10 Things Your Doctor Might Be Missing About Your OCD

What Your Doctor Might Be Missing About Your OCD

If you struggle with unwanted recurring thoughts and/or feel compelled to engage in repetitive behaviors, you may have Obsessive Compulsive Disorder. This common mental health condition affects about 1 in 40 adults and 1 in 200 children and is characterized by 2 things:

  • Obsessions—thoughts that are anxiety-provoking (such as fears of germs, thoughts of violence, or mental images of forbidden sexuality)
  • Compulsions—repetitive behaviors (such as excessive hand-washing, cleaning, or counting) that provide no pleasure but alleviate the anxiety of the obsessions

If you head to your primary care physician or a traditional mental health professional for help, the treatment is likely to focus on medication or certain forms of psychotherapy. Unfortunately, research in Current Psychiatry shows that up to 40% of people diagnosed with OCD don’t respond to treatment and are considered treatment-resistant.

Up to 40% of people diagnosed with OCD don’t respond to treatment and are considered treatment resistant. Click To Tweet

Why? There are many reasons why standard treatments for OCD may not work. In many cases, treatment failure may be due to something that’s often missed in conventional psychiatry.

Here are 10 things you need to know about OCD that traditional medical professionals may miss.

Here are 10 things you need to know about OCD that traditional medical professionals may miss. Click To Tweet

1. OCD isn’t just 1 thing.

OCD is part of a spectrum of disorders (OCSD) that may also include:

  • Trichotillomania (hair pulling)
  • Dermatillomania (skin picking)
  • Onychophagia (nail biting)
  • Tourette’s Syndrome (tic disorder)
  • Kleptomania (compulsive stealing)
  • Compulsive shopping
  • Hoarding disorder
  • Body Dysmorphic Disorder (unreasonably feeling a part of the body is excessively ugly)
  • Hypochondriasis (excessive preoccupation with or worry about having a serious illness)
  • Oppositional Defiant Disorder (persistent arguing)

2. OCD is associated with more than 1 type of brain pattern.

At Amen Clinics, brain SPECT imaging scans show that OCD is typically associated with hyperfrontality, which means there is too much activity in the frontal lobes. This pattern is often associated with rigid, inflexible, obsessive thinking, and compulsive behaviors. In people with hoarding disorder, however, the front part of the brain is underactive, which is associated with disorganization. Understanding the underlying brain structure can help find the most effective treatment, but most traditional psychiatrists never look at the organ they treat.

3. OCSD conditions may be linked to infections.

A growing body of scientific research suggests that the acute onset of some OCSD conditions—such as obsessive compulsive behavior and tic disorders—may be triggered by an infection. In some children, symptoms develop suddenly or worsen following a streptococcal (strep) infection, which is called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The sudden onset of symptoms due to other infection agents, including Borrelia burgdorferi (Lyme disease), mycoplasma pneumonia, herpes simplex, common cold, influenza, and other viruses is known as PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Healing the underlying infection needs to be a critical part of any treatment plan.

4. People with OCD are more likely to have anemia.

A 2015 study among psychiatric patients that was published in Neuropsychiatric Disease and Treatment found that over 25% of people with OCD were also suffering from anemia. Be sure to get your iron levels checked with a ferritin blood test. Levels between 50 and 100 ng/mL are ideal. Levels below 50 ng/mL can cause problems that exacerbate OCD symptoms.

5. OCD can look like other mental health conditions.

Many OCD symptoms overlap with those associated with other psychiatric issues. A 2015 study in the Journal of Clinical Psychiatry that looked at primary care physicians’ ability to identify OCD found that over half of OCD cases were misdiagnosed. OCD is often mistaken for anxiety, ADD/ADHD, or bipolar disorder. In some cases, it is misdiagnosed as autism, post-traumatic stress disorder (PTSD), or schizophrenia. If a medical professional doesn’t look at the brain with functional brain imaging, it is harder to distinguish conditions, and you be on the wrong treatment program.

OCD is often mistaken for anxiety, ADD/ADHD, or bipolar disorder. Click To Tweet

6. People with OCD may not be getting the maximum benefit from transcranial magnetic stimulation (TMS).

TMS is a non-invasive treatment that can change the brain for the better. It uses brief magnetic pulses to stimulate activity in the areas of the brain known to affect mood, anxiety, and pain. The FDA has approved TMS for the treatment of resistant depression, but evidence in The Journal of ECT shows it can potentially help improve a wide range of other brain-related issues, including OCD. At Amen Clinics, TMS is used differently than in most psychiatric settings. Based on the brain imaging work at Amen Clinics, settings can be changed based on an individual’s brain scans. Using the same treatment settings for everyone isn’t as effective as tailoring the therapy to your personal needs.

7. Neurofeedback may help.

Over 1,000 scientific studies have found that neurofeedback can help a wide variety of mental health and brain-related conditions. For example, a 2013 study in Neuropsychobiology showed that neurofeedback proved useful in improving symptoms of OCD.

8. Some foods make OCD worse.

Many healthcare professionals have yet to embrace the power of nutritional psychiatry, so you may not be aware that the foods you eat are either hurting or helping your symptoms. Typically, the best strategy to balance hyperfrontality in the brain—a pattern often seen in OCD—is to find natural ways to boost serotonin because it is calming to the brain. People with OCD may “self-medicate” with high-glycemic carbohydrates that quickly turn to sugar and increase serotonin. Although the serotonin boost can calm the brain, people with OCD may become addicted to simple carbohydrates like bread, pasta, and sweets. Avoid these quick fixes, because they can cause long-term health problems and may increase anxiety. Stick with smart carbs, such as sweet potatoes, most vegetables, and fruits like berries and apples.

9. Science-backed supplements can help balance serotonin.

Many psychiatrists and primary care physicians look to medications as the first line of defense and downplay supplements saying there’s no evidence they can be effective. Or they recommend supplements solely based on symptoms rather than on biology. Both of these approaches are flawed. A growing body of scientific evidence shows that certain nutritional supplements, such as 5-HTP (5-hydroxytryptophan) and saffron, can increase serotonin to calm the brain. And nutraceuticals can be much more effective when biological information from brain imaging is taken into consideration.

10. Exercise can soothe symptoms.

Physical exercise, which boosts serotonin, can be an effective treatment for OCD. The results of a 2017 trial in General Hospital Psychiatry showed that after 12 weeks of moderate aerobic exercise reduced OCD symptoms.


OCD, as well as other obsessive compulsive spectrum disorders, can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time.

At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834. If all our specialists are busy helping others, you can also schedule a time to talk.


  1. I live in Melbourne Australia, are there any clinics here?

    Comment by LisaG — August 31, 2020 @ 10:49 PM

  2. I am living in Istanbul/Turkey- do you have any colleagues or clinic to recommend for brain scanning? Thank you

    Comment by Ebru — September 2, 2020 @ 3:24 AM

  3. I also live in Australia, Queensland. Diagnosed with P-OCD, depression and anxiety. Would be interested as well.

    Comment by Dan — September 2, 2020 @ 3:39 AM

  4. Please Dr Amen, we really want to come to your clinic asap so my son can get a brain scan but we cant travel due to Covid 19 restrictions in our country so is there any other option we can do?

    Comment by Lopa — September 2, 2020 @ 3:45 AM

  5. Hi, I live in Brazil and I’d like to ask if any clinic in this country follows AMEN CLINIC’s methods/protocols.

    Comment by Rholden Botelho de Queiroz — September 2, 2020 @ 4:31 AM

  6. How do find out about correct diagnosis? What exam do do? What test shows?

    Comment by Aleksandra — September 2, 2020 @ 4:56 AM

  7. This is probably THE BEST article I have seen on this topic and its relationship to so many possible contributing factors.
    Too often we look at symptoms and not the cause. Thank you once again Dr Amen for putting the pieces together.

    Comment by Laura Temin — September 2, 2020 @ 5:21 AM

  8. I need help. I have struggled for years with OCD, anxiety, and depression. I have tried countless anti-depressants to no avail. They usually dont help with unwanted intrusive thoughts, worry, and anxiety. They also make me emotionally numb. It’s an awful way to live. I want a different approach that will work. I took the quiz and I am an 8. I have seen the supplements list I can take, but what else can I add to the list for happiness and calm thoughts?
    Thank you and God Bless,

    Comment by Ashley Walters — September 2, 2020 @ 6:39 AM

  9. My husband has Tourette’s and ocd. He’s been suffering for years. OCD has taken over his life. He is 63. Is there help for him?

    Comment by Daniel lanham — September 2, 2020 @ 8:07 AM

  10. Ashley, thank you for your comment, I could have signed my name to it. I pray you will find Good methods, supplements,
    botanicals, and guidance, and be much better soon. You WILL.

    Comment by Sarah — September 2, 2020 @ 8:43 AM

  11. I actually do neurofeedback with a clinic in Los Angeles and find it very effective. I also take 5 HTP which also helps with hormone imbalance due to menopause. Thanks for all that you do- it all helps with anxiety, depression and OCD.

    Comment by Lisa Gizara — September 2, 2020 @ 10:52 AM

  12. High doses of SSRIs are the usual treatment for OCD and if not that, then Clomipramine/Anafranil is the gold standard. If you’re going to treat it naturally then supplements like 5htp, inositol and NAC are very useful for it.

    Comment by Bernard Bates — September 2, 2020 @ 11:51 AM

  13. I have been treated for OCD for over 40 years. While it never goes away, (at least for me), Prozac has helped me more than anything else I’ve tried. Also exercise and a vitamin B complex has been helpful. I’m curious about the TMS treatment. How can we find out more about it and where it is offered?

    Comment by Gretchen — September 2, 2020 @ 12:35 PM

  14. My son who 44 has suffered ocd but never diagnosed. The host of meds he has been prescribed is frightening. He is always concentrating on all the horrible life events brain injury a loved one lost to suicide and other tragic events. Please help

    Comment by Mary Jane — September 2, 2020 @ 12:45 PM

  15. I live in South Carolina, i think Atlanta is the closest. How do I know what treatment involves for OCD, specific HOCD, and what is covered by insurance . And do you take United Health Care coverage.

    Comment by Debbie — September 2, 2020 @ 1:15 PM

  16. Also, I’ve read recently about NAC for OCD.

    Comment by B — September 2, 2020 @ 6:37 PM

  17. I’ve had COMPULSIVE SHOPPING DISORDER , – and compulsive merchandise return – my whole life. Also, a hard time making decisions (OCD). I was diagnosed with a LEARNING DISABILITY in 1 st grade. I developed a SEIZURE DISORDER around age 40. Anyone with any of these be cautious in the internet age. I suspect these are all somehow connected. Dr. Amen, – Great post on OCD!!
    I am initiating the KETOGENIC diet, and looking into various “Keto” supplements.
    Steven, the Roaring Fork Valley ,CO

    Comment by Steven — September 2, 2020 @ 9:15 PM

  18. I suffered from OCD for decades. My OCD was so resistant to psychotherapy and medication. Finally, a brilliant psychiatrist put me on high doses of Zoloft and effexor extended release at the same time. I’m finally able to live my life without the paralyzing thoughts and guilt that comes with OCD.

    Comment by Karen — September 3, 2020 @ 8:38 PM

  19. I Live in Sydney Australia and have had Pure OCD for 2 years now. It developed straight after the birth of my second child, is there any remote treatment programs available+?

    Comment by Meena — March 3, 2022 @ 12:00 AM

  20. My client with OCD behavior actually got a lot of positive movement when we worked on trauma release protocols during neurofeedback. Amazing!

    Comment by Cheryl North Desvernine — October 21, 2022 @ 5:44 PM

  21. great advice!

    Comment by Doug Morris — August 26, 2023 @ 2:35 PM

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