OCD that has not responded to treatment, or that comes with something else, needs a different kind of care
I assess and treat complex obsessive-compulsive disorder at Queen Square, using all three treatment modalities, medication, exposure-based cognitive behavioural therapy and neuroscience-based treatments, and I research each of them.
Most OCD responds to standard treatment. Some does not, because it has become severe and long-standing, because first-line therapy and medication have been tried without enough benefit, or because it arrives with something else: tics or Tourette syndrome, body dysmorphic disorder, autism, ADHD, depression, or a neurological condition. This is complex OCD, and it is the whole focus of my practice. It is treatable, and the first step is finding out precisely what is going on.
Understanding complex OCDSources: ECA and NCS-R prevalence studies; Hollander et al. on treatment delay. From my Dean's Grand Rounds lecture to the Royal College of Psychiatrists, April 2026.
What I Can Do
Three things, in order
- I. Establish what is going on
- I begin with a full assessment: the history of your illness and of every treatment you have tried, the conditions that may sit alongside it, your physical and neurological health, and standardised measures of severity. It ends with a written opinion and a plan we agree together, which, with your agreement, I share with your GP and anyone already treating you.
- II. Treat it properly
- I use the three modalities, chosen and combined to fit: exposure-based CBT and habit reversal, which I deliver or direct as a medical psychotherapist; medication used to its full extent, including higher-dose serotonergic treatment, clomipramine and augmentation; and, for the small number of people whose illness has resisted all of these, assessment for neuroscience-based treatments such as deep brain stimulation.
- III. Get you to the right place
- Where more is needed than an outpatient practice can provide, I help you reach it: the nationally commissioned intensive and inpatient OCD services, my NHS Tourette syndrome and OCD clinic at Queen Square, or the multidisciplinary neuromodulation pathway at the National Hospital. I also provide second opinions to clinicians and services already involved in your care.
Who I See
- OCD that has not responded to treatment
- OCD with Tourette syndrome or tics
- Body dysmorphic disorder (BDD)
- OCD with autism, ADHD or depression
- OCD alongside a neurological condition
- Health anxiety, phobias & related disorders
- OCD requiring DBS suitability assessment
- OCD requiring DBS aftercare
- OCD requiring neurosurgery and aftercare
Being Seen
I see patients at Queen Square Private Consulting Rooms, in person or by video, from the age of thirteen. You can contact my secretary directly; referrals from GPs and specialists are also welcome. New appointment £500; follow-up £285. I am recognised by Bupa, AXA Health, Vitality, Aviva and Healix.
Private Secretary
020 8123 0234 ·
secretary@drhimanshutyagi.com
About Me
I am Dr Himanshu Tyagi, MBBS, MRCPsych, FRCPsych, PhD, a consultant neuropsychiatrist at the National Hospital for Neurology and Neurosurgery, Queen Square, and a medical psychotherapist with a CCT in cognitive behavioural therapy. I lead the specialist Tourette syndrome and OCD stream of the national adult Tourette service, coordinated the UK's first randomised trial of deep brain stimulation for OCD, and co-founded the Royal College of Psychiatrists' network for obsessive-compulsive and related disorders. My research on the brain circuits of OCD continues at the UCL Queen Square Institute of Neurology.
More about me