People with OCD often describe having explained their symptoms to someone before and getting nowhere. The reasons are consistent, and they are worth naming, because they tell you what a psychiatric assessment is actually for.
Why OCD gets missed for years
OCD hides in plain sight for four reasons.
The symptoms are embarrassing. Intrusive thoughts about harming a child, about sexuality, about blasphemy or contamination are common features of OCD, and they are the last thing anyone volunteers in a ten-minute appointment. Many people describe “anxiety” instead and are treated for anxiety.
The compulsions do not look like handwashing. Mental reviewing, silent counting, re-reading, confessing, seeking reassurance from a partner, checking your own body for signs of illness and avoiding whole categories of situation are all compulsions. None of them is visible to anyone else.
It gets absorbed into another label. Health anxiety, perfectionism, generalised anxiety and “just how I am” are all places OCD ends up. Mind’s information on OCD treatment describes the condition and its treatment for comparison.
Treatment was given, but not properly. An SSRI at the dose used for mild depression, stopped after six weeks because nothing had changed, is a very common history. Judged against what OCD actually needs, that trial was neither high enough nor long enough to mean anything.
A private assessment cannot undo lost years. What it can do is produce a clear diagnosis, an honest view of severity, and a plan specific enough for you and your GP to act on.
What the assessment is looking for
The initial appointment is a 60-minute video consultation with a GMC-registered consultant psychiatrist. For OCD it goes in a particular direction.
The psychiatrist will map the obsessions and the compulsions and the link between them, because that link is what distinguishes OCD from worry. They will ask how much time the rituals take, what you avoid, and what has been given up: work, driving, cooking for others, touching your own children. They will ask who else has been drawn into the rituals, because family reassurance often maintains the condition. They will ask about the age it started and how it has moved between themes, since OCD characteristically migrates.
They will also separate OCD from what resembles it. Health anxiety, generalised anxiety, body dysmorphic disorder, autistic routines that are calming rather than distressing, and, rarely, psychotic symptoms all get confused with it. That distinction matters because it changes both the therapy and the medication. If anxiety is also present, or low mood has followed years of OCD, that is mapped too.
Then the medication history in detail: which SSRIs, what maximum dose, for how many weeks, and why each was stopped. This is the part most often missing from the record, and the part that most often changes the plan.
The core treatment is a therapy this clinic does not provide
It is better to read this before paying for anything. The main treatment for OCD is cognitive behavioural therapy including exposure and response prevention, usually shortened to ERP. It involves facing the trigger and deliberately not performing the compulsion, with a therapist, repeatedly, until the anxiety falls on its own.
NICE guidance on OCD recommends low-intensity psychological treatment including ERP, of up to 10 therapist hours, where impairment is mild; either an SSRI or more intensive CBT including ERP, at more than 10 therapist hours, for moderate impairment; and for severe impairment, combined treatment with an SSRI and CBT including ERP. The NHS says mild OCD typically needs 8 to 20 therapist sessions plus exercises at home.
Happy Clinic does not provide psychological therapy. In England you can refer yourself to NHS talking therapies without seeing a GP, using the NHS find a service page; those services treat OCD and deliver CBT. When you contact them, ask specifically whether the therapy offered is ERP for OCD, rather than general anxiety CBT, and say if you have had the general version before without benefit. In Scotland, Wales and Northern Ireland, your GP is the quickest route to the local equivalent.
If ERP is the treatment and it is available to you, you may not need a psychiatrist at all. That is a reasonable conclusion to reach from this page.
Where medication does earn its place
Medication is not a substitute for ERP, but it is far from a footnote. It is what makes exposure work possible for some people, and it is the mainstay when therapy is unavailable or has been tried without success.
NICE says the initial drug treatment should be one of fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram. Three features of OCD treatment differ from depression treatment, and all three are places where things commonly go wrong.
- Dose. OCD frequently needs a dose towards the top of the licensed range. NICE says increases should follow the schedule in the medicine’s summary of product characteristics.
- Time. NICE notes a delay in the onset of effect of up to 12 weeks. The NHS page on OCD treatment puts it the same way: “You may need to take an SSRI for up to 12 weeks before you notice any benefit.”
- Duration. NICE advises that where an SSRI is effective it should be continued for at least 12 months. The NHS says most people need treatment for at least a year.
Where an adequate trial of at least one SSRI has not helped or was poorly tolerated, NICE says clomipramine should be considered. Where there has been no response to a full trial of an SSRI alone, a full trial of combined CBT and an SSRI, and a full trial of clomipramine, it says the person should be referred to a multidisciplinary team with specific expertise in OCD. A private psychiatrist can tell you where you sit in that sequence, which is often the single most useful thing to come out of the appointment.
Reviewing treatment when ERP alone has not worked
A distinct group of people have done ERP, properly and at length, and remain unwell. Others cannot engage with exposure while the symptoms are this severe. Both are reasons to look at medication rather than to conclude that OCD is untreatable.
The questions in a review are concrete: was any previous trial long enough and high enough to count; is the current dose optimised; is there a reason to switch within class or to consider clomipramine; is co-occurring depression blocking progress; and would adding medication make a second attempt at ERP feasible. A medication review is the appointment for this if you already have a diagnosis and simply need the drug treatment rethought.
Treating the depression that follows
Depression on top of OCD is extremely common, and it is not a separate inconvenience. It drains the energy ERP requires, so treating it is often the step that makes therapy possible. The same SSRIs are used for both, which sometimes simplifies matters, but the dose and duration are usually judged by the OCD rather than by the mood. The depression page explains the wider medication decisions.
What to bring to the appointment
- A list of every psychiatric medicine you have taken, with the highest dose reached, how many weeks you took it, and why it stopped. A printout from your GP surgery is ideal.
- A note of any therapy you have had: how many sessions, whether exposure work was actually part of it, and what changed.
- A rough estimate of hours a day lost to obsessions and compulsions, and a list of what you now avoid.
- The themes you find hardest to say out loud, written down, if saying them is easier that way. Writing them is a legitimate way to get them into the appointment.
Costs and how to proceed
An initial psychiatric assessment is £400 for 60 minutes. Follow-up and review appointments are £200 for 20 minutes. A repeat prescription request for existing patients is £150, subject to clinical review. Fees are paid in advance, and prescriptions issued during an appointment are included, though pharmacy charges are not. Fees checked September 2026 — see the fees page for the current list.
Because OCD medication is judged over months rather than weeks, budget for an assessment plus at least one review. Consultations are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC), for adults aged 18 and over anywhere in the UK, with no GP referral needed. The first appointment page describes how the consultation runs, and you can book an appointment online.
Speak to a Consultant Psychiatrist
Book a secure video consultation with Happy Clinic, for adults aged 18 and over anywhere in the UK. No GP referral is needed and appointments are often available within days.
This page is general information and is not a substitute for personal medical advice. Consultations, diagnosis and prescriptions are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). If you are in crisis, call 999, go to A&E, call NHS 111 or call Samaritans free on 116 123.