Many people achieve significant symptom reduction and go on to lead full, unrestricted lives with the right combination of medication and therapy.
Why does standard talk therapy not work well for OCD?
Standard supportive therapy and insight-based approaches can inadvertently reinforce OCD by providing reassurance. ERP works differently — it teaches the brain that the feared outcome doesn't materialize and that anxiety decreases on its own without compulsions.
Ready to get evaluated?