Obsessive-Compulsive Disorder (OCD): Treatment For OCD and Related Disorders in Massachusetts

Obsessions are intrusive thoughts, images, or urges that cause anxiety or distress. These thoughts often surface when trying to focus on something else, making them difficult to ignore. Common obsessions include:

• Fear of germs, contamination, or illness
• Doubts about whether doors are locked or appliances are turned off
• A need for symmetry, order, or exactness
• Unwanted thoughts about aggression, harm, or inappropriate behavior
• Repetitive concerns about religious or moral issues

Compulsions are behaviors or mental rituals performed in an effort to ease anxiety or prevent a feared outcome. While these actions may provide brief relief, they are often excessive and not truly connected to the concern they aim to resolve. Common compulsions include:

• Excessive hand-washing or cleaning
• Repeatedly checking that doors are locked or appliances are off
• Counting or tapping in specific patterns
• Arranging items in a particular order
• Repeating words, prayers, or phrases silently
• Seeking reassurance from others about worries or fears

Studies using brain imaging have shown differences in the brain activity of individuals with OCD compared to those without the condition. Areas of the brain involved in decision-making, error detection, and habit formation—including the orbitofrontal cortex, anterior cingulate cortex, thalamus, and basal ganglia—appear to be overactive in people with OCD. However, it is still unclear whether these differences cause OCD or develop as a result of the disorder.

OCD has often been linked to serotonin, a neurotransmitter that helps regulate mood and behavior. Medications that increase serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs), are commonly used to treat OCD, which suggests serotonin plays a role in the condition. However, research indicates that OCD is not simply caused by a serotonin imbalance. Other neurotransmitters, including dopamine, glutamate, and GABA, may also be involved in the disorder’s progression.

There is evidence that OCD can run in families, but having a parent with OCD does not guarantee that a child will develop the condition. Studies suggest that genetic factors contribute to OCD risk, but environmental influences also play a role. Because many learned behaviors are passed down in families—such as specific fears, routines, and coping mechanisms—it is difficult to determine how much of OCD’s development is due to inherited traits versus life experiences.

While OCD is not solely caused by environmental factors, certain experiences may contribute to the onset or worsening of symptoms. Cultural and societal influences can shape the specific fears and compulsions a person develops. For example, during the 1980s HIV/AIDS crisis, there was a rise in contamination-related obsessions. More recently, the COVID-19 pandemic led to an increase in OCD symptoms related to health and cleanliness. Traumatic or stressful events may also play a role, though research suggests that genetics has a stronger influence on OCD than shared environments like family homes.

In some cases, OCD symptoms can appear suddenly in children following an infection. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are conditions in which the body’s immune response to an infection—such as strep throat—triggers severe OCD-like symptoms. Unlike typical OCD, which often develops gradually, these disorders cause symptoms to emerge abruptly and significantly disrupt the child’s life. Because PANDAS and PANS are diagnosed based on reported symptoms rather than a clear biological marker, it can be difficult to determine whether the infection directly caused OCD symptoms.

Although the exact cause of OCD is not fully understood, ongoing research continues to uncover factors that contribute to its development. While no single explanation applies to everyone with the condition, effective treatments are available to help manage symptoms and improve quality of life.

Exposure and Response Prevention (ERP) is the most effective form of therapy for OCD. This structured approach involves gradually confronting fears or intrusive thoughts while resisting the urge to perform compulsions. Over time, this process helps reduce the anxiety associated with obsessions and weakens the compulsive response. Though ERP can feel challenging at first, working with a trained therapist who moves at a comfortable pace can make a significant difference.

Individuals seeking ERP should look for therapists who specialize in OCD treatment. Resources such as the International OCD Foundation, Psychology Today, Therapy Den, and directories for LGBTQ+ and BIPOC therapists can help connect individuals with the right professional. ERP can be provided in various formats, including individual sessions, group therapy, and even teletherapy.

Medications are often used alongside therapy to help manage OCD symptoms. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are the most commonly prescribed. FDA-approved SSRIs for OCD include:

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)

Studies show that SSRIs can reduce OCD symptoms by up to 60%, though they may take 8 to 12 weeks to become fully effective. Side effects, such as sleep disturbances or weight changes, vary by individual. A healthcare provider can help determine whether medication is a suitable option and adjust the dosage as needed.

The right treatment program for OCD depends on the severity of symptoms and how much they interfere with daily functioning. Treatment options range from weekly therapy sessions to inpatient hospitalization for those in crisis.

• Outpatient Therapy – This is the most common treatment setting, where individuals meet with a therapist for one-on-one sessions, typically once or twice a week for about 45 to 50 minutes. Many therapists and specialized outpatient clinics offer this form of treatment.
• Intensive Outpatient Program (IOP) – A step up from traditional outpatient care, IOP involves attending therapy multiple times per week. This often includes group sessions along with at least one individual therapy session per day. IOPs provide more structured support while allowing individuals to continue living at home.
• Day Treatment (Partial Hospitalization Program) – This level of care provides full-day therapy, usually from 9 AM to 5 PM, up to five days a week. Treatment takes place at a mental health center, where individuals engage in a combination of group and individual therapy.
• Residential Treatment – Individuals live on-site at a mental health facility and receive around-the-clock care in a structured environment. This voluntary program allows for intensive therapy and support while maintaining a safe and stable setting.
• Inpatient Hospitalization – This is the highest level of care and is intended for individuals who need support for a mental health crisis. Treatment occurs in a secure, hospital-based setting, either voluntarily or involuntarily, for those who are at risk of harming themselves or others. The primary goal of inpatient care is stabilization, with stays typically lasting a few days to a week before transitioning to a lower level of care.