Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by unwanted, intrusive thoughts, images, or urges and/or repetitive behaviors or mental acts that a person feels driven to perform. OCD can affect children, teenagers, and adults and can interfere with relationships, school, work, sleep, and daily functioning.

At Ficus Psych, Gregory Sayer, MD provides psychiatric evaluation and individualized treatment for individuals experiencing OCD symptoms. Treatment is tailored to each person's symptoms, history, circumstances, and goals.

A comprehensive evaluation can help clarify whether symptoms are consistent with OCD or another psychiatric condition and can help guide decisions regarding psychotherapy, medication, or a combination of treatments.

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What Is OCD?

OCD involves obsessions, compulsions, or both.

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Obsessions

Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted and that typically cause significant anxiety or distress.

Examples can include concerns about:

• Contamination or illness

• Harm coming to oneself or others

• Making a mistake

• Responsibility for a negative outcome

• Morality or doing something "wrong"

• Relationships

• Sexual thoughts or fears

• Religious or moral concerns

• Symmetry, order, or completeness

People with OCD may recognize that their thoughts or fears seem excessive or unreasonable, although the degree of insight and ability to articulate the internal experience can vary. 

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Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform, often in response to an obsession or according to rigid rules.

Examples can include:

• Repeated checking

• Washing or cleaning

• Reassurance seeking

• Counting

• Repeating words or actions

• Ordering or arranging

• Avoiding particular situations

• Mentally reviewing events

• Repeating thoughts or phrases

• Seeking certainty about a feared outcome

Compulsions may provide temporary relief from anxiety or uncertainty, but they can become increasingly time-consuming and disruptive.​

 

Common Presentations of OCD

OCD can present in many different ways, and the specific content of obsessions or type of compulsion can vary significantly amongst those with the disorder. 

Some individuals experience primarily contamination-related fears and washing or cleaning compulsions. Others may experience intrusive fears about harming themselves or others, repeated checking, relationship-related doubts, intrusive sexual or religious thoughts, or a need for symmetry or completeness.

Some compulsions are not readily visible to other people. Mental compulsions may include repeatedly reviewing memories, analyzing thoughts, mentally checking one's feelings, seeking internal certainty, or repeatedly reassuring oneself.

Because some symptoms can be difficult to recognize, individuals may experience OCD for years before seeking treatment.

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OCD Is More Than Being Particular or Perfectionistic

Many people occasionally check something, prefer things to be organized, or experience unwanted thoughts. These experiences alone do not necessarily indicate OCD. OCD generally involves symptoms that are persistent, difficult to control, distressing, time-consuming, or associated with meaningful interference in daily life. 

Obsessive Compulsive Personality Disorder (OCPD), in contrast, is characterized by a longstanding pattern of preoccupation with orderliness, perfectionism, control, and rigidity. Individuals with OCPD may place a strong emphasis on rules, organization, details, productivity, or doing things in a particular way. Unlike typical OCD obsessions, these personality traits may be experienced as consistent with the individual's own values or expectations rather than as intrusive and unwanted.

The two conditions can sometimes occur together, and distinguishing between them requires consideration of the individual's symptoms, personality patterns, developmental history, and overall functioning.

A psychiatric evaluation considers the nature of the thoughts and behaviors, the degree of distress and impairment, the person's response to them, and which conditions may best explain the symptoms.

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OCD in Children and Teenagers

OCD can occur during childhood and adolescence. Research suggests that some people have an onset of symptoms in childhood/preadolescent (~age 11) while others have an age of onset in early adulthood (~age 23). 

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Young people may have difficulty recognizing or explaining their symptoms. Parents may instead notice behaviors such as repeated washing, checking, reassurance seeking, rituals, avoidance, or difficulty completing routines.

OCD symptoms can sometimes overlap with anxiety, ADHD, autism spectrum disorder, tic disorders, depression, and other psychiatric conditions. A developmental psychiatric evaluation can help place symptoms in the appropriate clinical context.

Treatment may also involve parents or other family members when appropriate.

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How OCD Is Evaluated

There is no blood test, brain scan, or other laboratory test that by itself establishes a diagnosis of OCD.

A comprehensive psychiatric evaluation may consider:

• Current symptoms

• Nature and frequency of obsessions and compulsions

• Degree of distress and functional impairment

• Psychiatric history

• Medical history

• Family history

• Developmental history

• Previous treatment

• Medications

• Sleep

• Substance use

• Other psychiatric symptoms

• School, work, and relationship functioning

The evaluation also considers whether symptoms may be better explained by another psychiatric or medical condition or whether multiple conditions may be present at the same time.

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Treatment for OCD

Treatment is individualized based on symptom severity, clinical history, previous treatment, medical factors, and personal preferences.

Treatment may include psychotherapy, medication, or a combination of approaches.

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Cognitive Behavioral Therapy and Exposure and Response Prevention

Cognitive behavioral therapy (CBT) is an established psychotherapy approach for OCD. A specific form of CBT called Exposure and Response Prevention (ERP) is commonly used in the treatment of OCD.

ERP involves gradually approaching situations, thoughts, or other triggers that lead to anxiety or discomfort while reducing or resisting the compulsive response. The specific approach and pace of treatment are individualized.

Not every form of psychotherapy is designed specifically to treat OCD. When OCD is the primary concern, treatment should be appropriately matched to the disorder and the individual's clinical needs.

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Medication

Medication can be an effective treatment option for some individuals with OCD.

Medications commonly used to treat OCD include certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). Medication decisions take into account:

• Potential benefits

• Possible side effects

• Previous medication experiences

• Medical conditions

• Other medications

• Symptom severity

• Individual preferences

Medication may be used alone or in combination with psychotherapy, depending on the individual's circumstances.

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When OCD Occurs With Other Conditions

OCD can occur alongside other psychiatric conditions, including:

• Anxiety disorders

• Depression

• ADHD

• Autism spectrum disorder

• Personality Disorders

• Tic disorders

• Substance Use Disorders

• Body dysmorphic disorder

• Eating disorders

• Others 

Identifying co-occurring conditions is an important part of a comprehensive psychiatric evaluation because symptoms from different conditions can overlap and treatment success can be impacted by unrecognized or undertreated comorbidities. 

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Frequently Asked Questions

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How do I know if I have OCD?

Intrusive thoughts or repetitive behaviors do not necessarily mean that someone has OCD. It is thought that about 25% of the population experiences some obsessions and compulsions. A psychiatric evaluation considers the nature of the symptoms, associated distress, compulsive behaviors or mental rituals, functional impairment, and alternative explanations.

Can OCD involve thoughts without visible compulsions?

Yes. Some compulsions are primarily mental and may not be apparent to other people. Repeatedly reviewing, analyzing, checking, or seeking certainty internally can function as compulsive behaviors.

Can children have OCD?

Yes. OCD can occur in children and adolescents. Symptoms may look different depending on developmental level, and family involvement can sometimes be an important part of treatment.

Is OCD the same as anxiety?

OCD and anxiety disorders can share features such as fear and anxiety, but they are distinct psychiatric conditions. OCD involves obsessions and/or compulsions that have particular clinical characteristics.

Is medication necessary for OCD?

No. Some individuals benefit from psychotherapy, while others benefit from medication or a combination of psychotherapy and medication. Moderate and severe cases often require a combination approach. Treatment recommendations are individualized.

Can OCD be treated without medication?

Yes. Evidence-based psychotherapy, particularly CBT incorporating ERP, is an important treatment option for OCD and may be used with or without medication.

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OCD Treatment at Ficus Psych

Ficus Psych provides psychiatric evaluation and individualized treatment for OCD in children, adolescents, and adults.

Gregory Sayer, MD is board certified in both adult psychiatry and child & adolescent psychiatry. His approach emphasizes careful diagnosis, evidence-based treatment, and consideration of the biological, psychological, developmental, and environmental factors that may contribute to psychiatric symptoms.

Treatment is available through in-person appointments in Beverly Hills and telepsychiatry for patients throughout California and New York.

If intrusive thoughts, compulsive behaviors, or persistent uncertainty are interfering with your work, school, relationships, or daily life, a comprehensive psychiatric evaluation can help clarify the symptoms and discuss appropriate treatment options.

Contact Ficus Psych to schedule an introductory phone consultation.

Ficus Psych | 8500 Wilshire Blvd, Beverly Hills CA 90211

OCD Psychiatrist Los Angeles | Obsessive-Compulsive Disorder Treatment

Ficus Psych provides individualized psychiatric care for OCD in Los Angeles, Beverly Hills, and throughout California via telepsychiatry. Virtual psychiatric treatment is also available for patients located in New York.