How is OCD diagnosed?

OCD is diagnosed clinically based on the presence of obsessions (recurrent, intrusive, distressing thoughts, images, or impulses) and/or compulsions (repetitive behaviours or mental acts performed to reduce distress or prevent a feared outcome), which take more than one hour per day or cause significant distress or functional impairment. The Y-BOCS (Yale-Brown Obsessive Compulsive Scale) is commonly used to assess severity. OCD is often missed or confused with GAD, depression, or psychotic disorders — appropriate diagnosis by a mental health professional is important for access to correct treatment.

Why do intrusive thoughts in OCD feel so distressing?

The content of OCD intrusive thoughts is often the opposite of the person's values — thoughts of harming loved ones in someone who is kind and caring, sexual thoughts in someone with religious scruples, or blasphemous thoughts in a deeply faithful person. Their ego-dystonic nature (feeling alien and abhorrent) is what makes them OCD rather than psychosis or genuine intent. The distress is a product of the person's values — the more something is fundamentally unacceptable to the person, the more their OCD targets it. Understanding this is important for reducing the shame associated with intrusive thoughts.

Can OCD go into remission?

OCD is a chronic condition for most people, but its severity fluctuates significantly. With effective treatment (ERP and/or SSRIs at appropriate doses), the majority of people achieve meaningful symptom reduction — often to the point where OCD has minimal impact on their lives. Full remission (symptom-free periods) occurs in a proportion of people. The most common pattern is chronic with varying severity — symptoms may worsen during stress but return to a manageable baseline with consistent management. Many people with OCD live full and productive lives with well-controlled symptoms.

Why do standard SSRIs not always work well for OCD, and what are the alternatives?

OCD requires higher doses of SSRIs than are typically used for depression or generalised anxiety — and requires 8–12 weeks of treatment at therapeutic doses before full assessment of response. If one SSRI is ineffective at maximum dose, another should be tried. Clomipramine (a tricyclic antidepressant with serotonergic effects) is effective for OCD and is used when SSRIs are insufficient. Adding an atypical antipsychotic (augmentation) may benefit those with partial response. ERP remains essential — medication and psychological treatment in combination produces the best outcomes.

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OCD involves recurrent, unwanted thoughts and compulsive behaviours that provide temporary relief but perpetuate the cycle. Evidence-based talking therapy, mindfulness-based approaches, and nutritional support for seroto

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Reviewed by Dr. Ava Gardner · Integrative Medicine Researcher26 March 2026Emerging evidence

Quick answer

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Intrusive, unwanted thoughts, images, or urges that feel impossible to ignore
Significant distress or disgust in response to intrusive content
Compulsive behaviours or mental rituals performed to neutralise the distress
Temporary relief after compulsions, followed by return of the obsession
Avoidance of triggering situations, objects, or people
Significant time consumed by obsessions and compulsions daily

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