Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
The first modern treatments for obsessive-compulsive disorder (OCD) came about in the 1950s, but a lot has changed since then. We know more about the disorder and have more treatment options.
For starters, OCD is more than just a series of neat-freak tendencies and is in fact a type of anxiety disorder.
And treatment for OCD has become much more nuanced over the years to target the symptoms associated with the disorder.
Read on to learn more about OCD along with four common treatment options proven to help.
Obsessive-compulsive disorder is one of the many anxiety disorders within the anxiety disorder family.
This goes beyond just disturbing thoughts or uncontrollable urges.
OCD can become so excessive that it can disrupt your life.
This often presents itself as excessive worrying, and for example, extreme concern about things like germs —resulting in behaviors like repetitive hand washing.
(Here’s how to tell if you might have anxiety.)
OCD symptoms often are categorized by obsessions or compulsions and uncontrollable, repetitive behaviors.
To be diagnosed with OCD, you must experience obsessions or compulsions for more than an hour a day, and/or experience significant daily distress from them that disturbs your lifestyle or routine.
Obsessions are any repetitive thought or urge that ultimately causes anxiety.
Some common obsessions associated with OCD include:
Fear of germs
Fear of contamination
Repetitive thoughts about sex
Repetitive thoughts about religion
Repetitive thoughts about harm
Aggressive thoughts in general
Need for physical symmetry
Compulsions are repetitive behaviors that stem from obsessive thoughts.
Common compulsions associated with OCD include:
Handwashing (sometimes multiple times)
Specific organization or arranging
Excessive checking on things
It’s important to note that all of us may occasionally do some of these specific behaviors.
However, the difference with someone with OCD is how often they spend on tasks like this and the impact of these tasks on quality of life.
For example, someone with OCD will likely feel no control over these types of thoughts and behaviors, spend a lot of time responding to these thoughts, and experience daily disruption due to these thoughts.
Some people might experience tics with OCD, though they not as common as obsessions and compulsions and not needed for a diagnosis of the disorder.
Tics are repetitive physical movements such as clearing the throat, jerking the head, shrugging or blinking.
A note about OCD: Receiving a diagnosis can depend on your age, as obsessive compulsive disorder can show up differently in children and young adults (vs. adults).
An early-onset case of OCD (diagnosed in childhood or the early teenage years) typically will present as more severe, male dominant and may come with other symptoms such as tics.
The average age of diagnosis for OCD is around 19 years-old, yet adults still can develop the disorder.
Over time, healthcare professionals have been learning more and more about how to treat OCD. Like many mental health illnesses, there is not a one-size-fits-all approach.
Standard treatment for OCD typically involves a combination of therapy and medication — however, the specifics of a treatment plan will depend on various factors, including your individual needs.
Here are four treatment options for OCD, many of which are used in combination with one another.
According to the OCD Foundation, the first line of treatment considered for anyone diagnosed is therapy for OCD.
More specifically, healthcare providers may recommend cognitive therapies such as cognitive behavioral therapy (CBT) and exposure-response prevention (ERP). Here’s more about these methods:
Cognitive behavioral therapy is a research-based therapy practice that involves evaluating thoughts and behaviors.
CBT stems from the belief that psychological difficulties can be rooted in unhelpful thoughts and learned patterns.
With CBT, psychologists and therapists hope to help patients understand thoughts and behaviors to create better coping methods.
And then over time — those same behaviors or thoughts can be addressed differently.
One way CBT works for OCD is through a process called exposure and response prevention. Many OCD symptoms force people to deal with their obsessive thoughts and compulsions, so this response prevention helps patients manage them.
Exposure response prevention takes place under the safe guidance of a therapist, and involves exposing someone to specific anxiety triggers or obsessions.
The therapist then helps them through the issue without sliding into obsessive-compulsive behaviors.
ERP can slowly and carefully expose someone to sources of anxiety to better manage the response (or compulsions) to such anxiety-producing triggers, thus improving anxiety symptoms over time.
Another way to treat OCD is through medication — specifically antidepressants.
Selective serotonin reuptake inhibitors (SSRIs) are most popular for treating OCD, and FDA-approved antidepressant options include:
Fluvoxamine was the first antidepressant shown to be effective for treating OCD. Fluvoxamine is still a popular choice among SSRIs for OCD.
Sertraline (which is the generic version of Zoloft®) is another effective SSRI found to help with both short-term and long-term treatment of OCD.
Paroxetine (the generic name for Paxil®) is an FDA-approved SSRI for the treatment of OCD. For most patients, it helps decrease symptoms, while others may find it helps them go into remission.
Similarly, fluoxetine (the generic name for Prozac®) is an FDA-approved SSRI treatment for OCD because of its ability to affect serotonin levels.
Other SSRIs not approved by the FDA for OCD treatment but sometimes used off-label include citalopram and escitalopram.
Citalopram (the generic name for Celexa®) is sometimes used off-label to treat OCD, and has been shown to work as well as other SSRIs in helping to manage OCD symptoms. However, it is not approved by the FDA to treat OCD.
In fact, in 2011 the FDA issued a black-box warning about using citalopram in doses beyond 40 mg/day, as it could cause arrhythmia and other potential ECG abnormalities.
It is also not recommended in doses above 20 mg/day for the elderly, and it’s said to be best avoided in general for anyone prone to arrhythmia.
Escitalopram (which is the generic name for Lexapro®) has also been shown to reduce OCD symptoms, and is sometimes prescribed off-label to treat the disorder.
However, one study does point out how escitalopram (and other SSRIs) might be less effective in reducing certain OCD symptoms, like hoarding.
Two other OCD treatment options that may be offered depending on the severity of OCD include inpatient programs and antipsychotic medications.
It should be noted that both of these are more typical if the first-line treatments (therapy and medication) do not work.
These options are also sometimes combined with the other, aforementioned OCD treatment options.
Most OCD treatment is outpatient, meaning you can live at home and go about your life at the same time.
For the most part, suggested treatment is whatever will be the least restrictive yet effective.
However, for severe or complicated OCD, inpatient care might be necessary.
Inpatient care involves support and treatment that happens within a facility and usually over a period of time.
Inpatient facilities are often centers that specialize in supporting those with severe cases of OCD.
When antidepressants are not working, a healthcare provider may consider adding antipsychotic medication to an OCD treatment plan.
Antipsychotics are not given to replace antidepressants but instead are added to antidepressant treatment.
As researchers and healthcare professionals learn more about OCD as a mental health disorder (and better understand the symptoms that occur with it) more treatment options will become available.
In the meantime, in person or online therapy and medication serve as the gold-standard plan when it comes to treating OCD.
OCD can be a debilitating disorder, but with therapy like CBT combined with medication, it can be managed and possibly overcome.
Your best place to start? Consult with a healthcare professional to discuss your symptoms and a potential treatment plan. Then you can be set on your best course of action, and treat your OCD for good.
Start your mental wellness journey today.