What we treat
Evidence-based psychiatric treatment for obsessive-compulsive disorder
Obsessive-Compulsive Disorder (OCD) is widely misunderstood. It is not about being organized, particular, or detail-oriented. OCD is a neurobiological condition that affects approximately 2.3% of U.S. adults during their lifetime, according to the National Institute of Mental Health. It involves intrusive, unwanted thoughts, images, or urges (obsessions) and repetitive behaviors or mental rituals (compulsions) that a person feels driven to perform to reduce the distress those thoughts cause.
That cycle is the hallmark of OCD. An intrusive thought triggers anxiety. A compulsion relieves it for a moment. The thought returns, the cycle repeats, and compulsions tend to escalate over time. Untreated, OCD can consume hours each day and take a heavy toll on relationships, work, and quality of life.
The intrusive thoughts in OCD are not desires and do not reflect who you are. People with harm obsessions do not want to harm anyone. People with sexual obsessions are not drawn to the content of their thoughts. People with religious scrupulosity do not doubt their faith. These thoughts are ego-dystonic: they feel foreign and distressing. The average delay between symptom onset and proper treatment is 14–17 years. With medication management and the right therapy, many people with OCD improve meaningfully.
The content of obsessions varies widely, but the mechanism is the same: an intrusive thought causes distress, and a compulsion follows. Common themes include:
In each case the anxiety drives the behavior, not a real preference or belief.
Obsessions are involuntary. They are not daydreams or ordinary worries, and they cannot simply be dismissed. Compulsions are the behaviors or mental acts done to neutralize them, usually according to rigid rules. Many compulsions are invisible: mental reviewing, rumination, quietly seeking reassurance, and avoiding triggers all count, and they are as central to OCD as washing or checking. A common diagnostic threshold is more than one hour a day spent on obsessions and compulsions; many untreated people spend far more.
OCD is also easy to confuse with conditions that share some features. Body dysmorphic disorder centers on perceived physical flaws. Hair-pulling and skin-picking can be compulsions or separate conditions. Health anxiety involves worry the person believes is justified, where somatic OCD involves thoughts that feel intrusive and unwanted. Generalized anxiety involves realistic worries without compulsions. Because treatment differs, Dr. Fredes uses the first evaluation to sort out what is actually going on.
The standard of care for OCD combines medication with Exposure and Response Prevention (ERP) therapy. At MindMED, Dr. Fredes manages the medication side and coordinates with licensed therapists who specialize in ERP, so both parts of treatment pull in the same direction.
SSRIs (selective serotonin reuptake inhibitors) are the first-line medication for OCD. Two things set OCD apart from depression treatment: it usually needs higher doses, and it takes longer to respond.
The SSRIs with the strongest evidence for OCD include sertraline, paroxetine, and fluoxetine. Therapeutic doses for OCD are often at or above the top of the range used for depression. Dr. Fredes starts low and increases gradually while watching for side effects and response.
Where depression often responds to an SSRI within 4–6 weeks, OCD typically needs 8–12 weeks at an adequate dose. This longer timeline is well established and is not a sign the medication is failing. Some improvement may show earlier, but the full benefit often takes 12 weeks or more.
Clomipramine, a tricyclic antidepressant, is one of the oldest and most studied treatments for OCD. It may be considered if SSRIs are insufficient or not tolerated. It carries more side effects than SSRIs and needs closer monitoring, but for some patients it is the most effective option.
If an adequate SSRI trial does not bring enough improvement, adding a low-dose antipsychotic such as aripiprazole or risperidone has research support in OCD. If one SSRI does not work at a full dose and duration, options include switching to a different SSRI, increasing the dose, or adding augmentation.
The sequence is deliberate: start an SSRI at a low dose, increase gradually to a therapeutic level, hold there for 8–12 weeks, then decide together whether to continue, adjust the dose, switch, or augment. Follow-up visits during this period are used to track side effects and early signs of response. Rushing the timeline is a common way OCD treatment falls short.
SSRIs turn down the intensity of obsessions and the urge to perform compulsions. On their own, they do not undo the learned link between a trigger and a ritual. ERP retrains that link by gradually exposing a person to triggers while they hold off on the compulsion. Someone with contamination fears might touch a doorknob and not wash; someone with harm obsessions might sit with the thought without asking for reassurance. It is uncomfortable at first. With repetition the anxiety settles on its own, and the feared outcome never arrives. Medication makes that work more tolerable, and ERP makes the gains more durable.
Dr. Fredes does not provide ERP herself. She works alongside licensed therapists who specialize in OCD so that medication changes and therapy goals stay aligned. If you do not have an ERP therapist, we can point you to clinicians in the Southlake and greater Dallas-Fort Worth area.
No. OCD is often mistaken for a personality trait or a preference for cleanliness. It is a neurobiological disorder involving unwanted, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that cause real distress and interfere with daily life. Many people with OCD are not especially organized or clean. Their compulsions may be invisible (mental reviewing, reassurance seeking) or unrelated to order.
OCD is not something anyone can promise to cure, but it can be managed well. Many people improve substantially with the right combination of medication and therapy (particularly Exposure and Response Prevention), and many reach a point where OCD is no longer a major part of their life, even if the tendency toward intrusive thoughts remains.
OCD typically requires higher SSRI doses and a longer time to respond (8–12 weeks at an adequate dose) than depression does. This is a well-established pattern, not a sign the medication is failing. Patience and consistent dosing matter.
Several options exist. Dr. Fredes may switch to a different SSRI, increase the dose, or add a low-dose antipsychotic such as aripiprazole or risperidone. Clomipramine, an older tricyclic medication, is also effective for OCD. Pairing medication with ERP therapy matters most in treatment-resistant cases.
OCD has a genetic component. Having a parent, sibling, or child with OCD raises your risk. Genetics is not destiny, though: stress, environment, and life events also shape whether and when OCD develops. Your family history is useful context for treatment planning.
Yes. OCD often begins in the teenage years or early twenties, but it can emerge at any age, sometimes after a major life stress. The average delay between symptom onset and treatment is 14–17 years, so if you are experiencing obsessions and compulsions now, an evaluation is worth pursuing.
Yes. Dr. Fredes manages the medication component of OCD treatment and coordinates with licensed therapists who specialize in Exposure and Response Prevention (ERP). If you need a referral to an ERP therapist in the Southlake area, we can recommend clinicians. Medication plus ERP is the standard of care for OCD.
They overlap but are distinct. Generalized anxiety involves worry about real-life concerns (finances, health, relationships). OCD involves intrusive thoughts (about contamination, harm, sexuality, religion, or relationships) that feel foreign and unwanted, plus compulsions to manage the distress. Dr. Fredes does a full diagnostic evaluation to tell them apart, since treatment differs.
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