OCD Treatment: ERP, Medication, and Adjunctive Strategies

Obsessive-Compulsive Disorder (OCD) is optimally treated with a combination approach:

1. Exposure and Response Prevention (ERP) – Gold Standard

• Hierarchical exposure to obsessional triggers while voluntarily refraining from compulsions
• Breaks the obsession → anxiety → compulsion → relief cycle
• 60–80% achieve clinically significant improvement

2. Pharmacotherapy

• SSRIs (fluoxetine, sertraline, fluvoxamine, paroxetine, escitalopram) at higher doses than depression (e.g., sertraline 200–400 mg)
• Clomipramine (TCA) – effective but more side effects
• Augmentation: atypical antipsychotics (risperidone, aripiprazole) for partial response
• Response in 8–12 weeks; continue 1–2 years before taper attempt

3. Adjunctive

• Mindfulness-Based CBT, ACT – reduce thought-action fusion
• Group therapy – reduces shame, normalizes experience
• Lifestyle: Exercise, sleep hygiene, caffeine/alcohol moderation
• Neuromodulation (rTMS, DBS) for severe refractory cases

Treatment should be individualized by an OCD specialist. The IOCDF (iocdf.org) provides provider directory and resources.