One of my goals with writing blogs is providing education for physicians and other healthcare professionals who specialize in functional medicine, from the lens of psychiatry. People seek a functional, integrative medicine approach to their health for a variety of reasons, including health anxiety motivations that can be driven by underlying obsessive compulsive disorder or traits.
Defining OCD
Obsessive-Compulsive Disorder is a mental health condition characterized by persistent, intrusive thoughts (obsessions) that cause distress, leading to repetitive behaviors or mental rituals (compulsions) aimed at reducing anxiety. These compulsions can provide temporary relief but ultimately reinforce the cycle of anxiety and rigidity.
OCD is a clinical diagnosis, meaning there are no labs or biomarkers that will indicate someone has OCD. While the DSM5 definitely has it's limitations, we can use it as a framework for diagnosing this condition. It's important to note that people can also just have obsessions and not compulsions, known as the subtype"Pure O" OCD.
To meet the criteria, a person must experience:
1. Obsessions (Intrusive, distressing thoughts, urges, or images)
Recurrent and persistent thoughts, urges, or images that are unwanted and cause significant anxiety or distress.
The individual attempts to ignore, suppress, or neutralize these thoughts with another thought or action (compulsion).
Common themes: contamination fears, symmetry/order, harm-related fears, existential worries, or moral scrupulosity.
2. Compulsions (Repetitive behaviors or mental acts to reduce anxiety)
Repetitive behaviors (checking, washing, organizing) or mental acts (counting, praying, repeating phrases) that the person feels driven to perform to prevent perceived harm or reduce distress.
The behaviors are excessive and not realistically connected to preventing the feared outcome.
3. Time-Consuming and Impairing
Obsessions and compulsions take up more than one hour per day or cause significant distress or impairment in social, occupational, or other areas of functioning.
4. Not Due to Another Condition
Symptoms are not better explained by another mental disorder (e.g., generalized anxiety, hoarding disorder, psychotic disorders) or due to substance use or a medical condition.
I will add an * to this - as people can be diagnosed with OCD due to a medical condition such as PANS or PANDAS that has an infectious etiology.
Functional Medicine and OCD
In functional medicine, the OCD-driven patient often applies this pattern to health, becoming hyper-focused on lab results, supplements, diet rules, and the fear of missing a crucial intervention. They may compulsively research, test, or change protocols in an attempt to achieve a sense of certainty and control over their health. This can lead to distress, overwhelm, and an inability to trust the healing process - and themselves.
Working with patients that have health anxiety or OCD requires a thoughtful balance of compassionate validation, structured guidance, and gentle redirection away from compulsive health-seeking behaviors.
Navigating OCD-Driven Health Seeking
1. Set Clear Expectations Early
Define a structured approach with a clear framework for testing and treatment.
Emphasize prioritization—not every test or treatment is necessary.
Set realistic timeframes for improvement to prevent excessive urgency.
2. Recognize & Address OCD Patterns in Treatment-Seeking
Patients may compulsively seek more lab tests, supplements, or interventions.
They might engage in reassurance-seeking, needing frequent confirmation that they are on the right path.
Help them differentiate between health optimization vs. obsession with perfection.
3. Use Motivational Interviewing & Gentle Limits
Validate concerns but guide them toward a balanced approach.
When they push for excessive interventions, reflect back:
“I hear that you want to do everything possible, but let’s focus on what will give the most impact first.”
Encourage flexibility rather than rigid protocols.
4. Address Perfectionism & Fear of Uncertainty
Frame uncertainty as a normal part of healing and a normal part of the field of medicine.
Encourage experimentation and tolerance for imperfection in health routines. I like to use the phase of patients trying a "n of 1 experiment" for a period of time.
Help them understand that "more is not always better" in functional medicine.
5. Address Gut-Brain & Inflammatory Factors
Functional medicine tools such as focusing on gut health, inflammation, mitochondrial function can support OCD, but should be applied systematically.
Prioritize basic interventions first such as ERP therapy, exercise, diet, sleep, and blood sugar balance before jumping into more in-depth (and expensive) testing.
6. Collaborate with Mental Health Providers
If obsessions and compulsions around health-seeking are interfering with function, CBT and ERP (Exposure & Response Prevention) can be essential.
Consider coordinating with an OCD specialist therapist.
More About ERP
ERP is the gold standard for OCD treatment and can help patients tolerate uncertainty, challenge black-and-white thinking about health and beyond. ERP can also help patients work on differentiating between proactive wellness choices and compulsive behaviors.
Functional medicine providers can collaborate by screening for OCD patterns, referring patients to ERP-trained therapists and ensuring that treatment plans do not unintentionally reinforce compulsions.
Sharing clear functional medicine goals with the therapist allows for a more integrated approach—such as addressing gut health without enabling extreme dietary restrictions. While some patients may resist therapy, presenting it as a tool to enhance their healing and improve their relationship with health interventions you are recommending can increase openness.
Closing Thoughts
It's important to recognize patterns early in your work together with your patients and integrate them into your holistic treatment approach. Just as you observe your patient's anxiety, be aware of any urgency or pressure you might feel as a clinician to do more in response to their distress. Noticing this dynamic can help you stay grounded and guide the treatment plan with clarity rather than being pulled into the compulsive need for more interventions.
A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.