Obsessive-Compulsive Disorder Differential Diagnoses

  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Dec 29, 2011
 
 

Diagnostic Considerations

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%)
  • ADHD
  • Tourette syndrome (5-7%)
  • Other tic disorders (20-30%)
  • Trichotillomania
  • Neurodermatitis
  • Idiopathic torticollis
  • Substance abuse
  • Eating disorders

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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Contributor Information and Disclosures
Author

William M Greenberg, MD  Director, Clinical Development, Forest Research Institute, Forest Laboratories, Inc; Visiting Scientist, Nathan S Kline Institute for Psychiatric Research; Private Practice

William M Greenberg, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Forest Laboratories, Inc. Salary Employment

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

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Table. Categorizing Obsessions and Compulsions
Obsessions Commonly Associated Compulsions
Fear of contaminationWashing, cleaning
Need for symmetry, precise arrangingOrdering, arranging, balancing, straightening until "just right"
Unwanted sexual or aggressive thoughts or imagesChecking, praying, “undoing” actions, asking for reassurance
Doubts (eg, gas jets off, doors locked)Repeated checking behaviors
Concerns about throwing away something valuableHoarding
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