Differentials
Obsessive-compulsive personality disorder (OCPD)
SIGNS / SYMPTOMS
More predominant among males; characterised by preoccupation with orderliness, details, rules, organisation, or schedules, to the degree that the point of the activity is lost.
Perfectionism, hoarding, workaholism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.
Absence of obsessions and compulsions in OCPD. May involve discomfort if things are sensed not to have been done completely.[43]
The greater discomfort (alterations in anxiety or affect) associated with OCD seems to be the clinical factor that best distinguishes between the two disorders.
Insight into behaviour or symptoms usually absent.
INVESTIGATIONS
History is used to distinguish OCPD from OCD.
Assessment of OCPD may be conducted through structured interviews for diagnosis such as the Structured Clinical Interview for DSM-II (SCID-II), the Diagnostic Interview for Personality Disorders (DIPD), and the Structured Interview for DSM-III Personality Disorders (SIDP).[44][45]
Clinically, the ego-dystonic nature of obsessions may also distinguish obsessions from the ego-syntonic traits of OCPD.
Body dysmorphic disorder (BDD)
SIGNS / SYMPTOMS
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.[1] Excessive repetitive behaviours or mental acts are performed in response to this preoccupation.[1]
INVESTIGATIONS
Separate diagnosis of OCD should be made only when the obsessions or compulsions are not restricted to concerns about appearance.[1]
Somatic symptom disorder
SIGNS / SYMPTOMS
Excessive thoughts, feelings, or behaviours related to somatic symptoms or associated health concerns.[1]
INVESTIGATIONS
Recurrent ideas about somatic symptoms or illness are less intrusive than in OCD, and individuals do not perform the associated repetitive behaviours aimed at reducing anxiety that occur in OCD.[1]
Illness anxiety disorder (hypochondriasis)
SIGNS / SYMPTOMS
Preoccupation with having or acquiring serious illness. Individual performs excessive health-related behaviours, such as repeatedly checking for signs of illness, or demonstrates maladaptive avoidance, such as avoiding medical appointments.[1]
INVESTIGATIONS
Preoccupations in illness anxiety disorder are focused on having a disease, whereas in OCD, the thoughts are intrusive and are usually focused on fears of getting a disease in the future. Individuals with OCD will likely have other concerns in addition to those about contracting disease.[1]
Delusional disorder
SIGNS / SYMPTOMS
False belief that is firmly sustained and based on incorrect inference about reality; compulsions may be absent.[46]
INVESTIGATIONS
OCD can share features with delusional disorders, such as magic thinking; in fact, it has also been conceptualised by cognitive theories as a form of belief disorder similar to a delusion or an overvalued idea that is a product of distorted reasoning processes.[47]
Severe social phobia
SIGNS / SYMPTOMS
Can mimic the anxiety related to OCD.
INVESTIGATIONS
None.
Panic disorder
SIGNS / SYMPTOMS
Can mimic the anxiety related to OCD.
INVESTIGATIONS
None.
Autism spectrum disorder (including Asperger's syndrome)
SIGNS / SYMPTOMS
Impaired social communication and social interaction with restricted and repetitive patterns of behaviour, interests, or activities.
Symptoms are present in the early developmental period and are not better explained by intellectual development disorder or global developmental delay.[1]
INVESTIGATIONS
In OCD, compulsions are typically performed in response to intrusive thoughts about contamination, organisation, or sexual or religious themes. In autism spectrum disorder, repetitive behaviours classically include more stereotyped motor behaviours or insistence on routines, which may be perceived as pleasurable and reinforcing.[1]
Hoarding disorder
SIGNS / SYMPTOMS
Persistent difficulty in discarding or parting with possessions, regardless of actual value, due to perceived need to save items and distress associated with discarding them.[1]
INVESTIGATIONS
In OCD, excessive acquisition is usually not present. If it is present, accumulated items are typically more unusual, such as fingernail cuttings and hair. Accumulation of these sort of items is very uncommon in hoarding disorder.
A dual diagnosis of OCD and hoarding disorder may be made if severe hoarding appears concurrently with other typical symptoms of OCD but is judged to be independent from these symptoms.[1]
Trichotillomania (hair-pulling disorder)
Excoriation (skin-picking) disorder
Substance-/medication-induced obsessive-compulsive or related disorder
SIGNS / SYMPTOMS
Symptoms of an obsessive-compulsive or related disorder, such as obsessions, compulsions, skin picking, and hair pulling predominate. Symptoms are attributable to effects of medication or drug of abuse, and develop during or soon after substance intoxication or withdrawal or after exposure to substance. Substance must be capable of reproducing symptoms.[1]
INVESTIGATIONS
Substance/medication-induced obsessive-compulsive and related disorder arises only in association with intoxication, whereas a primary obsessive-compulsive and related disorder may precede the onset of substance/medication use.[1]
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