What is OCD?
Obsessive Compulsive Disorder (OCD) is a distressing and often debilitating mental illness characterized by recurrent, unwanted, anxiety-provoking thoughts, images, or impulses (obsessions), as well as repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety. OCD affects about 2% of the general population, and it typically begins between the ages of 10 and 12 or in late adolescence/early adulthood. OCD has a genetic component, and it affects serotonergic and glutamatergic systems in the brain.
Common obsessions include a fear of germs or dirt, fear of harming someone unintentionally, concern with order, symmetry or exactness, religious obsession, preoccupation with numbers, or unwanted sexual thoughts.
Common compulsions are washing, checking, reassurance seeking, praying, counting,. Compulsions often temporarily reduce anxiety, but are not a long-term solution.
OCD sufferers can spend hours per day having obsessions and performing compulsions. Avoidance of people, places, and situations that could trigger obsessions or compulsions is very common. OCD can be very distressing and significantly interfere with important everyday activities. It most often requires treatment.
Treatment for OCD
The first-line treatments for OCD are cognitive behavioral therapy (CBT), medication with serotonin reuptake inhibitors (SRIs), or their combination.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) has been shown to be the most effective therapy for OCD and primarily consists of exposure and response prevention (ERP). With the assistance of an experienced clinician, individuals learn to repeatedly approach anxiety-provoking situations (exposure) while refraining from compulsions (response prevention). Exposures are done at a pace that the individual is comfortable with, and a patient is never forced to do anything that they are not willing to do. By confronting their fears, the patient has a chance to learn that their anxiety and distress will go down, and that feared consequences will not occur, even if they don’t complete rituals.
Parental involvement is often an important component in treating children and adolescents with OCD. In these cases, the therapist will guide the parent on how to best offer support and avoid counterproductive behaviors, such as offering reassurance (which may reduce anxiety in the short-term but ultimately maintains the anxiety).
Serotonin reuptake inhibitors (SRIs) are the most commonly prescribed medications for OCD. SRI dosages used to treat OCD are higher than the dose required to effectively treat depression symptoms. SRIs that are FDA approved for the treatment of OCD include: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), and Clomipramine (Anafranil). Additionally, Paroxetine (Paxil CR), Citalopram (Celexa), and Escitalopram (Lexapro) are commonly prescribed off-label for the management of OCD symptoms, and all of the aforementioned drugs have performed well in clinical trials for the management of OCD symptoms.
In addition to the commonly prescribed SRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) such as Duloxetine (Cymbalta) and Venlafaxine (Effexor) have been efficacious for the treatment of OCD in some patients.
An important aspect to keep in mind about medication for the management of OCD symptoms is to make sure you give them a fair trial with the assistance of your prescribing physician. SRIs can take between 10 and 12 weeks to start working and need to be taken regularly, not just when you are feeling anxious.
For more general information regarding treatment, please read our Treatment Approaches page on our website.
How CORD can help:
If you or someone you know is suffering from OCD, help is available. Our center specializes in evidence-based treatment for children and adults with OCD. We offer both cognitive behavioral therapy (CBT) and medication in our clinic and in the context of research studies. For more information, please contact:
If you are interested in learning more about our studies, please contact us at CORDResearch@mgh.harvard.edu.