Medscape is available in 5 Language Editions – Choose your Edition here.


Obsessive-Compulsive Disorder Differential Diagnoses

  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
Updated: Apr 19, 2016

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.

Contributor Information and Disclosures

William M Greenberg, MD Medical Director, Mental Health Association of Rockland County; Professor, St George's University School of Medicine; Private Practice

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

Disclosure: Nothing to disclose.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

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

Disclosure: Nothing to disclose.


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

  1. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988 Dec. 45(12):1094-9. [Medline].

  2. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989 Nov. 46(11):1006-11. [Medline].

  3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

  4. Pepper J, Hariz M, Zrinzo L. Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature. J Neurosurg. 2015 May. 122 (5):1028-37. [Medline].

  5. Andrade C. Ondansetron augmentation of serotonin reuptake inhibitors as a treatment strategy in obsessive-compulsive disorder. J Clin Psychiatry. 2015 Jan. 76 (1):e72-5. [Medline].

  6. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial. Biol Psychiatry. 2005 Sep 1. 58(5):424-8. [Medline].

  7. Greenberg WM, Benedict MM, Doerfer J, Perrin M, Panek L, Cleveland WL, et al. Adjunctive glycine in the treatment of obsessive-compulsive disorder in adults. J Psychiatr Res. 2009 Mar. 43(6):664-70. [Medline].

  8. Haghighi M, Jahangard L, Mohammad-Beigi H, Bajoghli H, Hafezian H, Rahimi A, et al. In a double-blind, randomized and placebo-controlled trial, adjuvant memantine improved symptoms in inpatients suffering from refractory obsessive-compulsive disorders (OCD). Psychopharmacology (Berl). 2013 Mar 23. [Medline].

  9. Ghaleiha A, Entezari N, Modabbernia A, Najand B, Askari N, Tabrizi M, et al. Memantine add-on in moderate to severe obsessive-compulsive disorder: randomized double-blind placebo-controlled study. J Psychiatr Res. 2013 Feb. 47(2):175-80. [Medline].

  10. Rodriguez CI, Kegeles LS, Levinson A, Feng T, Marcus SM, Vermes D, et al. Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept. Neuropsychopharmacology. 2013 Jun 19. [Medline].

  11. Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006 Nov. 31(11):2384-93. [Medline].

  12. Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008 Nov 13. 359(20):2121-34. [Medline].

  13. Jung HH, Kim CH, Chang JH, Park YG, Chung SS, Chang JW. Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results. Stereotact Funct Neurosurg. 2006. 84(4):184-9. [Medline].

  14. Stetka B, Correll, C. A Guide to DSM-5: Hoarding, Skin-Picking, and Rethinking OCD. Available. Medscape Medical News. Available at Accessed: July 1, 2013.

  15. APA. Obsessive-Compulsive and Related Disorders. Available at Accessed: July 1, 2013.

  16. Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Arch Gen Psychiatry. 1995 Jan. 52(1):53-60. [Medline].

  17. Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology (Berl). 1998 Apr. 136(3):205-16. [Medline].

  18. Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006 Jul. 11(7):622-32. [Medline].

  19. Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992 Sep. 49(9):681-9. [Medline].

  20. Pittenger C, Krystal JH, Coric V. Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder. NeuroRx. 2006 Jan. 3(1):69-81. [Medline].

  21. Wu K, Hanna GL, Rosenberg DR, Arnold PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol Biochem Behav. 2012 Feb. 100(4):726-35. [Medline]. [Full Text].

  22. van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Twin studies on obsessive-compulsive disorder: a review. Twin Res Hum Genet. 2005 Oct. 8(5):450-8. [Medline].

  23. Carey G, Gottesman I. Twin and family studies of anxiety, phobic, and obsessive disorders. Klein DF, Rabkin JG. Anxiety: New Research and Changing Concepts. New York: Raven Press; 2000.

  24. Arnold PD, Rosenberg DR, Mundo E, Tharmalingam S, Kennedy JL, Richter MA. Association of a glutamate (NMDA) subunit receptor gene (GRIN2B) with obessive-compulsive disorder: a preliminary study. Psychopharmacology. August 2004. 174:530-538.

  25. Arnold PD, Sicard T, Burroughs E, Richter MA, Kennedy JL. Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Jul. 63(7):769-76. [Medline].

  26. Denys D, Van Nieuwerburgh F, Deforce D, Westenberg H. Association between the dopamine D2 receptor TaqI A2 allele and low activity COMT allele with obsessive-compulsive disorder in males. Eur Neuropsychopharmacol. 2006 Aug. 16(6):446-50. [Medline].

  27. Dickel DE, Veenstra-VanderWeele J, Cox NJ, Wu X, Fischer DJ, Van Etten-Lee M, et al. Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Jul. 63(7):778-85. [Medline].

  28. Lin PY. Meta-analysis of the association of serotonin transporter gene polymorphism with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Apr 13. 31(3):683-9. [Medline].

  29. Rapoport JL. The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. paperback. New York: Penguin Putnam; 2001.

  30. [Guideline] American Psychiatric Association Work Group on Obsessive-Compulsive Disorder. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. July 2007. 164(suppl):1-56. [Full Text].

  31. Foa EB, Wilson R. Stop Obsessing!: How to Overcome Your Obsessions and Compulsions. Revis ed. New York: Bantam Dell; 2001.

  32. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders - Patient Edition (SCID-I/P, 11/2002 revision). New York: Biometrics Research Department, New York State Psychiatric Institute; November 2002.

  33. Berlin HA, Koran LM, Jenike MA, et al. Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2011 May. 72(5):716-21. [Medline].

  34. Simpson HB, Wetterneck CT, Cahill SP, Steinglass JE, Franklin ME, Leonard RC, et al. Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cogn Behav Ther. 2013 Mar. 42(1):64-76. [Medline].

  35. Grayson J. Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty. New York: Berkley Publishing Group; 2004.

  36. Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc. August, 2011. Available at [Full Text].

  37. US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. Available at Accessed: August 24, 2011.

  38. Komossa K, Depping AM, Meyer M, Kissling W, Leucht S. Second-generation antipsychotics for obsessive compulsive disorder. Cochrane Database Syst Rev. 2010 Dec 8. 12:CD008141. [Medline].

  39. FDA Public Health Advisory: Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. FDA Website. October 15, 2004. 1-3. [Full Text].

  40. FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications. FDA Website. May 2, 2007. 1-3. [Full Text].

  41. A Message From APA President Dilip Jeste, M.D., on DSM-5. Available at Accessed: December 1, 2012.

  42. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  43. Bartz JA, Hollander E. Is obsessive-compulsive disorder an anxiety disorder?. Prog Neuropsychopharmacol Biol Psychiatry. 2006 May. 30(3):338-52. [Medline].

  44. Bienvenu OJ, Samuels JF, Wuyek LA, Liang KY, Wang Y, Grados MA, et al. Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med. 2012 Jan. 42(1):1-13. [Medline].

  45. Brooks M. Adjunctive CBT First Choice for Refractory OCD. Medscape Medical News. Sep 11 2013. [Full Text].

  46. Castle DJ, Phillips KA. Obsessive-compulsive spectrum of disorders: a defensible construct?. Aust N Z J Psychiatry. 2006 Feb. 40(2):114-20. [Medline]. [Full Text].

  47. Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E. Epidemiologic and clinical updates on impulse control disorders: a critical review. Eur Arch Psychiatry Clin Neurosci. 2006 Dec. 256(8):464-75. [Medline]. [Full Text].

  48. Melville NA. CBT beats adjunctive antipsychotic for refractory OCD. Medscape Medical News. April 11, 2013. [Full Text].

  49. Simpson HB, Foa EB, Liebowitz MR, et al. Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Sep 11 2013. [Medline].

Table. Categorizing Obsessions and Compulsions
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
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.