Understanding OCD
Obsessive-compulsive disorder is not about being tidy or particular. It is a cycle of intrusive, distressing thoughts (obsessions) and the rituals or mental acts you feel driven to perform to relieve them (compulsions) — and it can consume hours of your day. OCD is treatable. Willow & Stone is led by Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, a board-certified Psychiatric-Mental Health Nurse Practitioner who treats OCD with evidence-based medication management alongside an integrative look at the physical factors that make symptoms harder to manage.
Signs and symptoms
OCD is widely misunderstood and frequently goes years without diagnosis. Common signs include:
- ✓Intrusive thoughts or images that feel disturbing and unwanted
- ✓Rituals — checking, washing, counting, arranging, or reassurance-seeking
- ✓Mental compulsions: reviewing, praying, or repeating phrases silently
- ✓Needing things to feel "just right" before you can move on
- ✓Significant time lost each day to obsessions or compulsions
- ✓Intense shame about the content of your thoughts
- ✓Brief relief after a compulsion, followed by the cycle starting again
Our integrative approach
Effective OCD care is specific — general anxiety treatment is not the same thing. Our approach:
Accurate diagnosis
OCD is routinely mistaken for generalized anxiety, and intrusive thoughts are often misread. Getting this right changes the whole treatment plan.
Evidence-based medication
OCD often responds to specific medications at specific doses, given an adequate trial period. We manage that carefully rather than cycling through options.
Coordination with ERP therapy
Exposure and response prevention is the gold-standard therapy for OCD. We coordinate medication with your therapist so the two work together.
Root-cause review
Sleep loss, inflammation, thyroid dysfunction, and nutrient deficiencies all raise the baseline of distress. We evaluate and address what we find.
Medication for OCD
Medication for OCD is related to medication for depression and anxiety, but it is not managed the same way, and many people who say “SSRIs didn’t work for my OCD” never had a full trial.
- The main medications target serotonin. Selective serotonin reuptake inhibitors are the most common first choice. Some older serotonin-targeting antidepressants are also used.
- It takes longer than people expect. According to the National Institute of Mental Health, it can take 8 to 12 weeks before OCD symptoms begin to improve, so a medication cannot be judged after a few weeks.
- Doses are often higher than for depression. OCD may need higher doses than are typically used for depression, raised gradually and watched for side effects. This is one reason a careful prescriber matters.
- Partial response has next steps. When a serotonin medication helps only partly, options include adjusting the dose, switching, or adding a second medication; the evidence and the trade-offs are explained in how augmentation decisions are made and antipsychotics as add-on treatment.
- ERP still matters most for many people. Exposure and response prevention, a specific form of CBT, reduces compulsions even for people who do not respond well to medication. Medication and ERP often work best together.
Before and during a medication trial, Dr. Forbes also looks at what raises the baseline of distress: sleep, thyroid function, nutrient status, alcohol and other medications. Bring every supplement you take as well, since some interact with serotonin medications; see supplement and medication interactions. Never stop an OCD medication abruptly; any change is planned with your prescriber. More on our overall approach: integrative medication management.
Sources: NIMH: OCD · MedlinePlus: OCD
If you need help right now
If you are in crisis or having thoughts of harming yourself, you deserve immediate support. Call or text 988 (the Suicide & Crisis Lifeline) or go to your nearest emergency room. Reach out to us afterward and we will help you from there.
Frequently Asked Questions
What is the difference between OCD and anxiety?
Anxiety is broad worry about real-life concerns. OCD follows a specific cycle: an unwanted intrusive thought creates intense distress, and a compulsion — physical or mental — temporarily relieves it, which reinforces the loop. The distinction matters because OCD responds best to specific medication strategies and to exposure and response prevention (ERP) therapy rather than general anxiety treatment.
Are intrusive thoughts dangerous?
Intrusive thoughts in OCD are distressing precisely because they conflict with your values — that is the hallmark of the condition, and having them does not mean you will act on them. They are a well-documented symptom, not a reflection of who you are. Please do not let shame keep you from getting help.
Does medication cure OCD?
Medication does not cure OCD, but it can substantially reduce the intensity and frequency of obsessions and compulsions, which makes therapy work far more effective. OCD medication often requires higher doses and a longer trial than depression treatment, so patience and careful management matter.
Do I need therapy as well as medication?
For most people, the strongest outcomes come from combining medication with exposure and response prevention (ERP) therapy. We do not provide ERP in-house, but we coordinate closely with your therapist — and if you do not have one, we can point you toward ERP-trained clinicians.
Do you treat OCD by telehealth?
Yes. We see patients by secure telehealth across Texas, New Mexico, Florida, Alaska, Arizona, Colorado, and Washington, with in-person visits available in the Fort Worth–Arlington area.
Your healing begins with a conversation.
Start with a telehealth consultation. Insurance is accepted for Texas patients; outside Texas, care is direct-pay with a superbill.
Schedule Your ConsultationOr call (469) 726-3768