Expert Telehealth Care for OCD in New York
Obsessive-Compulsive Disorder affects approximately 2–3 million adults in the United States — about 1.2% of the population — according to the International OCD Foundation. Despite frequent references in popular culture, OCD is widely misunderstood. It is not about being neat, particular, or detail-oriented. It is a chronic, often debilitating condition in which intrusive, ego-dystonic thoughts generate intense anxiety, driving repetitive behaviors or mental rituals that provide only temporary relief — and that can consume hours of a person's daily life.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides comprehensive telehealth evaluation and medication management for OCD for adolescents and adults — and works in close collaboration with specialized therapists to ensure access to the full spectrum of evidence-based care.
What is OCD?
OCD is characterized by obsessions, compulsions, or both — causing significant distress and/or impairment in daily functioning. OCD is ego-dystonic: the intrusive thoughts feel alien, unwanted, and deeply distressing to the person experiencing them — unlike thoughts consistent with their values or personality.
Obsessions are persistent, unwanted, intrusive thoughts, images, urges, or doubts that produce significant anxiety. Compulsions are repetitive behaviors or mental acts performed in response to obsessions, aimed at neutralizing distress or preventing a feared outcome — providing only temporary relief and ultimately reinforcing the OCD cycle over time
What Are The Signs And Symptoms of OCD?
Common OCD Presentations
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Contamination OCD: Obsessive fear of germs, illness, contamination, or spreading harm; compulsions include excessive handwashing, cleaning, or avoidance of "contaminated" surfaces or people
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Harm OCD: Intrusive, deeply unwanted thoughts about accidentally or intentionally harming oneself or others (these are ego-dystonic — they cause horror, not desire)
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Checking OCD: Persistent doubt about whether doors are locked, appliances are off, or mistakes have been made; compulsions involve repeated checking
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Symmetry and "Just Right" OCD: A compulsive need for objects to be arranged perfectly or for actions to be repeated until they feel "complete" or "right"
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Scrupulosity: Religious or moral obsessions — excessive fear of sin, blasphemy, moral imperfection, or having offended a higher power
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Relationship OCD (ROCD): Persistent, intrusive doubt about one's romantic partner, one's love for them, or one's own fidelity and character
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Primarily Obsessional ("Pure O"): OCD characterized by predominantly mental obsessions with less visible compulsions — often involving mental reviewing, reassurance-seeking, and avoidance
Common Compulsions
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Washing, cleaning, or sanitizing
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Checking and rechecking — locks, appliances, texts sent
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Counting, tapping, or repeating actions a specific number of times
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Ordering and symmetrical arrangement
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Mental reviewing and reassurance-seeking
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Avoidance of triggers
What Are The Risk Factors of OCD?
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Genetics: OCD is strongly heritable — first-degree relatives of someone with OCD have a significantly elevated risk
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Neurobiological factors: Differences in serotonin regulation and orbitofrontal-striatal brain circuits
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Trauma or stressful life events: Can trigger OCD onset or exacerbate existing symptoms
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Personality factors: Perfectionism and inflated personal responsibility can increase vulnerability
How is OCD Diagnosed?
OCD is diagnosed through a comprehensive clinical evaluation assessing the content and severity of obsessions and compulsions, the time they consume daily, the distress they cause, and their impact on functioning. At Strong Enough Mental Health, Salvatore uses a careful clinical interview to ensure accurate diagnosis — differentiating OCD from generalized anxiety, PTSD, and other conditions that may share some features.
What Are Possible Treatments For OCD?
Medication for OCD
Serotonin-based medications are the pharmacological cornerstone of OCD treatment. Importantly, OCD typically requires higher medication doses and longer treatment durations than depression or anxiety — and premature discontinuation is one of the most common reasons for treatment failure. At Strong Enough Mental Health, we prescribe evidence-based OCD medication protocols and facilitate referrals to therapists specializing in Exposure and Response Prevention (ERP) — the gold-standard behavioral treatment for OCD, and most effective in combination with medication.
Selective Serotonin Reuptake Inhibitors (SSRIs) — First-Line Treatment
SSRIs are the first-line pharmacological treatment for OCD. Higher doses than those used for depression or anxiety are typically required, and a full therapeutic response may take 10–12 weeks or longer. Adequate duration is critical.
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Fluvoxamine (Luvox) — FDA-approved for OCD; particularly potent serotonergic profile
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Fluoxetine (Prozac) — FDA-approved for OCD
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Sertraline (Zoloft) — FDA-approved for OCD
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Paroxetine (Paxil) — FDA-approved for OCD
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Escitalopram (Lexapro) — Used off-label; well-tolerated
Clomipramine (Anafranil)
Clomipramine is a tricyclic antidepressant with powerful serotonergic properties and is FDA-approved for OCD. It is often the most pharmacologically potent option and is used when SSRIs have been insufficient. Its side effect profile — including anticholinergic effects and cardiac monitoring requirements — means it is typically not a first-line choice, but it remains an important treatment option for treatment-resistant OCD.
Augmentation for Treatment-Resistant OCD
When SSRIs alone provide insufficient response — which is common in OCD — augmentation with a second medication can produce significant additional benefit.
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Atypical antipsychotics: risperidone (Risperdal) or aripiprazole (Abilify) — The most evidence-supported augmentation strategy for OCD; added to ongoing SSRI treatment
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Buspirone — Sometimes used as an adjunct medication