Differential Diagnosis of Obsessive Compulsive Disorder

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A. Substance-Induced Anxiety Disorder or Anxiety Disorder Due to a Medical Condition. Amphetamines, cocaine, caffeine and other symptomatic agents may mimic some of the anxiety symptoms associated with OCD. On rare occasions a brain tumor or temporal lobe epilepsy can manifest with OCD symptoms.

B. Major Depressive Disorder. Major depression may be associated with severe obsessive ruminations (eg, obsessive rumination about finances or a relationship). These obsessive thoughts are usually not associated with compulsive behaviors and are accompanied by other symptoms of depression.

C. Generalized Anxiety Disorder. In GAD, obsessive worries are about real life situations; however, in OCD, obsessions usually do not involve real life situations.

D. Specific or Social Phobia, Body Dysmorphic Disorder or Trichotillomania. Recurrent thoughts, behaviors or impulses may occur in these disorders. OCD should not be diagnosed if symptoms are caused by another psychiatric condition (eg, hair pulling in trichotillomania).

E. Schizophrenia. Patients with schizophrenia may have obsessive thoughts or compulsive behaviors; however, schizophrenia is associated with frank hallucinations and delusions.

F. Obsessive-Compulsive Personality Disorder (OCPD). Individuals with OCPD are preoccupied with perfectionism, order, and control, and they do not believe that their behavior is abnormal. They do not exhibit obsessions or compulsions.

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