OCD (Obsessive-Compulsive Disorder)

Obsessive-compulsive disorder (OCD) is often misunderstood as simply liking things neat and orderly — the reality is a cycle of intrusive thoughts and compulsive behaviors that can be exhausting and disruptive. Greater Boston Psychiatric Services provides psychiatric evaluation and ongoing medication management for OCD, by telehealth or in person at our office in Medway.

What Is OCD (Obsessive-Compulsive Disorder)?

OCD is a condition centered on two components: obsessions, which are intrusive, unwanted thoughts, images, or urges that cause significant anxiety; and compulsions, which are repetitive behaviors or mental acts performed to reduce that anxiety or prevent a feared outcome. The compulsions provide only temporary relief, which reinforces the cycle. OCD ranges widely in how it presents — common themes include contamination fears, a need for symmetry or exactness, intrusive taboo or violent thoughts, and fears of causing harm — but the underlying obsession-compulsion cycle is consistent across presentations.

Types of OCD (Obsessive-Compulsive Disorder)

• Contamination & Cleaning — fear of germs, illness, or contamination, paired with excessive washing or cleaning rituals

• Checking — repeated checking of locks, appliances, or actions, driven by fear of causing harm through carelessness

• Symmetry & Ordering — a need for things to feel "just right," evenly arranged, or done a specific number of times

• Intrusive Thoughts — unwanted, distressing thoughts — often violent, sexual, or blasphemous in nature — that the person finds disturbing and doesn't want, paired with mental compulsions like reviewing or seeking reassurance

Signs & Symptoms

• Recurrent, intrusive thoughts, images, or urges that cause distress

• Repetitive behaviors (washing, checking, counting, arranging) performed to reduce anxiety

• Recognizing, at least at times, that the thoughts or behaviors are excessive (though this insight can vary)

• Significant time consumed by obsessions or compulsions — often an hour or more per day

• Avoidance of situations that trigger obsessive thoughts

• Significant distress or impairment in daily functioning

Causes & Risk Factors

• Genetics and family history of OCD or related anxiety disorders

• Differences in brain circuitry involving the areas that regulate error-detection and habitual behavior

• Serotonin system involvement, which is part of why SSRIs are effective treatment

• Stress or significant life changes, which can trigger onset or worsen existing symptoms

How It's Diagnosed

OCD is diagnosed through a clinical evaluation focused on identifying the specific pattern of obsessions and compulsions, how much time they consume, and how much distress or impairment they cause. Because OCD often overlaps with anxiety and depression, and because people are sometimes reluctant to describe intrusive thoughts out of shame or fear of judgment, a thorough and non-judgmental evaluation is important to an accurate diagnosis.

Treatment Options

The most effective treatments for OCD are SSRIs (often at higher doses than used for depression) and a specific form of therapy called Exposure and Response Prevention (ERP), ideally in combination. Our clinicians manage the medication component of treatment. We don't provide ERP therapy directly, but it's the gold-standard therapeutic approach for OCD, and we're glad to coordinate with a therapist trained in ERP or help point you toward one.

When to Seek Help

If intrusive thoughts and repetitive behaviors are consuming significant time, causing distress, or interfering with work, relationships, or daily routines, an evaluation can help clarify the diagnosis and appropriate treatment. Many people live with undiagnosed OCD for years out of shame about the content of their intrusive thoughts — those thoughts are a symptom of the condition, not a reflection of a person's character or intentions.

Insurance & Self-Pay

We're in-network with Blue Cross Blue Shield, Aetna, Harvard Pilgrim Healthcare, Optum, Tufts Health Plan, Wellpoint, United Healthcare, HPI, Mass General Brigham, Carelon, UMR, and UniCare. Self-pay options are available. We are unable to bill Medicare, Medicaid, or supplemental plans.

Frequently Asked Questions

Is OCD just about being tidy or organized?

No — that's a common misconception. OCD is a cycle of intrusive, distressing thoughts and compulsive behaviors performed to relieve that distress. Many people with OCD have themes that have nothing to do with cleanliness, such as intrusive violent or taboo thoughts, checking behaviors, or a need for symmetry.

Are intrusive thoughts a sign that I might act on them?

No. Intrusive thoughts in OCD are, by definition, unwanted and distressing to the person having them — the distress is part of what makes them an OCD symptom rather than a genuine desire or intention. This is one of the most important things to understand about OCD, and something your clinician can discuss with you in detail.

What medications are used to treat OCD?

SSRIs are the first-line medication treatment for OCD, though they're often prescribed at higher doses than for depression or general anxiety. Your clinician will discuss an appropriate starting dose and adjust based on your response.

Do I need therapy in addition to medication?

Exposure and Response Prevention (ERP) therapy has the strongest evidence for OCD and is often most effective combined with medication. We manage the medication side of treatment and can help connect you with an ERP-trained therapist.

How long does OCD treatment take to show results?

SSRIs for OCD can take longer to show full effect than for depression — sometimes eight to twelve weeks at an adequate dose. Patience and consistent follow-up during this period matter.

Can OCD develop suddenly in adulthood?

OCD often begins in childhood or adolescence, but it can also emerge or intensify in adulthood, sometimes triggered by significant stress or life changes. An evaluation at any age can identify the condition and appropriate treatment.

Related Conditions We Treat

OCD (Obsessive-Compulsive Disorder) often overlaps with, or can be mistaken for, other conditions. We also provide evaluation and medication management for Anxiety & Panic Disorders, PTSD (Post-Traumatic Stress Disorder), Depression.

Get Started

If you're experiencing symptoms of ocd (obsessive-compulsive disorder), the first step is a comprehensive psychiatric evaluation, available by telehealth or in person at our office in Medway. Schedule an appointment or view our full list of conditions we treat.