Understanding Obsessive-Compulsive Disorder (OCD)
If you or a loved one is struggling with repetitive thoughts or behaviors that feel impossible to control, you’re not alone. Obsessive-Compulsive Disorder (OCD) is a treatable mental health condition, and with the right care, many people experience significant relief and healing.
As a psychiatrist, I offer compassionate, evidence-based treatment for OCD tailored to each individual’s needs. This page is designed to help you understand what OCD is, how it’s diagnosed, and how we can work together to manage it.
What Is OCD?
OCD is a mental health condition characterized by either or both:
- Obsessions: Unwanted, intrusive thoughts, images, or urges that cause significant anxiety or distress.
- Compulsions: Repetitive behaviors or mental acts performed to reduce the distress caused by obsessions.
These cycles can take up hours of a person’s day and interfere with relationships, work, or daily functioning. Common examples include excessive hand-washing, checking, arranging, or seeking reassurance.
The symptoms are not better explained by another mental health condition or the effects of a substance or medical issue.
It’s important to know that OCD isn’t just about being neat or orderly—it’s about unwanted, distressing thoughts and rituals that feel out of control.
How Common Is OCD?
- OCD affects approximately 1–2% of the population at any given time.
- 1 in 40 adults and 1 in 100 children in the U.S. experience OCD
- Symptoms typically begin in childhood, adolescence, or early adulthood, with two common peaks: around age 10 and again in the late teens to early twenties. Symptoms often start by age 19 and 50% develop them before adulthood.
- Men and women are equally affected, though men often show earlier onset.
People of all backgrounds can develop OCD—it’s not a sign of weakness, and it’s certainly not your fault.
What Causes OCD?
OCD is a biologically based condition that arises from a complex interplay of genetic, neurological, and environmental factors. While the exact cause is still being studied, research over the past several decades has uncovered key brain systems and processes involved in OCD.
Brain Circuitry Involved in OCD
One of the most consistent findings in OCD research is abnormal activity in a network of brain regions known as the cortico-striato-thalamo-cortical (CSTC) circuit. This loop connects parts of the brain responsible for:
- Decision-making and impulse control (orbitofrontal cortex)
- Habit formation and movement regulation (striatum, particularly the caudate nucleus)
- Emotional processing and filtering information (thalamus)
In people with OCD, this circuit becomes overactive—leading to excessive “error signals” in the brain. That’s why even after checking a locked door multiple times, it may still feel like something is wrong. The brain essentially struggles to “turn off” the warning signal, reinforcing obsessive thoughts and compulsive behaviors.
Neurotransmitters: The Role of Serotonin
The neurotransmitter serotonin plays a critical role in regulating mood, anxiety, and inhibitory control. Dysregulation of serotonin signaling is thought to contribute to the symptoms of OCD. This is why SSRIs (Selective Serotonin Reuptake Inhibitors)—which increase serotonin availability in the brain—are often effective treatments.
Other neurotransmitters, like dopamine and glutamate, have also been implicated, particularly in individuals who do not respond to SSRIs alone. Research into glutamatergic agents and other novel treatments is ongoing and something that can be considered if someone doesn’t respond or tolerate SSRIs.
Genetic Contributions
OCD tends to run in families, suggesting a genetic component. Twin and family studies estimate that 40–50% of the risk may be inherited, especially in childhood-onset cases. While no single “OCD gene” has been found, researchers have identified several gene variants that may affect brain signaling and contribute to risk.
Developmental and Environmental Factors
Early life stressors, infections (like PANDAS, related to streptococcal infections in children), and traumatic experiences can also influence the development of OCD in genetically vulnerable individuals. These factors may alter brain circuitry during critical periods of brain development. From my child psychiatry training at the Stanford Immune Behavioral Health Clinic during my fellowship, I have familiarity in diagnosing and treating those with OCD associated with PANS/PANDAS.
Stressful life events can sometimes trigger symptoms, but OCD is rooted in biology—not personal choices.
How Is OCD Diagnosed?
During an evaluation, I take the time to understand your experiences, history, and current challenges. This includes:
- A detailed clinical interview exploring your thoughts, behaviors, and emotional patterns.
- Ruling out other conditions that may mimic OCD symptoms (like anxiety, tics, or PTSD).
- Providing a diagnosis only if it fits your experience—and always discussing it with you collaboratively.
If you are curious about whether you have OCD, please take a look through the Yale-Brown Obsessive Compulsive questionnaire.
You’ll have space to share your story at your own pace. My goal is to make you feel heard, not judged.
Treatment Options I Offer
OCD is highly treatable. I offer a range of effective, personalized options, including:
Cognitive Behavioral Therapy (CBT)
Specifically, Exposure and Response Prevention (ERP) is the gold-standard therapy for OCD. It involves gradually facing your fears without performing rituals—allowing your brain to “rewire” and reduce anxiety over time.
Medication
Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine or sertraline are often effective. They help reduce obsessive thoughts and the urge to perform compulsions. These are often the first line options. OCD often requires higher doses and longer trial periods (8–12 weeks) than depression. Side effects vary but are often manageable.
Other Options
- Clomipramine (a tricyclic antidepressant) may be used if SSRIs aren’t effective.
- Augmentation strategies—like low-dose atypical antipsychotics (e.g., aripiprazole)—can boost response when needed.
- Novel treatment options include amantadine, lamotrigine, memantine, ondansetron (possibly the most effective add-on medication for OCD), topiramate, dextroamphetamine, high-dose caffeine
We’ll talk through the pros and cons of each option, monitor closely, and adjust based on how you’re feeling. Medication isn’t about changing who you are—it’s about giving your brain the space to heal and thrive.
Non-Medication Interventions
Transcranial Magnetic Stimulation (TMS)
TMS is a non-invasive treatment that uses magnetic pulses to stimulate underactive areas of the brain involved in OCD. It’s FDA-approved for OCD and may be helpful for individuals who haven’t had success with medication or therapy alone.
TMS uses gentle magnetic pulses to stimulate specific areas of the brain that are underactive in people with OCD, particularly the dorsomedial prefrontal cortex. This helps “reset” overactive brain loops involved in obsessions and compulsions, reducing symptoms over time.
Key Benefits
- Non-invasive: No surgery or anesthesia
- Medication-free: Can be used alone or alongside medication
- Minimal side effects: Most common is mild scalp discomfort during treatment
- No downtime: You can return to normal activities immediately after each session
What to Expect
- A course typically involves daily 20–30 minute sessions, 5 days a week, for 6 weeks, followed by a tapering phase. There are alternative treatment courses available such as an accelerated schedule with multiple sessions per day for a shorter amount of time.
- Most patients start to see changes by week 3–5, with continued improvement after the course ends.
- It’s safe, well-tolerated, and backed by strong clinical research.
For more information about TMS, please check out the International OCD Foundation page on this.
Nutritional & Natural Supplements
Some people explore over-the-counter supplements to help with their OCD. While not a replacement for primary treatment, certain options may offer mild benefit:
- N-Acetylcysteine (NAC): An antioxidant that may reduce compulsive urges by modulating glutamate levels in the brain.
- Inositol: A type of B-vitamin shown in small studies to have effects similar to SSRIs at high doses.
- Omega-3 fatty acids: May support mood and reduce inflammation.
Tailored Treatment Plans
Every person is different. Some benefit from therapy alone; others from a combination of therapy, medication, behavioral interventions, brain stimulation, supplements, or other treatment options. I work closely with you to create a plan that matches your goals, preferences, and life circumstances.
You Don’t Have to Face OCD Alone
If you’re ready to explore treatment—or if you’re just wondering whether what you’re experiencing could be OCD—I invite you to reach out by scheduling an appointment using the button below. Together, we can take the first step toward clarity and healing.
My Publications Related to OCD:
Review article on Obsessive Compulsive Disorder in Pediatrics in Review (the American Academy of Pediatric Medical Journal)