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Mental Health
3 Min Read
Last Updated: 12.06.23

The Science & Treatment of Obsessive Compulsive Disorder (OCD)

Huberman explores the biology and psychology of OCD, discussing its treatments—behavioral, pharmacologic, holistic, and emerging options. He explains the neural circuitry behind OCD and the effectiveness of therapies like exposure therapy and SSRIs. This episode is valuable for individuals with OCD, OCPD, and anyone interested in understanding the brain’s control over thoughts and actions.

Key Takeaways

High level takeaways from the episode.

OCD includes thoughts (obsessions) and actions (compulsions)

  • Obsessions are intrusive and recurrent
  • Compulsions provide brief relief but often reinforce obsessions

OCPD (Obsessive-​​compulsive personality disorder) is distinct from OCD

  • People with OCPD may be “obsessive” but do not have the same intrusive, recurrent obsessions as those with OCD

OCD is extremely common

  • Estimates: 2.5% to 4% of people suffer from OCD
  • Many cases go unnoticed or unreported due to shame or hiding

Debilitating effects of OCD

  • Ranked 7th in most debilitating illnesses
  • Takes time away from other aspects of life
  • Focus on obsessions and compulsions prevents focus on other tasks

Three general categories of OCD

  • Checking obsessions and compulsions 
    • Example: checking locks or stoves multiple times
  • Repetition obsessions and compulsions 
    • Example: counting numbers or performing actions repeatedly
  • Order obsessions and compulsions 
    • Example: cleanliness, symmetry, or incompleteness
    • Can also involve disgust or contamination concerns

Obsessions and compulsions are bound by anxiety

Example: fear of turning left on a street

  • Obsession: belief that turning left will lead to something bad happening
  • Compulsion: always turning right to avoid the perceived danger
  • Anxiety reinforces the obsession and compulsion

40–50% of OCD cases have some genetic component

  • Based on twin studies
  • Not always directly inherited from a parent

Yale Brown Obsessive Compulsive Scale (Y‑BOCS) is a common diagnostic tool

  • Defines obsessions and compulsions
  • Identifies target symptoms and the fears driving the obsessions

Exposure based Cognitive Behavior Therapy encourages or forces patients to define their biggest, most catastrophic fear

  • Helps disrupt the corticostriatal thalamic loop and provide relief from symptoms
  • Involves bringing patients close to their fears and interrupting the circuit

Study on Exposure-​​Based CBT, SSRIs, Placebo for OCD:

  • Placebo had no significant effect on OCD symptoms
  • CBT had a dramatic effect in reducing OCD symptoms
  • SSRIs had a significant effect in reducing OCD symptoms, but not as much as CBT

Cannabis can reduce anxiety, but its effectiveness in treating OCD is still under investigation

  • No clear evidence that cannabis or CBD can alleviate OCD symptoms

Early studies on ketamine therapy for OCD show some relief for some patients, but not overwhelmingly effective

  • More extensive clinical trials needed

Transcranial magnetic stimulation (TMS) shows some effectiveness in reducing OCD symptoms, but not a magic bullet

Best used in combination with drug treatments or cognitive behavioral therapy (CBT)

Study findings on hormones and OCD:

  • Females with OCD: significantly elevated cortisol and DHEA
  • Males with OCD: increased cortisol and significant reductions in testosterone

Relationship between hormones and GABA:

  • DHEA is a potent antagonist of the GABA system
  • Testosterone also affects the GABA system
  • Hormone patterns in OCD patients result in overall reduction in GABA, leading to increased excitation in certain brain networks

Manipulations of hormone systems might prove useful in adjusting the symptoms of OCD

  • Many treatments for reducing DHEA, increasing testosterone, or reducing cortisol are FDA-​​approved and available in generic form

Mindfulness meditation can be useful in OCD treatment by impacting focus on cognitive behavioral therapies

  • Indirectly improves OCD symptoms

5‑HTP and tryptophan (serotonin pathway)

  • Can improve/​​reduce OCD symptoms similarly to SSRIs

Obsessive Compulsive Personality Disorder

  • OCPD can be both adaptive and maladaptive, depending on the context and degree of expression

OCPD can be productive and enhance functioning in certain domains of life (e.g., work, home organization)

  • Can synergize well with activities and professions that require precision and delayed gratification (e.g., architecture, science, mathematics, engineering)


Science-​​based tools and supplements that push the needle.

Exposure-​​based Cognitive Behavioral Therapy (CBT) for OCD




Nutraceuticals for OCD



We recommend using this distillation as a supplemental resource to the source material.

  • The Science & Treatment of Obsessive Compulsive Disorder (OCD)

    Huberman Lab Podcast #78

    Huberman delves into OCD, covering its biology, psychology, and treatments. This episode is valuable for understanding OCD and related conditions.

Full Notes

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