OCD — obsessive-compulsive disorder

What OCD actually looks like

OCD has two parts that feed each other: obsessions (unwanted, intrusive thoughts, images, or urges that feel impossible to ignore) and compulsions (mental or physical acts done to neutralize the obsession or prevent some feared outcome). Most people with OCD know the thoughts don’t make logical sense — that’s part of what makes it so distressing.

Common patterns we see:

• Contamination concerns — fear of germs, illness, or contamination, with washing, cleaning, or avoidance.
• Checking — locks, stove, doors; needing certainty that something terrible didn’t happen.
• “Just-right” or symmetry — needing things ordered, aligned, or done a specific way.
• Intrusive harm thoughts — unwanted violent or sexual thoughts that horrify you (these are some of the most distressing and least talked about).
• Religious or moral scrupulosity — intrusive thoughts about morality, blasphemy, or doing something terrible.
• Health-related obsessions — fear that you have or will get a serious illness, with checking, reassurance-seeking, or avoidance.
• Mental compulsions — counting, praying, mentally reviewing — less visible but just as real.

If you have intrusive thoughts that scare you

Having a thought you don’t want isn’t the same as wanting it. People with OCD have intrusive harm thoughts — about hurting people they love, about doing socially unacceptable things — precisely because those thoughts are the opposite of who they are. That’s why the thoughts feel so distressing. They’re a symptom, not a sign that something is wrong with you as a person.

How we treat OCD

Exposure and Response Prevention (ERP)

ERP is a specialized form of CBT and the gold-standard psychotherapy for OCD. It involves gradually facing the things that trigger the obsessions while resisting the compulsion. Done well, with a trained therapist, it produces meaningful improvement in 60–80% of patients. We can deliver ERP at Northline or refer you to specialty OCD providers when intensive treatment is the right fit.

Medication

SSRIs are the first-line medication for OCD — usually at higher doses than what’s used for depression or anxiety, and with a longer trial period (10–12 weeks at adequate dose). Common choices: fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox). For partial response, augmentation with another medication is sometimes added.

Deep TMS for severe OCD — coming soon

Deep TMS using the BrainsWay H-coil is FDA-cleared for OCD that hasn’t responded to other treatments. It’s part of our planned interventional service line at the East Lyme office. More on TMS →

What we don’t recommend

Reassurance-seeking and avoidance feel helpful in the moment but make OCD worse over time. We’ll work on this together — not by withholding warmth, but by helping you build a different relationship with the obsessions.