OCD treatment that targets the cycle, not just the symptoms
Obsessive-compulsive disorder is one of the most misunderstood and most undertreated conditions in outpatient psychiatry. At Wave Psychiatric Group, our board-certified psychiatrists provide comprehensive, evidence-based OCD treatment in West Los Angeles and via telehealth throughout California — addressing the full complexity of this condition with the clinical depth it requires.
Understanding OCD
Obsessive-compulsive disorder is characterized by two defining features: obsessions and compulsions. Obsessions are intrusive, unwanted thoughts, images, or urges that generate significant distress and that the person recognizes as excessive or unreasonable, even when they cannot stop them. Compulsions are repetitive behaviors or mental acts performed in response to obsessions — attempts to neutralize the distress, prevent a feared outcome, or restore a sense of certainty or completeness. The temporary relief that compulsions provide is precisely what makes them self-reinforcing and what drives the escalating cycle that defines the disorder.
OCD is not, as popular usage of the term suggests, a preference for tidiness or a tendency toward perfectionism. It is a clinically significant condition that can consume hours of a person's day, restrict their functioning across every domain, and produce profound suffering — often in silence, because shame and the bizarre or disturbing content of obsessions frequently prevent people from disclosing what they are experiencing.
The content of obsessions varies considerably across individuals and does not reflect the person's true desires, values, or character. Contamination fears, fears of harming others, religious or moral obsessions, sexual obsessions, symmetry and exactness obsessions, and existential or philosophical obsessions are among the most common presentations — but the specific content matters less clinically than the underlying mechanism of intrusion, distress, and compulsive response that defines the disorder across all of its forms.
OCD is also highly ego-dystonic in most presentations — meaning that the person experiencing it recognizes the obsessions as foreign, unwanted, and inconsistent with who they are. This is an important clinical distinction from obsessive-compulsive personality disorder, which involves ego-syntonic perfectionism and rigidity that the person experiences as integral to their identity rather than as intrusive and distressing.
OCD presentations we treat
OCD manifests in a wide range of presentations, many of which go unrecognized because they do not fit the stereotypical image of contamination fear and hand-washing. At Wave, we treat the full spectrum of OCD presentations, including the following.
Contamination OCD
Fear of contamination — from germs, illness, chemicals, or perceived moral or psychological pollution — is the most commonly recognized OCD presentation. Compulsions typically involve excessive cleaning, washing, or avoidance of perceived contaminants. The COVID-19 pandemic significantly exacerbated contamination OCD in many patients, and its effects continue to be clinically relevant.
Harm OCD
Harm OCD involves intrusive thoughts or images of harming oneself or others — not because the person wants to cause harm, but precisely because they do not. The distress generated by these thoughts, and the effort expended to suppress or neutralize them, is the defining feature. Harm OCD is frequently misunderstood — by patients, their families, and sometimes their clinicians — as indicative of genuine violent intent, when in fact the opposite is true. People with harm OCD are not dangerous; they are tormented by thoughts that are repugnant to them.
Pure O
So-called Pure O — purely obsessional OCD — refers to presentations dominated by intrusive thoughts without obvious external compulsions. In reality, Pure O almost always involves covert mental compulsions — reassurance-seeking in one's own mind, mental reviewing, thought suppression — that are less visible but equally driven by the obsession-compulsion cycle. Pure O frequently goes unrecognized because the absence of visible rituals makes it harder to identify.
Religious and moral OCD
Scrupulosity — OCD centered on religious or moral perfectionism — involves obsessions about sin, blasphemy, moral failure, or the possibility of having done something wrong, accompanied by compulsions including prayer, confession, reassurance-seeking, and mental reviewing. It is particularly common in religious communities and particularly prone to misidentification as genuine religious or moral concern rather than as a psychiatric condition.
Relationship OCD
Relationship OCD involves persistent, intrusive doubts about the authenticity of one's feelings for a partner, the rightness of a relationship, or the partner's feelings and fidelity. It is frequently mistaken for genuine relationship ambivalence or incompatibility, when it is in fact a manifestation of OCD's demand for certainty in a domain where certainty is inherently unavailable.
Existential OCD
Existential OCD involves obsessive rumination on unanswerable philosophical questions — the nature of reality, consciousness, death, free will, or the meaning of existence — that generates significant distress and compulsive mental reviewing. It is among the least recognized OCD presentations and is frequently misidentified as philosophical curiosity or existential anxiety rather than as a clinical condition.
OCD treatment at Wave is individualized and draws on the full range of evidence-based modalities available, matched to the specific presentation and the patient's history and goals.
Exposure and Response Prevention
ERP is the gold standard psychotherapeutic treatment for OCD and has the strongest evidence base of any intervention for this condition. The core principle is straightforward in concept and challenging in practice: the patient is exposed to the thoughts, images, situations, or objects that trigger obsessional distress — either directly or imaginally — while refraining from performing the compulsive response. Through repeated exposure without the feared consequence, the obsession loses its capacity to generate overwhelming anxiety, and the patient learns that distress diminishes on its own without compulsive neutralization.
ERP is not about forcing patients into distressing situations without support. It is a graduated, collaborative process in which the exposure hierarchy is constructed carefully with the patient, beginning with situations that generate manageable distress and progressing systematically toward more challenging triggers. The rationale is explained fully, the pace is calibrated to the individual, and the therapeutic relationship provides the support within which the difficult work occurs.
Acceptance and Commitment Therapy
ACT approaches OCD from the perspective of psychological flexibility — developing the capacity to observe intrusive thoughts without fusing with them, accepting the presence of uncertainty and discomfort without acting to eliminate it, and committing to valued behavior in the presence of obsessional distress. ACT is particularly well-suited for patients who have had limited response to more direct cognitive approaches or for whom the acceptance-based framework resonates.
Medication management
Several medications have well-established evidence bases for OCD. SSRIs are the first-line pharmacological treatment — at doses that are typically higher than those used for depression — and produce meaningful symptom reduction in a significant proportion of patients. Clomipramine, a tricyclic antidepressant with strong serotonergic activity, has a robust evidence base for OCD and is used when SSRIs have not produced adequate response. Augmentation strategies — including low-dose antipsychotics — have evidence for partial SSRI responders and are employed when clinically indicated.
Medication and psychotherapy in combination produce better outcomes than either alone for most patients with moderate to severe OCD, and our psychiatrists integrate both components within a unified treatment plan where indicated.
Our approach to OCD treatment
OCD and comorbidity
OCD rarely presents in isolation. Depression is among the most common comorbidities — a natural consequence of the exhausting, shameful, and functionally impairing nature of the disorder — and requires explicit attention in treatment planning. Anxiety disorders co-occur with OCD at high rates. Tic disorders, including Tourette syndrome, have meaningful overlap with OCD and influence both diagnosis and treatment selection. ADHD, body dysmorphic disorder, hoarding disorder, and eating disorders are among the other conditions that co-occur with OCD with meaningful frequency.
Our psychiatrists assess for comorbid conditions as a routine component of every OCD evaluation and factor them explicitly into the treatment plan.
A note on referrals for specialized OCD therapy
ERP for OCD is a specialized skill that requires dedicated training beyond general CBT competency. When the intensity or complexity of a patient's OCD exceeds what our scheduling capacity allows, or when a patient requires the frequency or specialization of treatment that a dedicated OCD specialist provides, we refer to therapists in our clinical network with specific ERP training and expertise. Our psychiatrists maintain close communication with referred therapists and continue to provide medication management and psychiatric oversight within a collaborative care arrangement.
Insurance and fees
Wave Psychiatric Group accepts Aetna, Optum / UnitedHealthcare Behavioral Health, Meritain Health, Oxford Health Plans, ComPsych, UC SHIP, and others for diagnostic assessment appointments. Self-pay rates are also available.
Call us at 323-688-6380 or complete our intake form and our team will verify your benefits before your first appointment.
Frequently Asked Questions
Is OCD just being a perfectionist or liking things clean?
No. OCD is a clinical condition defined by intrusive, unwanted obsessions and compulsive responses that cause significant distress and functional impairment. The casual use of "OCD" to describe preferences for orderliness or attention to detail has contributed to widespread misunderstanding of what the condition actually involves — and to delays in diagnosis and treatment for people who are genuinely suffering. True OCD is not ego-syntonic preference. It is an unwanted, distressing, and time-consuming cycle that the person experiencing it typically wishes they could stop.
Does having violent or disturbing obsessions mean I am dangerous?
No. Intrusive thoughts about harm — to oneself or others — are among the most common OCD presentations and are entirely inconsistent with genuine violent intent. The distress generated by these thoughts, and the effort expended to suppress or avoid them, is the defining feature of harm OCD. People with harm OCD are not dangerous — they are tormented by thoughts that are deeply repugnant to them. If you are experiencing intrusive thoughts of this kind and have been afraid to tell anyone, a psychiatric evaluation in a non-judgmental clinical environment is the appropriate next step.
How is OCD different from OCPD?
Obsessive-compulsive disorder and obsessive-compulsive personality disorder are distinct conditions that share a name but differ fundamentally in their nature. OCD is characterized by ego-dystonic intrusive obsessions and compulsions — the person experiences them as foreign, unwanted, and inconsistent with who they are. OCPD is characterized by ego-syntonic perfectionism, rigidity, and preoccupation with control that the person experiences as integral to their identity and that manifests primarily in interpersonal and occupational functioning. The treatment approaches for the two conditions differ substantially.
Can OCD be treated via telehealth?
Yes. ERP and other psychotherapy modalities for OCD are available via secure telehealth video for patients anywhere in California, and the evidence base for telehealth-delivered ERP is growing and supportive. Some aspects of in vivo exposure work may require creative adaptation in the telehealth format, which our psychiatrists approach collaboratively with each patient.