You Are Not Alone
Information for Individuals

Treatment Challenges

It’s not always easy to recognize OCD symptoms, and there can be many barriers to success in Cognitive Behavior Therapy.  Knowledge is a powerful tool that can help you overcome common challenges to gaining relief.

Getting appropriate treatment for OCD and committing to a treatment plan are key to realizing relief from OCD.  Even when treatment gains are made, it can be difficult to sustain improvement.  Knowledge is a powerful tool that is linked to success in treating OCD, and understanding barriers will help you recognize and overcome difficulties such as:

Under-Diagnosis and Under-Treatment

Even though OCD is a relatively common illness and effective treatment is available, OCD is often under-diagnosed and under-treated.  There are a number of reasons why:

  • Hiding symptoms:  Some people hide their symptoms and do not seek help.  Many do not know that OCD is a treatable illness.  Some are reluctant to admit that they need help.  OCD is a medical condition, like high blood pressure or allergies.  There is no need to be ashamed to seek treatment.
  • Avoidance:  Avoidance is not always recognized as a symptom of OCD.  Some people with OCD avoid places, events, objects and even people because of uncontrollable, irrational fears.  For example, a person with contamination obsessions may avoid public restrooms or refuse to borrow a pen from someone else.  In these cases, avoidance is a compulsive behavior.  Continued avoidance strengthens obsessions and worsens the disorder.  Another kind of avoidance is recovery avoidance.  If someone who has OCD avoids getting treatment, or doesn’t fully commit to treatment sessions and the accompanying homework, he or she derails the treatment process.
  • Discomfort:  OCD can involve unwanted disturbing thoughts, including violence, sexuality, blasphemy and illness.  Some people with OCD are uncomfortable discussing disturbing thoughts, even with a treatment provider.  A person with OCD normally has no desire to act on these thoughts, which recur precisely because they are so upsetting.  Cognitive behavior therapists are trained to work with people whose lives are impaired by such unwanted thoughts.
  • Fear of Change:  Change can be difficult.  It takes courage to make changes and face fears, particularly if the obsessions and compulsions have existed for many years.  Some people with OCD are afraid to begin treatment, but living with untreated OCD is vastly more painful than any discomfort associated with treatment.
  • Physician Diagnosis:  Not all physicians know how to diagnose and treat OCD.  At routine check-ups, some doctors do not ask questions about a patient’s mental health.  Some doctors—even psychiatrists—have not been trained to recognize symptoms of OCD.  Others may prescribe only medications because they aren’t aware that CBT is the treatment of choice.
  • Treatment Provider Education:  Some psychologists and psychiatrists still rely on unproven, ineffective theories about treating OCD.  Psychoanalytic therapy and therapy that focuses on family dynamics, early childhood trauma or issues of self-esteem are not effective treatments for OCD.  While other forms of therapy such as marriage and family counseling can help with some of the difficulties that can accompany OCD, only CBT can reduce symptoms of the disorder.
  • Misdiagnosis:  Common but less familiar symptoms may not be understood as forms of OCD.  The disorder can take many forms and is not limited to familiar or obvious types such as compulsive washing or checking door locks.  Examples of symptoms that can go unrecognized as OCD include:
    • Procrastination
    • Difficulty making decisions
    • Asking repetitive questions
    • Reassurance-seeking
    • Avoidance of people, places, objects or events
  • Affordability:  Some people who have OCD are not able to afford treatment.  Those without health insurance, or whose insurance policies do not fully cover mental health care, sometimes struggle to get the treatment they need.  Some cognitive behavior therapists offer fees on a sliding scale to low-income clients, making it more affordable.

If a therapist recommends the use of medication in conjunction with therapy, patients may be able to obtain drugs at a reduced price.  A number of resources offer information about prescription assistance, including:

Partnership for Prescription Assistance: 1-888-4PPA-NOW or and Needy Meds


If CBT therapy “isn’t working” it’s a good idea to dig deeper into what may be blocking success.

Treatment Resistance

Most people who undergo a course of cognitive behavior therapy for OCD will experience a significant reduction in symptoms.  Those who don’t do well in treatment should consider these possible obstacles to success:

  • Comorbid Disorders:  A mood disorder such as major depression or bi-polar disorder, alcoholism or substance abuse, or other comorbid disorder can interfere with success in therapy and may require separate treatment.
  • Poor Communication with Therapist:  Open and honest communication about the exact nature and frequency of obsessions and compulsions is a must so that the therapist can design effective exposures.  When people fear revealing all of their obsessions (either because they feel ashamed of their thoughts or because they believe that therapy could not help particular obsessions or compulsions that seem the most difficult) they can unknowingly prevent a therapist from helping them.  Keeping certain aspects of OCD secret will impair the therapist’s ability to help them overcome their OCD.
  • Insufficient Exposures:  Exposures must be sufficiently challenging, and “homework” of daily exposures must be completed between therapy sessions.
  • Infrequent Sessions:  Therapy sessions are generally scheduled weekly, but in some cases may need to be more frequent—even daily—or conducted in a residential treatment setting.
  • Improper Session Location:  Therapy sessions may be more effective if they are held in locations that trigger obsessions and compulsions—for example, in a person’s home, car or outdoors.  Some therapists will conduct sessions out of the office, or by telephone.
  • Family Interference:  Family members who participate in an individual’s compulsive rituals, provide reassurance or enable avoidance behavior can actually sabotage success in therapy.  Sometimes a family member can be trained to act as a “coach” to keep track of exposures and discourage behavior by others that perpetuate the rituals.
  • Wrong Choice of Therapist:  Someone who does not succeed with one therapist may enjoy excellent results with another.  The personality fit may not be right, or that therapist may not design challenging, appropriate exposures.  The therapist may also be inexperienced.  As for a second opinion, request a referral or interview other therapists to find a good match.
  • Inappropriate Therapy:  CBT, sometimes accompanied by medication, is the only treatment for OCD that is supported by scientific evidence.  Research does not support the use of treatments such as hypnosis, herbal or homeopathic remedies, psychoanalysis, relaxation therapy, eye movement desensitization reprocessing (EMDR), nutritional supplements and the like.
  • Lack of Support:  Talking to others who have learned to master their symptoms can encourage a person with OCD to undertake the challenge of therapy and boost the likelihood of success.  Joining a local support group, participating in an online support group or contacting OCD Chicago or the national Obsessive Compulsive Foundation are good ways to find people with similar experiences.  Note:  support groups should not be considered a substitute for CBT therapy.

Read personal stories of others who have successfully been treated for OCD

Read Expert Perspectives on OCD treatment

Find books about gaining control over OCD

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