Obsessive-compulsive disorder (OCD)
What Is OCD?
OCD involves persistent obsessions (e.g., fears of contamination, harm) and compulsions (e.g., excessive washing, checking) that consume at least one hour per day and significantly impair social or occupational life. According to the American Psychiatric Association’s OCD overview, it affects about 1–2% of the population.
Signs and Symptoms
OCD symptoms fall into two domains:
| Domain | Examples |
|---|---|
| Obsessions | Intrusive fears of germs, unwanted aggressive or sexual thoughts, need for symmetry |
| Compulsions | Repetitive rituals: handwashing, checking locks, counting, mental rituals to “neutralize” obsessions |
Symptoms often begin in late adolescence or early adulthood and may wax and wane in severity.
What Causes OCD?
OCD stems from a combination of factors:
Neurobiological: Abnormalities in cortico-striato-thalamo-cortical circuits and serotonin dysregulation
Genetic: Family history increases risk
Environmental: Childhood trauma, stress, and in some children, PANDAS (post-streptococcal autoimmune response)
How Is OCD Diagnosed?
Dr. Budhwar will:
Conduct a clinical interview to document the content, frequency, and distress level of obsessions and compulsions.
Use standardized scales like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to assess severity.
Apply DSM-5 criteria to confirm diagnosis and rule out other conditions (e.g., generalized anxiety disorder).
Treatment Options
Evidence-based guidelines recommend a stepped approach:
1. Cognitive-Behavioral Therapy (CBT) with ERP
Exposure and Response Prevention (ERP): Gradual, therapist-guided exposure to feared stimuli without performing compulsions, leading to anxiety reduction over time.
First-Line: Monotherapy in mild cases; combined with medication in moderate–severe cases.
2. Medications
Selective Serotonin Reuptake Inhibitors (SSRIs): High-dose sertraline, fluoxetine, paroxetine, fluvoxamine
Clomipramine: Effective tricyclic option when SSRIs are insufficient
Adjunctive Antipsychotics: For treatment-resistant cases, risperidone or aripiprazole may be added.
3. Combined Therapy
Combination of CBT/ERP plus SSRIs yields faster and more robust symptom relief, particularly in severe or refractory OCD.
Self-Help Strategies
Psychoeducation: Understand OCD’s mechanisms and treatment rationale.
Structured ERP Exercises: Under therapist guidance, practice mini-exposures and refrain from rituals.
Stress Management: Deep breathing, progressive muscle relaxation, mindfulness.
Routine & Planning: Schedule ERP practice and enjoyable activities to balance exposure work.
When and How to Seek Help
If obsessions or compulsions consume significant time or cause distress, consult Dr. Budhwar:
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OCD is treatable. With early intervention, consistent therapy, and, when needed, medication, patients can significantly reduce symptoms and reclaim fulfilling lives.