OCD treatment in Texas
Telehealth psychiatric care for adults — based in Austin, serving patients statewide.
Obsessive-compulsive disorder (OCD) is not about being tidy, organized, or “particular.” It is a treatable mental-health condition characterized by obsessions — intrusive, unwanted thoughts, images, or urges that create intense distress — and compulsions, which are mental or behavioral acts performed to neutralize the distress. The cycle is exhausting and time- consuming, and it often takes adults years to recognize what they're experiencing as OCD because the obsessions can feel so personal, shameful, or strange that they don't come up with anyone, including past therapists.
OCD shows up in many forms — contamination and cleaning are the stereotype, but there's also harm OCD (intrusive thoughts of hurting someone you love), relationship OCD, sexual-orientation OCD, scrupulosity (religious/moral OCD), symmetry/just-right OCD, and more. The OCD-spectrum also includes conditions like body-focused repetitive behaviors (trichotillomania, skin-picking) and body dysmorphic disorder. None of these mean you are dangerous or bad — they mean your brain has gotten stuck in a loop that has an evidence-based way out.
Signs you may benefit from treatment
- Recurring intrusive thoughts, images, or urges that feel disturbing or wrong
- Compulsive behaviors performed to reduce distress (washing, checking, counting, ordering)
- Mental compulsions — silent reviewing, praying, neutralizing thoughts with other thoughts
- Avoidance of triggers that set off obsessions (objects, people, situations)
- Reassurance-seeking from family, partners, or providers that briefly calms but feeds the cycle
- Significant time loss — hours per day spent on rituals or mental work
- Doubt that won't resolve, even after thorough checking or thinking it through
- Shame about the content of obsessions, with reluctance to disclose them
- Comorbid anxiety, depression, or substance use that developed on top of OCD
- Co-occurring tics, hair-pulling, skin-picking, or body-image preoccupations
- OCD that worsens during stress, hormonal shifts, or postpartum
- Family history of OCD, anxiety, or tic disorders
How Eki Mental Health PLLC treats ocd
Diagnostic clarification matters. OCD is often misdiagnosed as generalized anxiety, depression, or even a personality issue, and the symptoms can be hidden by patients who feel ashamed of the content. We use validated screening tools like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), take a careful history, and create space for the parts of OCD you may not have told a clinician before.
Once we agree on the diagnosis, treatment combines medication management — typically SSRIs at OCD-effective doses (often higher than depression doses, and with a longer time to response) — with referral to a therapist trained in Exposure and Response Prevention (ERP), the gold-standard psychotherapy for OCD. ERP is a specialized therapy and works best with a clinician who specializes in it; we coordinate referrals to Austin therapists with ERP training.
Treatment options
1. SSRIs at OCD-effective doses
SSRIs are the first-line medication for OCD. The evidence-supported options:
- Fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro).
- Two important differences from depression treatment: OCD often requires higher doses (sometimes the upper end of the FDA range), and it takes longer to see response — often 8–12 weeks at a therapeutic dose before judging whether a medication is working. We'll plan for that timeline together so you don't give up too early.
- Clomipramine — a tricyclic antidepressant with strong OCD evidence; sometimes used when SSRIs alone haven't worked.
2. Augmentation strategies
For patients who partially respond to an SSRI but have residual symptoms, augmentation with a low-dose atypical antipsychotic (such as aripiprazole or risperidone) has evidence-based support. We'll discuss the benefits and side-effect profile if this becomes the right move.
3. Exposure and Response Prevention (ERP) — therapy referral
ERP is the most effective psychotherapy for OCD and is often more important than medication for long-term recovery. It is a specialized therapy — not the same as general CBT — and works best with a clinician trained specifically in ERP. The International OCD Foundation (IOCDF) maintains a directory of ERP specialists, and Austin has several excellent options. I'm glad to coordinate a referral and communicate with your ERP therapist throughout treatment.
4. Treatment-resistant OCD
For patients who haven't responded to two adequate SSRI trials plus ERP, options include clomipramine, augmentation, intensive outpatient OCD programs (Austin Anxiety & OCD Specialists is a respected local option), or specialty consultation. We don't give up on OCD — there are many tools.
5. OCD-spectrum and comorbid conditions
Trichotillomania, excoriation (skin-picking) disorder, and body dysmorphic disorder often co-occur with OCD and respond to similar treatments — though with their own evidence base. Comorbid anxiety, depression, and ADHD are common and we treat them integratively rather than ignoring them.
What to expect at your first visit
Your first visit is a comprehensive 60–90-minute evaluation. We will review the kinds of obsessions and compulsions you experience, how much time they take, and what you've tried before. You can tell me anything — including obsessions you've never told a clinician because the content felt shameful or strange. Disclosing the content of OCD obsessions does not change how I see you, and it's often the first step toward getting effective treatment.
Optional: GeneSight pharmacogenomic testing
If you'd like, we can order GeneSight at your first visit — a simple cheek-swab genetic test that analyzes how your body metabolizes psychiatric medications and provides a clinician-facing report to guide prescribing.
Benefits:
- Reduces medication trial-and-error by predicting which medications you're likely to tolerate well
- Identifies medications you may metabolize too quickly (less effective) or too slowly (more side effects)
- Especially useful if you've had a hard time tolerating medications in the past or first-line options haven't worked
- Covers 60+ psychiatric medications — antidepressants, antipsychotics, mood stabilizers, anxiolytics, ADHD meds
- One-time test — your genes don't change, so results stay relevant for life and follow you to future prescribers
- Non-invasive cheek swab; results typically return within 2–3 days
Entirely optional — we only order it if you want it. Insurance coverage varies; we'll review cost and coverage with you before ordering.
Insurance & cost
In-network with Aetna and UnitedHealthcare / Optum; most insured patients pay $20–$60 per visit after benefits. Self-pay rates: $400 initial evaluation, $250 standard follow-up. Superbill provided for out-of-network reimbursement. Full pricing & insurance details →