Our multidisciplinary team—including many leaders in their fields—takes a collaborative approach to personalizing care plans to treat obsessive-compulsive disorder (OCD), tics, and Tourette's disorder. We start by performing in-depth assessments and diagnostic evaluations. We then provide evidence-based treatments, such as behavioral therapies and medication consultations, to help relieve the symptoms and address the underlying causes.
Conditions We Treat
Our specialists treat a range of conditions, including:
- Obsessive-Compulsive Disorder (OCD): Someone with OCD has uncontrollable thoughts and fears (obsessions). These obsessions often compel them to perform certain (compulsions) over and over. Patients often feel they have no control over these feelings. Intense anxiety and worry may cause patients to perform these repetitive behaviors. Compulsions can be very time consuming and can make it hard to live a normal life. In the same way, avoiding situations that trigger OCD can also interfere with daily routines. OCD symptoms often begin during childhood but can start at any point. Getting proper treatment can be difficult. Patients may be misunderstand or misdiagnosed. Often, years go by before a patient or a loved one seeks help or gets an accurate diagnosis. People with OCD may also have other conditions. These can include tic symptoms or Tourette's disorder, autism symptoms, other anxiety or mood disorders, attention-deficit/hyperactivity disorder (ADHD), and social or learning difficulties. At Mount Sinai, we take into account all your symptoms as we develop a treatment plan.
- Tics: Tics are sudden, rapid, non-rhythmic yet recurrent involuntary movements or sounds. Tics start in childhood. About 15 percent of school-age children may have some tics at one time or another. Tic disorders–when multiple tics are present and symptoms persist for more than a year–are less common. They can cause distress and impairment.
- Tourette's disorder: Tourette's disorder involves multiple motor tics and at least one vocal tic. The most complex of the tic disorders, this condition lasts at least a year. Tics often start during childhood and may come and go. Motor tics often begin in the head and neck area, but any part of the body can be involved. Verbal tics come in many forms. In addition, people with Tourette's disorder may also have OCD or OCD-like symptoms (for example, having to touch, tap or rub things or perform acts repeatedly until they feel “just right”). You or your loved one might also experience other anxiety or mood symptoms, attention-deficit/hyperactivity disorder (ADHD) symptoms, autism spectrum disorders, and/or social or learning problems. At Mount Sinai, we do a comprehensive evaluation of psychiatric, psychological, and related areas of development before we make a treatment plan.
- Trichotillomania: People with this condition have ongoing urges to pull or twist their own hair. This can lead to hair loss. It can affect hair anywhere on the body, but it’s usually head and facial hair.
- Body-focused repetitive behaviors: Nail biting and skin picking also fall into the category of OCD-related disorders.
Tics, OCD, and Related Disorders Program
A tic is a repetitive motion, usually in the face, that you cannot control. If you or a loved one has an obsessive-compulsive disorder (OCD), tic, or Tourette's disorder, Mount Sinai can help. Our team performs an in-depth evaluation to diagnose your condition. Then we develop a comprehensive and personalized treatment plan for you or your loved one. We used the most advanced treatments, supported by the latest research. We may use behavioral therapies, medical treatments, or both.
Psychotherapy for OCD
The behavioral therapies we use most often include:
- Exposure and response prevention (ERP or ExRP): Considered the gold standard for treating OCD, this approach targets the uncomfortable and distressing OCD thinking processes. We want to help our patients get rid of the repeated compulsions as well as the worries and fears that go along with them. ERP involves confronting fearful thoughts without performing the rituals linked to them. First, we map out all the OCD symptoms and the fears that are linked to them. We use ERP in an incremental way, starting with the least difficult ones up to the more difficult. Our therapist is there at all times. We also give patients homework so that they practice outside of the treatment sessions. This approach makes treatment move more quickly. Over time, patients learn to separate the obsessions and the anxiety. We call this process habituation. For ERP to be effective, patients cannot perform OCD behaviors during the therapy. This may be difficult, but it is also very effective.
- Mindfulness: This approach helps patients learn to accept themselves and their condition. It enables patients to live in the moment, rather than worry about the future. It may involve writing scripts, imagining fearful thoughts, or using motivational techniques. Patients may use cognitive therapy at the same time.
- Other Talk Therapies: Some patients benefit from discussing their feelings and thoughts about how their lives have been affected by living with OCD. We often use this type of therapy after ERP or medication treatment has helped control the active symptoms.
For your convenience, we offer psychotherapy sessions both on site, and with home visits as a part of our treatment services.
Medications for OCD
The most effective medications in the treatment of OCD are serotonin reuptake inhibitors (SRIs). At Mount Sinai, we tend to use a type of SRIs called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine, sertraline, and fluvoxamine. Serotonin is a chemical messengers, called a neurotransmitters. It helps nerve cells (neurons) to communicate with each other. We also use SSRI medications to treat depression; studies have shown that they work well whether the OCD patient is depressed or not. Clomipramine is an older SRI medication that helps with OCD. We sometimes use it along with SSRI treatment.
Transcranial Magnetic Stimulation (TMS) for OCD
If medication or CBT do not help, we can use transcranial magnetic stimulation (TMS), which uses electrical impulses to control symptoms. TMS is a state-of-the-art procedure approved by the FDA to treat OCD and depression. It involves placing a coil above the head that generates a magnetic field to improve brain function. It has few side effects, and is not painful. Research shows that this treatment can reduce the severity of OCD.
Deep Brain Stimulation for OCD
If medication, CBT, or TMS do not help, we can use deep brain stimulation (DBS), performed by neurosurgeons at the Center for Neuromodulation. DBS is a state-of-the-art surgical procedure that we use with Parkinson’s disease and tremors. It uses electrical impulses to control symptoms. It works with several neurological, neuropsychiatric, and psychiatric disorders. The U.S. Food and Drug Administration has approved use of DBS for patients who aren’t helped by other approaches. DBT involves implanting electrodes in certain regions of the brain. Then we stimulate those electrodes. In collaboration with the pioneering research performed at Nash Family Center for Advanced Therapeutics, studies show that this treatment can reduce the frequency and severity of OCD symptoms.
Tics and Tourette's Disorder
Diagnosing tics, including Tourette's disorder, can be difficult. We start by doing a comprehensive evaluation and medical history. We ask about early development, educational and occupational histories, social development, medical conditions, and previous treatments. We may also do a physical exam and imaging such as magnetic resonance imaging, a computed tomography scan, an electroencephalogram, or blood tests. If necessary, we may do a formal neuropsychological evaluation. This tests tells us about the patient’s learning style and cognitive development. Next we develop a personalized treatment plan. We use a variety of advanced treatments. These may include cognitive behavioral therapy and medication.
Treatments for Tics and Tourette's Disorder
Our team offers a variety of approaches to treat active symptoms. The most common approaches are:
- Comprehensive Behavioral Intervention for Tics (CBIT): This form of cognitive behavioral therapy targets active and difficult tic symptoms. It does not use medication. CBIT can decrease tic severity and intensity. It also gives you other, more acceptable movements or sounds to replace tics that are disruptive.
- Individual psychotherapy: Talk therapy can help patients cope with Tourette's disorder. Psychotherapy and general therapeutic talk therapy allows patients discuss and explore their feelings and thoughts. It helps them think about how their lives have been affected by Tourette's disorder. Sometimes, family therapy approaches can be helpful as well.
- Other psychotherapies: Some Tourette's patients experience anxiety, mood, or non-tic behaviors. We may suggest other types of psychotherapy to help. Examples might include dialectical behavioral therapy or therapies that address mood symptoms or improved interpersonal communication.
Medications for Tics and Tourette's Disorder
We use several types of medication to reduce tic symptoms. The most common are:
- Pimozide and haloperidol are approved by the FDA to treat Tourette's disorder. We use these drugs in low doses.
- Medications designed to treat high blood pressure: Some alpha adrenergic agonists, such as guanfacine and clonidine, can have help with tics.
- Neuroleptic medications: Medications such as aripiprazole and ziprasidone are antipsychotic medications that can help treat tics. We use these medications in low doses.
With any of these medications, we monitor you regularly for side effects and to make sure we are using the best dosage. We want to help you return to your regular routine.