What is the typical treatment for social obsessive-compulsive disorder (OCD)?

Social OCD: Patient Handout on Treatment Options

The most effective treatment for social obsessive-compulsive disorder (OCD) is a combination of cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs). 1

Understanding Social OCD

Social OCD involves obsessions and compulsions related to social interactions and situations. Common symptoms include:

• Intrusive thoughts about saying or doing something inappropriate in social settings 1
• Excessive worry about offending others or being judged 1
• Compulsive behaviors like excessive apologizing, seeking reassurance, or mentally reviewing social interactions 1

First-Line Treatment Options

Psychological Treatment

• Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is the psychological treatment of choice for OCD 2, 1
• ERP involves gradual exposure to fear-provoking social situations while preventing compulsive responses 1
• CBT shows larger effect sizes than medication alone (number needed to treat of 3 for CBT versus 5 for SSRIs) 1
• Typically requires 10-20 sessions, which can be delivered in-person or via telehealth 1
• Key success factor: Completing between-session homework (ERP exercises) is the strongest predictor of good outcomes 3, 1

Medication Options

• Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment 1, 4, 5
• Higher doses of SSRIs are typically required for OCD than for depression or other anxiety disorders 1, 4
• Common SSRIs used for OCD include:
  • Fluoxetine (Prozac): Starting at 20 mg/day, may increase to 40-80 mg/day 4
  • Sertraline (Zoloft): Effective for OCD as established in 12-week trials 5
• Medication should be maintained for at least 12-24 months after achieving symptom remission 1

Treatment Selection Algorithm

Your healthcare provider will help determine the best treatment approach based on:

• For mild to moderate OCD: CBT with ERP alone may be sufficient 2, 1
• For moderate to severe OCD: Combined treatment with both CBT and an SSRI is recommended 1, 6
• For severe OCD that prevents engagement with therapy: Starting with an SSRI first, then adding CBT when symptoms improve 1

What to Expect During Treatment

• Initial response: Most patients begin to see improvement within 8-12 weeks of consistent treatment 4, 5
• Full response: May take 5 weeks or longer to experience the full therapeutic effect 4
• Long-term management: Treatment typically continues for 12-24 months after symptoms improve 1

For Treatment-Resistant Cases

If first-line treatments don't provide adequate relief:

• Switching to a different SSRI 1
• Considering clomipramine (a different type of antidepressant) 7
• Augmentation with low-dose antipsychotic medication 8
• More intensive outpatient or residential treatment programs 2
• Newer approaches like transcranial magnetic stimulation (TMS) for severe cases 7

Important Tips for Success

• Be patient: OCD treatment takes time to work 1
• Stay consistent: Don't skip therapy sessions or medication doses 1
• Complete homework: ERP exercises between sessions are crucial for success 3, 1
• Involve family: Family support can improve outcomes and reduce accommodation of symptoms 1
• Communicate with your provider: Report side effects or concerns promptly 1

Common Pitfalls to Avoid

• Stopping medication too soon (high relapse risk) 1
• Using inadequate medication doses (OCD requires higher doses than depression) 1, 4
• Avoiding exposure exercises due to anxiety 1
• Family members accommodating OCD behaviors, which reinforces symptoms 1

Remember that with proper treatment, most people with social OCD experience significant improvement in their symptoms and quality of life.