When Your Mind Won't Let Go

If intrusive thoughts loop endlessly in your mind, if you're trapped in rituals you can't stop, if you spend hours checking, washing, or seeking reassurance—you're not broken. You're not weak. And you're definitely not alone.

OCD is a real medical condition that deserves specialized, compassionate care. Not judgment. Not dismissal. Not being told to "just stop."

Table of Contents

• What OCD Actually Is
• What OCD Looks Like
• OCD Subtypes
• How OCD Differs from Other Conditions
• Medical Causes We Rule Out
• Our Approach to OCD Treatment
• Medication Management
• The Critical Role of ERP Therapy
• What Treatment Looks Like
• Ages We Serve
• Telehealth Throughout Colorado
• Insurance & Access
• Frequently Asked Questions

What OCD Actually Is

OCD is NOT about being neat, organized, or particular.

It's a serious anxiety disorder involving:

• Obsessions: Intrusive, unwanted thoughts, images, or urges that cause significant distress and anxiety
• Compulsions: Repetitive behaviors or mental acts done to reduce the anxiety caused by obsessions

The Key Features:

• You recognize the thoughts are irrational or excessive
• But you can't stop them
• The compulsions provide only temporary relief
• Then the cycle starts all over again
• It takes up significant time (often 1+ hours per day)
• It causes real distress and impairment in your life

OCD is:

• A neurobiological condition (differences in brain circuits)
• Highly heritable (runs in families)
• One of the top 10 most disabling conditions worldwide
• Very treatable with proper care

What OCD Looks Like

Common Obsessions:

Contamination:

• Fear of germs, illness, dirt, bodily fluids
• Fear of environmental contaminants
• Fear of getting others sick
• Disgust responses

Harm:

• Fear of causing harm to yourself or others
• Intrusive images of violence
• Fear of acting on unwanted impulses
• Important: These thoughts are completely opposite to your values, which is why they're so distressing

Sexual:

• Unwanted sexual thoughts or images
• Intrusive thoughts about inappropriate sexual acts
• Obsessive doubts about sexual orientation (not the same as questioning)
• Fear of being a pedophile (when you're not)

Religious/Moral (Scrupulosity):

• Fear of sinning or being immoral
• Intrusive blasphemous thoughts
• Excessive concern about right/wrong
• Need for moral perfection

Symmetry/Exactness:

• Need for things to be "just right"
• Symmetry or evenness
• Specific order or arrangement
• Distress when things feel "off"

Relationship (ROCD):

• Constant doubts about relationships
• "Do I really love them?"
• Checking feelings
• Comparing partner to others
• Need for certainty about relationship

Existential:

• Intrusive thoughts about reality, consciousness, existence
• Philosophical questions that become obsessive
• Hyper-awareness of existence

Health/Somatic:

• Hyper-focus on bodily sensations
• Fear of specific illnesses
• Constant body checking
• Different from health anxiety (more ritualistic)

Common Compulsions:

Washing/Cleaning:

• Excessive hand washing
• Long showers or cleaning rituals
• Avoiding "contaminated" objects
• Elaborate cleaning routines

Checking:

• Repeatedly checking locks, appliances, switches
• Checking that you didn't cause harm
• Rereading, rewriting
• Checking body for signs of illness

Counting/Repeating:

• Must do things a certain number of times
• "Good" numbers vs "bad" numbers
• Repeating actions until they feel right
• Counting in patterns

Ordering/Arranging:

• Things must be symmetrical
• Specific arrangement required
• Redoing until "just right"

Reassurance Seeking:

• Constantly asking others for reassurance
• Needing to confess
• Asking "Did I do something wrong?"
• Needing validation

Mental Compulsions:

• Mental reviewing or checking
• Counting in your head
• Repeating phrases or prayers
• Trying to neutralize bad thoughts with good thoughts
• Mental rituals that others can't see

Avoidance:

• Avoiding triggers becomes a compulsion itself
• Avoiding places, people, objects
• Avoiding thoughts or feelings
• Life becomes smaller and smaller

OCD Subtypes

"Pure O" (Purely Obsessional OCD)

What It Is:

• Compulsions are primarily mental rather than observable behaviors
• From the outside, looks like "just thoughts"
• But mental compulsions are just as present and time-consuming

Common Themes:

• Harm obsessions with mental reviewing
• Sexual obsessions with mental reassurance-seeking
• Scrupulosity with mental confessing
• Relationship obsessions with mental checking

Why It's Misunderstood:

• People think "I don't do any compulsions"
• But mental compulsions ARE compulsions
• Often causes severe shame and isolation
• Frequently misdiagnosed

Harm OCD

The Most Misunderstood OCD Subtype:

• Intrusive thoughts about harming yourself or others
• Critical: These are UNWANTED thoughts that cause extreme distress
• You do NOT want to act on them (that's what makes it OCD)
• The thoughts are the opposite of your values and character

What It Looks Like:

• Intrusive images of violence
• Thoughts like "What if I hurt someone?"
• Fear of losing control
• Avoiding knives, heights, driving (anything that triggers the thoughts)
• Constant reassurance-seeking about being a good person
• Mental checking: "Would I do that? Am I capable of that?"

Why It's So Distressing:

• The thoughts feel real (but they're not)
• Extreme guilt and shame
• Fear of being a dangerous person
• Often too scared to tell anyone

Important: Harm OCD is NOT the same as wanting to harm someone. People with harm OCD are NOT dangerous. They're experiencing intrusive thoughts that horrify them.

Relationship OCD (ROCD)

What It Is:

• Obsessive doubts about relationships
• Constant questioning of feelings
• Need for certainty about love

What It Looks Like:

• "Do I really love them?"
• Analyzing feelings constantly
• Comparing partner to others
• Checking physical responses to partner
• Seeking reassurance about relationship
• Breaking up and getting back together repeatedly

Why It's Different from Normal Doubts:

• The questioning is constant and distressing
• It takes up significant time
• It causes relationship problems
• Reassurance only helps temporarily

Scrupulosity

What It Is:

• Religious or moral obsessions
• Fear of sinning or being immoral
• Need for moral perfection

What It Looks Like:

• Constant fear of having sinned
• Excessive confessing
• Repeated prayers or rituals
• Fear of blasphemous thoughts
• Excessive moral scrupulosity

Important: This is OCD, not religiosity. It causes suffering, not peace.

How OCD Differs from Other Conditions

OCD vs. Generalized Anxiety Disorder (GAD):

• OCD: Specific obsessions and compulsions
• GAD: Diffuse worry about multiple things without specific rituals

OCD vs. OCPD (Obsessive-Compulsive Personality Disorder):

• OCD: Unwanted, distressing (ego-dystonic) - "I don't want these thoughts"
• OCPD: Perfectionism is valued, seen as right way to be (ego-syntonic) - "This is just how things should be"

OCD vs. Psychosis:

• OCD: You know thoughts are irrational (insight preserved) - "I know this doesn't make sense but I can't stop"
• Psychosis: Loss of insight about reality - belief in the thoughts

OCD vs. Autism:

• Can co-occur
• Both may have repetitive behaviors
• OCD behaviors are anxiety-driven and distressing
• Autism behaviors are often regulating or enjoyable

Medical Causes We Rule Out First

Before diagnosing OCD, we check for medical conditions that can mimic or worsen OCD:

We Test For:

• Thyroid problems: Can worsen OCD and anxiety
• Autoimmune conditions: PANDAS/PANS (pediatric autoimmune neuropsychiatric disorders)
• Neurological conditions: Brain injury, tumors, seizures
• Vitamin deficiencies: Can affect mood and anxiety
• Substance use: Stimulants can worsen or mimic OCD
• Medication effects: Some medications worsen OCD

We Also Assess For:

• Tic disorders: Tourette syndrome often co-occurs with OCD
• Body-focused repetitive behaviors: Hair pulling, skin picking
• Eating disorders: Often have OCD-like features
• Hoarding disorder: Related to OCD but separate condition

Co-Occurring Conditions: OCD rarely exists alone:

• Depression: 50-60% have major depression at some point
• Anxiety disorders: Very common
• ADHD: Can co-occur
• Autism: Higher rates of OCD
• Eating disorders: Overlap in symptoms
• Substance use: Self-medication for OCD distress
• Suicidal ideation: OCD causes severe suffering

Our Approach to OCD Treatment

We Understand OCD Requires Specialized Care:

• OCD is NOT the same as other anxiety disorders
• It requires higher doses of medication
• ERP (Exposure and Response Prevention) therapy is essential
• Treatment takes time
• We provide knowledgeable, compassionate support

Our Treatment Philosophy:

• Medication + ERP therapy is gold standard
• Medication alone rarely provides full relief
• ERP is hard but incredibly effective
• We support you through the process
• We don't judge your obsessions (we've heard it all)
• No compulsion is "too weird" or "too embarrassing"

Medication Management

First-Line Treatment: SSRIs at Higher Doses

Important: OCD requires HIGHER doses than depression:

• Fluoxetine (Prozac): 40-80mg (depression dose: 20-40mg)
• Sertraline (Zoloft): 150-200mg (depression dose: 50-150mg)
• Paroxetine (Paxil): 40-60mg (depression dose: 20-40mg)
• Fluvoxamine (Luvox): 200-300mg (specifically FDA-approved for OCD)
• Escitalopram (Lexapro): 20-30mg (depression dose: 10-20mg)

Timeline:

• Takes 10-12 weeks for full effect (longer than for depression)
• May see some improvement at 4-6 weeks
• Need to stay on adequate dose for adequate time
• Don't give up too soon

If SSRIs Don't Work:

Clomipramine (Anafranil):

• Tricyclic antidepressant
• Very effective for OCD (sometimes more than SSRIs)
• More side effects (dry mouth, constipation, sedation)
• Requires monitoring
• Often underused but very helpful

Augmentation Strategies:

If SSRIs Help But Not Enough:

For Specific Symptoms:

For Severe Anxiety:

• Short-term benzodiazepines (used very carefully)
• Hydroxyzine (non-addictive anti-anxiety)

For Tics with OCD:

• Medications targeting tics
• Certain antipsychotics

For Insomnia from OCD:

• Addressing OCD improves sleep
• Sleep medications if needed

Our Medication Approach:

• Start with SSRIs at appropriate (higher) doses
• Give adequate time (10-12 weeks minimum)
• Increase dose if partial response
• Try different SSRI if first doesn't work
• Consider clomipramine for treatment-resistant OCD
• Use augmentation strategies when appropriate
• Never say "you've tried everything" until really tried everything

The Critical Role of ERP Therapy

ERP (Exposure and Response Prevention) is the Gold Standard for OCD:

What ERP Is:

• Gradually exposing yourself to feared situations (exposure)
• While preventing compulsions (response prevention)
• Learning that anxiety decreases without compulsions
• Retraining your brain

Why ERP Works:

• Medication reduces anxiety enough to do ERP
• ERP provides lasting change
• Combined medication + ERP is most effective
• ERP has lasting effects even after therapy ends

What ERP Looks Like:

• Creating hierarchy of fears (least to most distressing)
• Starting with manageable exposures
• Gradually working up hierarchy
• Practicing response prevention
• Homework between sessions
• It's hard but incredibly effective

We Strongly Recommend ERP:

• We're not ERP therapists, but we know excellent ones
• We coordinate with your ERP therapist
• We adjust medication to support ERP
• We provide encouragement through the process

Finding an ERP Therapist:

• Must be specifically trained in ERP for OCD
• Regular CBT isn't enough
• We can provide referrals to OCD specialists

What Treatment Looks Like

Initial Evaluation (60-90 minutes):

• Detailed assessment of obsessions and compulsions
• Understanding themes and triggers
• How OCD affects your daily life
• Previous treatments tried
• Co-occurring conditions
• Family history
• Suicide risk assessment

Lab Work:

• Medical workup to rule out other causes

Treatment Planning:

• Medication options and dosing
• Timeline expectations
• ERP therapy referrals
• Support resources
• Crisis planning

Starting Medication:

• Usually starting with SSRI at moderate dose
• Increasing to therapeutic OCD dose over weeks
• Monitoring for side effects

Follow-Up Appointments:

• Every 2-4 weeks initially
• Monitoring response and tolerability
• Dose adjustments as needed
• Coordination with ERP therapist
• Support and encouragement

Long-Term Management:

• Once stable, appointments every 1-3 months
• Most people need medication long-term
• ERP provides lasting tools
• Addressing relapses if they occur
• Ongoing support

Ages We Serve

• Teens (12+): OCD often begins in childhood or adolescence
• Young adults: Peak onset is late teens/early 20s
• Adults: Ongoing management or new diagnosis
• Older adults: Long-term management

Telehealth Throughout Colorado

All appointments are virtual:

• Privacy for discussing sensitive obsessions
• Reduced anxiety about appointments
• No compulsions about getting to appointments
• Available throughout Colorado

Insurance & Access

We accept most major insurance including:

• Aetna
• Cigna
• United Healthcare
• Oscar
• Optum
• Blue Cross Blue Shield
• Private pay options

Note: We do not accept Medicaid or Medicare at this time.

You're Not Your Intrusive Thoughts

The thoughts aren't you. The compulsions aren't who you are. You're a person experiencing OCD, and there's effective treatment.

Ready for Specialized OCD Care?

If you're trapped in OCD's cycle, if you're ready for treatment that actually understands OCD, if you want providers who won't judge your obsessions—we're here.

Book an appointment online or call us at (719) 212-1951.

Same-week appointments available. Freedom from OCD is possible.

Frequently Asked Questions

Forest Path Psychiatry & Healing is a nurse-led psychiatric practice serving all of Colorado via telehealth. Our board-certified PMHNPs provide specialized, compassionate OCD treatment with understanding of all OCD subtypes and strong ERP therapy referral networks.