Good therapists still miss OCD. Here’s why...
READ TIME : 4 min
Honestly, rates for healthcare providers to accurately diagnose OCD are not stellar.
These are findings from a few studies I pulled:
35% of LICENSED psychologists misdiagnosed OCD cases (sexual orientation & symmetry)
50% of primary care physicians misdiagnosed OCD
Misidentification rates for some subtypes as high as 88%
Kind of concerning right?
Why?
Because most providers simply don’t get enough education or supervision in OCD.
For example, one review found that over half of medical programs failed to teach that aggressive obsessions are ego-dystonic and don’t make people more likely to harm.
**Dr. Eric Storch made an important point that is worth repeating: these gaps in OCD training likely extend to lack of training in other psychiatric disorders too.
Why am I making a whole blog post about this?
Because, OCD is one of the top 10 most debilitating disorders worldwide. That means if left untreated (or not properly treated) it can have a huge impact on daily functioning.
symptoms can usually worsens over time and risk of suicide increases.
can make OCD harder to treat in the future
increased risk of suicide
Some of the most misdiagnosed subtypes?
Sexual obsessions (child or nonchild)
Harm obsessions (to self or others)
Relationship OCD (ROCD)
Data from one study showed:
77% misidentification for sexual obsessions
88% misidentification for ROCD
Often mistaken for “relationship problems” or general worry
With these aggressive or sexual obsessions, people may not realize: These obsessions DO NOT make someone more likely to harm themselves or others. They’re ego-dystonic symptoms of OCD, not proof of intent.
When OCD is missed or misdiagnosed, clients may:
Be told their thoughts mean they’re dangerous (or have CPS or 911 called)
Get a wrong diagnosis (like psychosis or “relationship issues”)
Be prescribed meds that worsen OCD
Try talk therapies that unintentionally fuel symptoms
The gold standard treatment?
ERP (Exposure and Response Prevention)
*there are other modalities that are gaining evidence of effectiveness (i-CBT) or as an add on modality (ACT).
SSRIs (often at higher doses than for other anxiety disorders)
I’m not saying every therapist needs to specialize in OCD. But we’d all benefit from:
Being able to screen for OCD (tools like the Y-BOCS)
Knowing that it’s ok not to know everything and consulting with a colleague who does specialize in OCD (hi, it’s me)
Knowing ERP is the evidence-based therapy
Equipping clients with IOCDF.org for medication recommendations and reliable psychoeducation
Referring through IOCDF.org, not just “OCD” checkboxes on directories
My goal here isn’t to shame other providers.
It’s about acknowledging that most of us weren’t trained well in OCD and choosing to do better. If you’re a therapist with questions, please ask. OCD is tricky, and there’s never a dumb question. Collaboration only helps clients get the care they deserve.
Sources:
Weinberg et al., J Clin Psychol (2025)
McGrath et al., Clinical Psychologist (2024)
Lahey et al., J Med Educ Curric Dev (2024)
Stahnke, J Affect Disord Rep (2021)
Glazier et al., J Clin Psychiatry (2015)
Glazier et al., Ann Clin Psychiatry (2013)
Storch, J Clin Psychiatry (2015)
Whether you’re living with OCD or treating it...the more we talk about what it ACTUALLY looks like, the better care people will get.
Hi, I’m Michelle
I’ve been working in mental health since 2010 and struggling with anxiety for oh, idk, maybe my entire life.
And with my lived experience having anxiety, I know what works, what doesn’t, and what makes things feel worse. In here, you’re not alone, and I’ll work with you to shed the shame along with the anxiety. And by using evidence-based practices, I’ll help you recover, not just feel better.