Getting the Word Out About Obsessive-Compulsive Disorder (OCD): Robert Hudak, MD, on OCD Treatment and Education

Robert Hudak, MD (Professor of Psychiatry), is an expert on the clinical treatment of obsessive-compulsive disorder (OCD), a chronic, debilitating, and often misunderstood psychiatric disorder that is characterized by repetitive, compulsive behaviors, as well as obsessions.

Dr. Hudak is the psychiatrist at the UPMC Western Psychiatric Hospital (WPH) Center for Treatment of Obsessive-Compulsive Disorders Intensive Outpatient Program, a highly respected clinic that receives patient referrals from OCD experts nationwide. An award-winning teacher and mentor, Dr. Hudak developed the clerkship for the Obsessive-Compulsive Disorder Intensive Outpatient Resident Elective (the first of its kind at WPH), created an Outpatient OCD Resident Elective, and serves as course director for the General Anxiety Disorder and Obsessive-Compulsive and Related Disorders Combined Course for psychiatry residents. 

In addition to providing outstanding, expert clinical care for individuals with OCD and teaching the next generation of physicians, Dr. Hudak is dedicated to teaching mental health professionals and non-psychiatric physicians nationwide about treatment of the disorder.

What were some of your early experiences in the treatment of OCD and physician education?

Following residency, I worked at the Veterans Administration (VA) Medical Center, where it was my job to evaluate patients and refer them to outpatient clinics. I saw many veterans with OCD, but there was nowhere to send them. It became evident to me that psychiatrists were not receiving sufficient training to help individuals with this disorder. I saw pervasive misunderstanding of OCD, even among mental health professionals. In fact, at that time, it was a common belief that veterans don’t get OCD, which I knew was not true. So, I started a clinic. It was the first of its kind at any VA medical center. 

Later, when I joined WPH, the OCD program needed an attending physician, and I became medical director of the Center for Treatment of Obsessive-Compulsive and Related Disorders. From my very first days here, we received numerous referrals from outside WPH for patients who were described as experiencing treatment-resistant OCD. Typically, these individuals had been suffering for a long time with symptoms that had not improved. However, the vast majority of them had never been offered standard, evidenced-based care; their symptoms were never truly treatment resistant in the first place. We now know that 75% of people with OCD do not receive the correct diagnosis from a mental health professional, and when they do get a diagnosis of OCD, 80% of those patients are never offered evidence-based treatment. 

How did that early experience shape your focus at UPMC and the University of Pittsburgh?

The numbers are staggering, but seeing it firsthand really drove home the point: OCD patients do not get offered good treatment from the medical community at large. I realized that there was a marked education gap: most psychiatric residencies in the United States do not offer specialized training in OCD to their residents. Moreover, in non-psychiatric residencies, most physicians receive no exposure to OCD during their training, even though OCD and other OC-related disorders are common in the general population and frequently seen in the medical and primary care settings. The situation isn’t any better for psychologists, therapists, and other mental health professionals: virtually no graduate program in the United States teaches the first-line treatment for OCD—Exposure with Response Prevention, or ERP—as part of its curriculum. As a result, the rates of OCD diagnosis are far lower than we would expect, and only about 2% of patients with OCD have ever received ERP.

In general, psychiatry residents who want to learn how to diagnose and treat OCD properly, providing ERP in combination with medication, would have to seek training out on their own. I started the resident rotation in the OCD clinic—both intensive outpatient as well as standard outpatient—at WPH, which is one of the first of its kind in the nation. It gives psychiatric residents educational opportunities not typically available elsewhere. These rotations last 3-6 months, and I estimate that I have directly supervised close to 200 residents on OCD-specific clinical rotations during my time here.

It was because of these experiences that I decided to focus my career, in addition to caring for and treating people with OCD, on educating as many medical and mental health professionals as possible on OCD. 

Beyond resident education, how else do you get the word out?

I try to do this through lectures and classroom teachings, which I do nationally and internationally as often as I can. I have five grand rounds at departments of psychiatry around the United States coming up this year, as well as invitations to speak at national conferences. When asked, I have given resident lectures and didactics at other institutions. I take every opportunity to speak in front of audiences I have not spoken to before. In addition to mental health professionals, I have spoken to primary care physicians, emergency physicians, plastic and cosmetic surgeons, Ob/Gyns, dentists, and pharmacists. OCD is so common that every physician needs to understand it. 

I love to lecture and teach others about OCD; it is my favorite professional activity. When only a small minority of OCD patients receive appropriate care for this disorder, education of medical professionals must be part of the solution. I’ve made it my mission to educate the health care community and the public at large about OCD!

Thank you for speaking with us, Dr. Hudak!