Obsessive-Compulsive Disorder (OCD)

OCD and Co-Occurring Psychosis

A meaningful subset of OCD presents alongside schizophrenia-spectrum conditions, sometimes called 'schizo-obsessive' presentations. The overlap is increasingly recognized in the research literature and is one of the most common drivers of OCD that fails standard treatment. We have deep experience teasing these apart and treating them simultaneously: ERP for OCD alongside the psychosocial and pharmacologic interventions that target the cognitive systems disturbed by psychosis. When OCD has felt treatment-resistant, this dual lens often changes the outcome. See our clinical review to learn more about distinguishing OCD from psychosis.

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting mental health condition in which a person experiences uncontrollable, recurring thoughts, behaviors, or both. While many people experience minor obsessive thoughts or compulsive habits from time to time, OCD is characterized by symptoms that interfere significantly with daily life, take up at least an hour a day, and cause intense distress. The Two Main Components OCD is primarily driven by a continuous cycle of obsessions and compulsions. 1. Obsessions Obsessions are repeated, persistent, and unwanted thoughts, urges, or mental images that cause debilitating anxiety, fear, or disgust. The individual usually recognizes these thoughts as irrational but cannot simply turn them off. Common obsessions include: Intense fear of contamination by germs, dirt, or illness. Unwanted and taboo thoughts involving sex, religion, or harm. Aggressive thoughts about accidentally or purposefully harming oneself or others. An overwhelming need to have items arranged in perfect symmetry or a highly specific order. 2. Compulsions Compulsions are repetitive physical behaviors or mental acts that a person feels fiercely driven to perform in response to an obsession. These actions are aimed at reducing the anxiety caused by the obsession or preventing a feared event, though they are often not logically connected to the problem they are trying to fix. Common compulsions include: Excessive hand washing, showering, or cleaning of surroundings. Repeatedly checking things (such as verifying that doors are locked or the oven is off). Compulsive counting, tapping, or repeating certain words silently. Ordering and arranging items in a rigid, exacting way. The OCD Cycle The condition typically operates in an exhausting loop: Obsession: An unwanted thought or urge triggers intense distress. Anxiety: The psychological discomfort becomes overwhelming. Compulsion: The person performs a behavior or mental act to relieve the anxiety. Temporary Relief: The anxiety subsides briefly, but the obsessive thought eventually returns, restarting the cycle. Treatment and Management OCD is a highly treatable condition. While there is no "cure," it is effectively managed so that symptoms no longer dictate a person's life. Psychotherapy: Cognitive Behavioral Therapy (CBT) is highly effective. A specific type of CBT called Exposure and Response Prevention (ERP) is considered the gold standard for OCD. ERP involves gradually exposing the person to their fears or triggers while coaching them to resist the urge to perform their compulsions, eventually breaking the cycle. Medication: Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressants, are commonly prescribed to help reduce the severity of OCD symptoms. Note: If you or someone you know is struggling with symptoms that sound like OCD, reaching out to a licensed mental health professional is the best first step toward an accurate diagnosis and effective relief.

Obsessions

Intrusive, unwanted thoughts or images that feel upsetting or hard to control. Examples include:

• Fears about contamination or getting sick
• Worry about accidentally harming yourself or others
• 'Not just right' feelings or perfectionistic thoughts
• Taboo or distressing intrusive images
• Doubt and uncertainty about memory, intentions, or identity

Compulsions

Behaviors or mental rituals someone does to feel safer or reduce anxiety. Relief is brief, and the fear usually returns.

• Repeated cleaning or washing
• Checking locks, appliances, or tasks over and over
• Seeking reassurance from others
• Silent mental rituals, counting, replaying thoughts, repeating phrases

Typical Onset

OCD often begins between ages 8 and 13, with a second peak in late adolescence and early adulthood, frequently triggered or amplified by stressful transitions. Many individuals experience their first symptoms around age 19, putting OCD onset squarely in our age range.