Understanding OCD in Kids and Teens: A Conversation with Dr. Justin Mohatt

"OCD is really good at finding the weak link."

In this episode, Kaila and Dr. Sir talk with Harvard-trained child psychiatrist Dr. Justin Mohatt, a national voice on psychopharmacology in children and behavioral health design architecture for children's hospitals.

We open on the broader crisis of youth social disconnection before diving in. We explore how OCD differs from OCPD and casual "I'm so OCD" talk. Dr. Mohatt explains how symptoms shift between kids and adults and why family accommodation can quietly escalate a two-hour bedtime ritual into a household crisis. Dr. Mohatt walks through why reassurance backfires, what gold-standard treatment (ERP plus medication) actually looks like for OCD, why OCD often needs higher SSRI doses than depression, and when to consider augmenting with an atypical antipsychotic for challenging OCD cases. We close on comorbidity, suicide risk, and why careful, specialized assessment matters so much.

Dr. Mohatt's website: https://www.empirebehavioralhealth.com/justinmohatt

0:00 Cold open: how parental accommodation fuels OCD
1:51 Welcome back + introducing Dr. Justin Mohatt
2:55 Icebreaker: the youth social disconnection crisis
9:14 Bridging into OCD: why this is "a therapy generation"
10:57 Dr. Mohatt's path from sports medicine to child psychiatry
16:04 What pulled him into specializing in OCD
22:34 OCD myths: OCD vs. OCPD, and "I'm so OCD"
25:23 How OCD presents differently in kids vs. adults
33:07 Family systems, accommodation, and how OCD finds the "weak link"
39:12 Why reassurance backfires — and what to do instead
47:29 The gold-standard treatment landscape: therapy and medication
51:08 Medication dosing: why OCD needs higher doses and more time
57:52 Building a true multidisciplinary care team
1:00:24 When to add atypical antipsychotics
1:05:44 OCD, depression, and the real suicide risk
1:10:22 Closing thoughts and where to find Dr. Mohatt

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The contents of this show are for informational and educational purposes only and are not intended to replace professional medical or clinical advice. This content does not establish a patient-provider relationship. Always seek the guidance of a qualified healthcare provider for any questions regarding your health or treatment. If you are experiencing a psychiatric emergency, please call emergency services or go to your nearest hospital immediately.

Gender-affirming care is life saving care. In this episode of Mind Meets Medicine, Kaila and Dr. Sir welcome Dr. Cassy Friedrich—a double board-certified family medicine and psychiatry physician who has spent their career providing gender-affirming care, from student-run free clinics at UC Davis to directing a gender-affirming care program across dozens of Planned Parenthood clinics.

Dr. Friedrich walks through what this care actually involves: creating welcoming clinical environments, respecting chosen names and pronouns, and the medical side of hormone therapy. They offer an accessible overview of estrogen-based and testosterone-based protocols, non-binary embodiment goals, and how they tailor treatment to each patient's goals along with the practical realities of monitoring, side effects, and the risks of unmonitored access.

The conversation doesn't shy away from the current climate. Dr. Friedrich discusses federal and state efforts to restrict access, hospital program closures, and the confusion that leaves many patients believing hat their care is no longer covered. They share sobering data from The Trevor Project.

Throughout, they bring both clinical expertise and deep compassion, describing patients whose lifelong anxiety lifted after starting hormones and teens whose lives were saved once they received the care they needed. The three also explore how to talk with hesitant families, the role of puberty blockers, the history of pathology in psychiatry, WPATH standards, the evolving practice of letter writing, and simple ways any clinic can become more affirming.

Whether you're a clinician, a parent, or someone seeking to understand this care more deeply, this episode offers a grounded, humane, and evidence-based look at work that is genuinely lifesaving.

https://lgbtqhealthcaredirectory.org/provider/cassy-friedrich

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00:00 Intro & Meet Dr. Cassy Friedrich
02:38 Finding This Work: Free Clinics & Planned Parenthood
04:20 The Rare Family Medicine + Psychiatry Path
07:34 What Gender-Affirming Care Actually Means
10:31 The Current Political & Legal Landscape
15:00 The Age 19 Cutoff & Access in California
18:06 The Data: Access, Suicide Risk & Anti-Trans Legislation
20:28 Talking to Hesitant Families & Believing Kids
24:15 Gender Dysphoria, Diagnosis & Mental Health Outcomes
33:30 Hormone Therapy: A Medical Overview
40:39 Monitoring, Side Effects & Unmonitored Access
48:02 Letter Writing, WPATH & the History of Pathologization
01:00:06 Creating Affirming Clinical Spaces

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The contents of this show are for informational and educational purposes only and are not intended to replace professional medical or clinical advice. This content does not establish a patient-provider relationship. Always seek the guidance of a qualified healthcare provider for any questions regarding your health or treatment. If you are experiencing a psychiatric emergency, please call emergency services or go to your nearest hospital immediately.

"Their gender is their gender... we just legitimize it medically and psychologically for them to receive care, but they're not attached to the diagnosis. They get attached to themselves."

In this episode, Kaila and Dr. Sir sit down with Sean Garcia, LMFT, a South Bay therapist specializing in gender-affirming care and neurodivergence. We open by talking honestly about the weight clinicians are carrying right now — political shifts, legal rollbacks on trans healthcare, and the unique isolation of holding space for patients while managing your own distress in real time.

Sean walks us through his path from psychology to "high tech" and back into psychotherapy work, and how his work organically became centered on trans clients. Unexpectedly, he focused on the striking overlap between neurodivergence and gender identity. We dig into what that means day to day: masking two identities at once, the exhaustion of constant self-monitoring, decision fatigue, and why so many neurodivergent and trans kids struggle in academic environments not built for them.

We talk through the high-stakes territory of college transitions, the shift from parent-as-advocate to young-adult independence, and the real danger of over-pathologizing kids with diagnosis after diagnosis. Sean unpacks how he supports parents who are scared, resistant, or grieving — including honest psychoeducation around hormone therapy and puberty blockers.

The heart of the episode: family support. Sean tells us this is the true gold standard of gender-affirming care. We close on the grief that runs through this entire journey for patients and parents alike, and how Sean built a thriving support community for families navigating it together.

Find Sean: https://seangarciatherapy.com/

0:00open: gender dysphoria as diagnosis, not identity

1:54 Introducing Sean Garcia + icebreaker on his caseload

5:38 Holding heaviness: political climate and clinician burnout

13:43 Sean's path into gender-affirming and neurodivergent care

19:53 Living in a world not built for neurodivergent, trans people

25:45 The daily toll: masking, vigilance, and decision fatigue

33:14 Navigating college and the shift to independence

41:10 Over-pathologizing vs. why gender dysphoria is a diagnosis, not an identity

49:54 Talking to resistant parents and debunking HRT fears

59:31 Family support as the gold standard, grief, and Sean's support group

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The contents of this show are for informational and educational purposes only and are not intended to replace professional medical or clinical advice. This content does not establish a patient-provider relationship. Always seek the guidance of a qualified healthcare provider for any questions regarding your health or treatment. If you are experiencing a psychiatric emergency, please call emergency services or go to your nearest hospital immediately.