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For health professionals
OCD: Differential diagnosis and screening questions
Differential diagnosis
- The main differential diagnosis is depression and many patients with OCD have comorbid depressive symptoms.
- Other differentials include phobic disorders, anorexia nervosa, obsessive or anakastic personality and occasionally schizophrenia.
- The symptoms of OCD are seen in other conditions such as Tourette's syndrome, autism and frontal lobe lesions.
- Obsessive-compulsive-related disorders (OCRD) and a range of disorders which share characteristics with OCD (e.g. in symptom profile, biology and treatment outcome).
- OCRDs include body dysmorphic disorder (BDD - concerns of imagined ugliness), hypochondriasis (concerns about imagined illness), eating disorders and impulse control disorders such as trichotillomania (hair pulling).
Screening questions for OCD1
- Do you have frequent unwanted thoughts that seem uncontrollable?
- Do you try to get rid of these thoughts and, if so, what do you do?
- Do you have rituals or repetitive behaviours that take a lot of time in a day?
- Do you wash or clean a lot?
- Do you keep checking things over and over again?
- Are you concerned with symmetry and putting things in order?
- Do your daily activities take a long time to complete?
- Do these problems trouble you?
- Does this behaviour make sense to you?
Non-psychiatrists who may be referred patients with OCD
Professional |
Reason for consultation |
| GP | Anxiety, depression |
| Dermatologist | Chapped hands, eczema, trichotillomania |
| Cosmetic surgeon | Concerns about appearance |
| Oncologist | Fear of cancer |
| Genitourinary specialist | Fear of HIV |
| Neurologist | OCD associated with Tourette's syndrome |
| Obstetrician | OCD in pregnancy |
| Gynaecologist | Vaginal discomfort from douching |
1 These screening questions were compiled from the following articles:
- El-Sayegh S, Bea S and Agelopoulos A. "Obsessive Compulsive Disorder: Unearthing a hidden problem". Cleveland Clinic Journal of Medicine (2003) 70, Number 10: 824-840.
- National Collaborating Centre for Mental Health commissioned by the National Institute for Health and Clinical Excellence. "Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder". National Clinical Practice Guideline, Number 31. Published by The British Psychological Society and The Royal College of Psychiatrists, Jan 2006.
- Heyman I, Mataix-Cols D, Fineburg N A. "Obsessive-compulsive disorder". BMJ (2006), 333: 424-429.
What is obsessive-compulsive disorder?
Differential diagnosis and suggested screening questions
