Obsessive-compulsive disorder, or OCD, is a serious mental health condition that causes people to experience unwanted, intrusive thoughts (called obsessions) and to perform repetitive behaviors or rituals (called compulsions) in an effort to reduce anxiety or prevent something bad from happening.
In severe cases, OCD can take over someone’s daily life. People may spend hours each day stuck in obsessive thoughts and compulsive behaviors, making it hard to go to work, attend school, or maintain relationships. Fortunately, research shows that there are effective treatments that can help, even for people with severe OCD.
One of the most proven treatments for OCD is a type of therapy called Exposure and Response Prevention (ERP). This is a form of cognitive-behavioral therapy (CBT) that has been studied for decades.
In ERP, a person gradually faces the situations that trigger their obsessive thoughts (this is the “exposure” part), and they work on resisting the urge to do their usual rituals or compulsions (this is the “response prevention” part).
Over time, the brain starts to learn that nothing terrible happens even if the compulsion isn’t done. A large number of clinical studies have shown that ERP is highly effective and is considered the gold standard treatment for OCD.
According to the International OCD Foundation, about 60–70% of people who complete ERP therapy show significant improvement.
For people with severe OCD, therapy alone may not be enough. Medication can play a big role in treatment. The most commonly prescribed medications are selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant. These include drugs like fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), and paroxetine (Paxil).
Although originally developed for depression, SSRIs help regulate serotonin, a brain chemical that’s involved in OCD. These medications usually need to be taken at higher doses than for depression, and they can take 10–12 weeks to show full effects.
Research published in JAMA Psychiatry shows that SSRIs can reduce OCD symptoms in many patients, though they may not work for everyone.
In cases where SSRIs don’t work well enough, doctors might try other medications. One common option is to add an antipsychotic medication like risperidone or aripiprazole, even if the person doesn’t have psychosis. Studies have found that this combination can be helpful for people who don’t respond fully to SSRIs alone.
Sometimes, even therapy and medication together aren’t enough for very severe OCD. In these cases, more advanced treatments may be considered. One option is deep brain stimulation (DBS), which involves placing electrodes in specific parts of the brain to change how signals are sent.
DBS is still mostly used in research or in very rare cases, but it has been approved for treatment-resistant OCD in some countries, including the United States. A review in The American Journal of Psychiatry found that about 60% of patients who received DBS had meaningful symptom improvement.
Another option being explored is transcranial magnetic stimulation (TMS), which uses magnetic pulses to stimulate brain areas linked to OCD. TMS is non-invasive and has shown promise in recent trials.
In addition to medical and therapy-based approaches, lifestyle changes and support can help manage OCD. Regular exercise, healthy sleep, stress reduction, and support from family or support groups can improve quality of life and help people stay on track with treatment.
For some, working with a therapist who specializes in OCD is critical, as general therapists may not have the training to deliver effective ERP.
In summary, there is no one-size-fits-all approach to treating severe OCD, but the best outcomes usually come from a combination of treatments. ERP therapy and SSRIs are the most common and effective first steps.
When those aren’t enough, additional medications or advanced treatments like DBS or TMS may be explored. With the right support and persistence, even people with severe OCD can experience real relief and lead fulfilling lives.
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