Treatment-Resistant Obsessive-Compulsive Disorder

Treatment-resistant obsessive-compulsive disorder (OCD) refers to OCD in which clinically significant obsessions and compulsions persist despite adequate trials of evidence-based treatments, including serotonin reuptake inhibitor (SRI) medications and specialized psychotherapy such as exposure and response prevention (ERP). Individuals with treatment-resistant OCD often experience severe functional impairment, marked distress, and diminished quality of life.

Patients with treatment-resistant OCD may present with:

  • Persistent or severe obsessions and compulsions despite multiple medication trials
  • Partial or no response to ERP or difficulty tolerating intensive psychotherapy
  • High levels of anxiety, avoidance, or ritualistic behavior interfering with daily functioning
  • Co-occurring depression, anxiety, or other psychiatric conditions
  • Chronic illness course with limited symptom-free periods

Our Approach to Treatment-Resistant OCD

At the UTHealth Houston Center for Interventional Psychiatry, care for treatment-resistant OCD is guided by comprehensive evaluation and matched-care clinical decision-making. The goal is to reduce symptom severity, improve functioning, and support sustained engagement in treatment.

Each patient undergoes a detailed assessment to:

  • Confirm diagnosis and symptom profile
  • Review adequacy and tolerability of prior medication and psychotherapy trials
  • Assess functional impairment, distress, and safety
  • Identify comorbid psychiatric or medical conditions that may influence treatment

Based on this evaluation, patients are matched to the most appropriate level of care, which may include outpatient services, intensive outpatient treatment, partial hospitalization, or inpatient care, depending on symptom severity and functional impact.

Treatment Options

Treatment plans are individualized and may include:

  • Medication optimization, including high-dose SRI strategies and augmentation approaches when appropriate
  • Evidence-based psychotherapy, particularly ERP, delivered in individual or group formats and adapted to illness severity
  • Interventional and neuromodulation therapies for severe or refractory symptoms, including:
    • Transcranial Magnetic Stimulation (TMS), when clinically indicated
    • Electroconvulsive Therapy (ECT), in select cases with comorbid mood symptoms or severe impairment
    • Other advanced interventions based on symptom profile and response history

All treatment decisions are made collaboratively with patients, with careful discussion of potential benefits, risks, and alternatives.

Continuity and Functional Recovery

Because OCD is often a chronic condition, care emphasizes long-term management, relapse prevention, and functional recovery. Patients may transition between levels of care as symptoms change, with structured planning to support continuity and sustained improvement.

Through this integrated and flexible approach, the Center aims to improve outcomes and quality of life for individuals living with treatment-resistant obsessive-compulsive disorder.