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.

Workup

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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

Obsessive-Compulsive Disorder Differential Diagnoses

Diagnostic Considerations

References

Tables

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