OCD Psychiatrist in New Hampshire

What OCD Can Actually Look Like

OCD can look like returning repeatedly to check a locked door, losing an evening to washing, or mentally reviewing a conversation long after it ended. Some adults spend much of the day trying to settle a doubt that keeps returning. Others are distressed by unwanted thoughts they find difficult to describe, while appearing to function normally to everyone around them.

Obsessive-compulsive disorder involves recurring, unwanted thoughts, images, or urges called obsessions, and repetitive behaviors or mental acts called compulsions. Compulsions are often attempts to reduce distress, prevent a feared outcome, or make something feel complete. The relief is usually temporary, and the pattern can consume time and interfere with work, relationships, and daily responsibilities.

OCD is often missed when it is understood only as excessive cleanliness or orderliness. It may be treated as anxiety without the obsessional pattern being recognized. Intrusive thoughts can also be misunderstood as reflecting a patient’s desires or character, which can lead to shame and delayed care. A careful evaluation distinguishes unwanted obsessional thoughts from intent and considers the full clinical picture.

OCD Presentations Evaluated and Treated

Dr. Narlesky evaluates and treats a range of OCD presentations in adults, including:

• Contamination and washing — fears of contamination that lead to repeated washing, cleaning, or avoidance that disrupts daily life.
• Checking — recurring doubt about safety, mistakes, or responsibility that leads to repeated checking despite earlier attempts to resolve the concern.
• Symmetry and ordering — a distressing sense that objects or actions are uneven, incomplete, or not “just right,” leading to arranging or repeating.
• Intrusive or taboo thoughts — unwanted harm-related, sexual, or religious thoughts that provoke distress and may lead to avoidance, reassurance seeking, or mental rituals.
• Religious or moral scrupulosity — persistent fears of wrongdoing or violating religious beliefs, accompanied by compulsive prayer, confession, or checking that goes beyond ordinary religious practice.
• Primarily obsessional presentations — patterns in which compulsions are often less visible, including mental review, silent repetition, and attempts to neutralize unwanted thoughts.

These are patterns within OCD rather than separate diagnoses. Several can occur together, and the subject of the obsessions may change while the underlying cycle remains similar.

How Dr. Narlesky Approaches OCD Treatment in New Hampshire

An evaluation for OCD needs to account for symptoms that may never be visible during an appointment. A patient may describe constant anxiety without mentioning the repeated checking or mental rituals that take up much of the day. Understanding that pattern changes the treatment plan.

Matthew Narlesky, DO, is an ABPN board-certified psychiatrist, fellowship-trained at Dartmouth-Hitchcock. His evaluations allow time to understand how symptoms developed, how the patient responds to them, and where earlier treatment may have fallen short. A typical initial assessment includes:

• A detailed history of intrusive thoughts, doubts, urges, and repetitive behaviors, including when they began and what triggers them.
• Assessment of mental rituals, reassurance seeking, and avoidance that may have gone unrecognized in prior care.
• The time symptoms consume and their effects on work, relationships, sleep, and daily responsibilities.
• Distinguishing obsessional patterns from generalized anxiety and trauma-related symptoms, including whether more than one condition is present.
• Review of previous medication and psychotherapy, including doses, treatment duration, benefits, and side effects.
• Medical and family psychiatric history, current medications, mood symptoms, and safety considerations.

Exposure and response prevention, or ERP, is a specific form of cognitive behavioral therapy often found to be beneficial for OCD. This information is provided for general education. ERP isn’t something offered directly through this practice — the focus here is psychiatric evaluation and medication management, not standalone psychotherapy. Patients weighing how medication management and psychotherapy fit together can read about the difference between a psychiatrist and a therapist.

OCD Treatment

OCD medication management begins with the patient’s symptom pattern, medical history, prior treatment response, and preferences. Dr. Narlesky explains why a medication is being considered, what it targets, what side effects to watch for, and how progress will be assessed. Progress includes the time spent on rituals and the ability to carry out daily activities, alongside the patient’s level of distress.

Selective serotonin reuptake inhibitors, or SSRIs, are commonly used as first-line medications for OCD. The Cleveland Clinic notes that some patients may need higher SSRI doses than those typically used for depression, with response often assessed over 8 to 12 weeks. The appropriate dose and duration depend on the medication, tolerability, and clinical response. Dose changes are made under medical supervision, with follow-up to assess benefits and adverse effects.

When symptoms remain significant after an adequate treatment trial, the next step is a careful reassessment — reviewing the diagnosis, medication dose and duration, consistency of use, and whether ERP has been part of care. Some individuals may benefit from augmentation medications, considered based on individual response and clinical judgment; these decisions involve discussion of additional considerations, risks, and monitoring needs. Transcranial magnetic stimulation (TMS) is also FDA-cleared as an adjunctive treatment for adults with OCD who have not responded adequately to first-line treatment. This information is provided for general education; this practice does not provide TMS directly.

For more complex presentations, Dr. Narlesky also assesses whether the patient’s needs can be met through ongoing outpatient care or require a more intensive treatment setting.

When to Consider a Psychiatric Evaluation for OCD

Many adults seek an evaluation when:

• Intrusive thoughts or recurring doubts are difficult to disengage from and cause significant distress.
• Washing, checking, arranging, or mental rituals take increasing amounts of time.
• Avoidance or reassurance seeking begins to restrict work, relationships, or ordinary activities.
• Symptoms have been described as anxiety, but treatment has left the repetitive thought-and-ritual pattern largely unchanged.
• Psychotherapy has helped only partly, or a therapist recommends a medication evaluation.
• Prior medication treatment has not helped enough, has caused side effects, or has left questions about the diagnosis.

An established OCD diagnosis is not required before seeking an evaluation. Clarifying whether OCD explains the symptoms is part of the assessment.

What to Expect From a New Hampshire OCD Psychiatrist

The first appointment is typically 60 minutes, conducted through secure video. Patients must be adults 18 or older and physically located in New Hampshire at each visit. Dr. Narlesky reviews the history, evaluates current symptoms, and discusses clinical impressions, a working diagnosis, and initial treatment recommendations.

Follow-up visits include ongoing assessment, OCD medication management when appropriate, and discussion of changes in daily functioning. Early follow-up is typically within two to four weeks, with later visits guided by clinical need. Medication response, side effects, and coordination with an outside therapist help determine the next steps.

Who This Practice Serves

This practice provides ongoing outpatient psychiatric care for adults 18 and older located in New Hampshire. It is not equipped for acute psychiatric crises, frequent or recurring safety-related needs, inpatient or intensive outpatient-level care, benzodiazepine management, forensic or disability evaluations, standalone psychotherapy, or addiction treatment as a primary concern. Full details are available on the Disclaimer and FAQ pages.

If you’re in crisis, call or text 988, or call 911 or go to your nearest emergency room.

Accepting New Patients Across New Hampshire

New patient appointments are available on a rolling basis for adults seeking an OCD psychiatrist in New Hampshire. All appointments with Dr. Narlesky are virtual, providing access to psychiatric evaluation and ongoing care from anywhere within the state.

In-network with:
Anthem Blue Cross Blue Shield (NH) · Aetna · Cigna · Carelon Behavioral Health · Point32 Healthcare · Providence Health Plan.

An estimated session cost based on the patient’s insurance benefits will be provided before the first appointment.