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Most OCD or OCD-related disorders begin in childhood. Onset after the age of 35 is rare.
At your initial visit, our team will conduct a comprehensive evaluation to ensure a correct diagnosis of OCD or a related disorder. We then assess the presence of any co-occurring conditions (such as depression or anxiety), the severity of these conditions, and the extent to which they have been stabilized. From this complete assessment of your health status, we decide whether our clinic is an appropriate treatment setting for you. If you can be best cared for here, we begin to tailor a treatment plan. For most, this will include a combination of cognitive behavioral therapy (group or individual sessions) and medications, typically anti-depressants (like Lexapro or Zoloft) administered at two to three times the standard doses used to treat depression or anxiety disorders.
About 40 percent of patients will not respond to the first medication prescribed. In this case, we will try switching to another drug within the same class of drugs (typically selective serotonin reuptake inhibitors) and/or prescribe an adjunct (booster) drug. About 75 percent of patients will respond to this approach with significant improvements in quality of life and an ability to resume normal day-to-day activities. At this point, the goal is to reduce the chances of a relapse by ensuring the patient continues practicing the techniques of cognitive behavioral therapy and continues taking their medications as prescribed.
Most patients experience substantial improvements in two to three months with progressively greater alleviation of symptoms after four months to a year of treatment. A person’s pace of progress is affected by other conditions they may have, as well as the severity of their OCD or OCD-related disorder.
Cognitive behavioral therapy is an umbrella term that describes a variety of techniques used to teach people to recognize distorted thinking or beliefs; restructure their thinking and control their response (behavior).
For those with OCD, the most effective cognitive behavioral therapy – and the one used at UC San Diego Health – is exposure and response prevention. An afflicted person is presented with anxiety-provoking stimuli, starting with the least problematic, and is taught to make a choice not to respond with the usual compulsive behavior. Over time, the person learns to confront dreaded thoughts, images, objects and situations with less anxiety and with less or no reaction.
Exposure and prevention response therapy was developed more than 30 years ago. Its efficacy and safety has been well vetted and documented. With a success rate of 60 to 75 percent, it remains the method of choice for eliminating associated compulsive behaviors. Paired with medication, more than 75 percent of patients experience a significant improvement in their symptoms and quality of life.
After the initial 90-minute appointment, subsequent medication management appointments may be scheduled once every 3 weeks to once every 3 months, depending on a person’s particular situation. Appointments are typically half an hour.
Cognitive behavioral therapy sessions are usually weekly, sometimes biweekly, for 45 minutes to an hour. Therapy may continue for three to six months, or even a year. Therapy can be in either group or one-on-one sessions.
OCD and related disorders are considered life-long chronic conditions, with a severity that may wax and wane with a person’s stress levels. Major life events such as the loss of a job, divorce or serious illness can trigger a relapse in symptoms. If relapse happens, you will be brought back in for evaluation and will repeat treatment, modified as needed to address new circumstances. Relapse may also occur when a patient stops taking their medications or stops practicing the techniques of cognitive behavioral therapy.