Obsessive-Compulsive Disorder Differential Diagnoses
- Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD more...
The most common medical pitfall in the treatment of OCD is a failure to make the diagnosis. Clinicians should be familiar with the diagnostic criteria and consider OCD in their differential when evaluating tics, mood and anxiety disorders, or other compulsive behaviors, such as trichotillomania or neurodermatitis.
Another common pitfall is the failure to identify the comorbid diagnoses frequently encountered in patients with OCD. These can include the following:
Major depressive disorder (30-70%)
Panic disorder (14%, 35% lifetime incidence)
Body dysmorphic disorder (14.5%)
Generalized anxiety disorder (20%)
Social phobia and simple phobia (24%)
Tourette syndrome (5-7%)
Other tic disorders (20-30%)
Identification of these diagnoses guides treatment interventions and identifies patients who are at higher risk for suicide or self-harm. Not surprisingly, patients with OCD have a significant risk for suicide, which increases with the severity of symptoms and the number of concurrent psychiatric diagnoses.
Persons with OCD often do not seek treatment. Many individuals with OCD delay for years before obtaining an evaluation for obsessive-compulsive (OC) symptoms. Patients with OCD often feel shame regarding their symptoms and put great effort into concealing them from family, friends, and health care providers.
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|Obsessions||Commonly Associated Compulsions|
|Fear of contamination||Washing, cleaning|
|Need for symmetry, precise arranging||Ordering, arranging, balancing, straightening until "just right"|
|Unwanted sexual or aggressive thoughts or images||Checking, praying, “undoing” actions, asking for reassurance|
|Doubts (eg, gas jets off, doors locked)||Repeated checking behaviors|
|Concerns about throwing away something valuable||Hoarding|