Disorders Related to (and sometimes confused with) OCD

One of the stumbling blocks to accessing effective treatment for individuals with OCD is that OCD can sometimes be confused with other disorders. The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — which mental health professionals use to help diagnose mental health disorders — in fact, groups together these “related disorders” in the same chapter. While some disorders can have overlapping symptoms with each other, being diagnosed with the right disorder has incredibly important implications for treatment, and therefore it is important to make sure you receive the right diagnosis. For example, a sprained ankle is treated differently than a broken ankle. Even similar disorders can have very different treatments. And providing the wrong treatment for someone can result in extended, unnecessary suffering, wasted time, wasted resources, and potentially feeling hopeless about getting better.

Below is a list of disorders grouped together in a “chapter” in the DSM-5 because they share some common characteristics, but can also be differentiated in predictable ways. These are all referred to as Obsessive Compulsive Related Disorders or OC Related Disorders (they are also sometimes called OC Spectrum Disorders):

Related Disorder

How This Disorder “Looks Like” OCD

How This Disorder Differs from OCD

Hoarding Disorder

To learn more:

“Compulsive Collecting” has up until recently been considered a sub type of OCD. Hoarding behavior is similar to OCD in that some individuals with OCD also spend a great deal of time preoccupied with arranging, ordering and/or collecting items. People with Hoarding Disorder:

  • Don’t see a problem with their excessive collecting.
  • Don’t respond well to traditional OCD treatments such as Exposure and Response Prevention (ERP) or anxiety-based treatment approaches.

People with OCD:

  • Don’t want to engage in their compulsive behavior.

Body Dysmorphic Disorder (BDD)

To learn more:

People with BDD and people with OCD both:

  • Do repetitive checking.
People with BDD:

  • Have checking behaviors and obsessions that only focus on their body or the way they look. Are very likely to seek cosmetic surgery.

People with OCD:

  • Do not usually have thoughts or behaviors that focus on the way they look.

Body Focused Repetitive Behaviors (BFRBs) 

(Trichotillomania / Hair-pulling Disorder and Skin-picking / Dermotillomania / Excoriation Disorder)

To learn more:

People with BFRBs and people with OCD both:

  • Do repetitive behaviors.
  • Do repetitive behaviors in response to feeling uncomfortable.
People with BFRBs:

  • Get a good feeling from pulling out their body hair or picking at skin; some use it to relieve stress.
  • Respond better to habit reversal and to different medicines then people with OCD.

People with OCD:

  • Repeat their behaviors to get away from bad feelings like anxiety.

In 1998, Dr. Susan Swedo identified a subtype of OCD in kids which she referred to as PANDAS. The importance of this observation is that these children tend to show OCD symptoms in a more extreme way and need medical attention in addition to psychological help. It is important, in cases where a child shows OCD symptoms “seemingly overnight” and with a severe onset, that they be evaluated by their pediatrician as soon as possible.

Related Disorder

How This Disorder “Looks Like” OCD

How This Disorder Differs from OCD

PANDAS / PANS 

(Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) / (Pediatric Acute-onset Neuropsychiatric
Syndrome)

To learn more:

Children and teens with OCD and PANDAS/PANS both:

  • Experience typical obsessions (fear of contamination; fear of harm; over responsibility, etc.)
  • Experience common compulsions (excessive checking, washing and/or cleaning, or reassurance seeking, etc.)
Children with OCD:

  • Typically see first onset between 8–12 years old, and symptoms become gradually more severe over time.

While PANDAS/PANS:

  • Typically affects children between 4–14 years old, with acute (sudden), dramatic onset of symptoms.

Additionally, children with PANDAS/PANS will show additional symptoms not typically seen in kids with OCD including:

  • Severe separation anxiety
  • Anorexia or disordered eating
  • Urinary frequency
  • Tics and/or purposeless motor movements
  • Acute handwriting difficulty

In addition to the Related Disorders there are some additional disorders that are commonly confused with OCD. These disorders show some common characteristics and overlapping features, but can also be distinguished from OCD and one another by a well-trained mental health provider. These disorders include:

Similar Disorder

How This Disorder “Looks Like” OCD

How This Disorder Differs from OCD

Tic Disorders/Tourette Syndrome

To learn more:

People with Tics/Tourette Syndrome and people with OCD both:

  • Repeat physical behaviors like eye-blinking touching or tapping. Repeat vocal behaviors like clearing their throat.
People with Tics or Tourette Syndrome:

  • Do their tics because they have a sense of discomfort or need to feel “just right”.
  • Respond better to habit reversal and to different medicines than people with OCD.

People with OCD:

  • Do their repetitive behaviors in response to an obsession (thought or image).

Impulse Control Disorders

(addictions to gambling, sexual activity, excessive shopping)

To learn more:

People with Impulse Control Disorders and people with OCD both may have:

  • Strong urges to repeat certain behaviors
  • Attention problems
People with Impulse Control Disorders:

  • Repeat their behaviors as a way to increase good feelings like arousal or excitement and engage in risky behaviors.

People with OCD:

  • Repeat their behaviors to get away from bad feelings like anxiety and tend to go out of their way to avoid risk.

Obsessive Compulsive Personality Disorder (OCPD)

To learn more:

People with OCPD and people with OCD both have problems with:

  • Making excessive lists
  • Perfectionism
People with OCPD:

  • Have problems finishing tasks because of their preoccupation with perfectionism.
  • Don’t see a problem with their “symptoms”

People with OCD:

  • Do not always have perfectionism problems.
  • Do not like their OCD “symptoms”

Autism Spectrum Disorders

To learn more:

People with Autism Spectrum Disorders and people with OCD all may have:

  • “Stereotyped” behaviors like following rigid routines, an “obsessive” interest in something
People with Autism Spectrum Disorders:

  • Usually have thoughts and behaviors that only focus on repeating things.
  • Don’t try to prevent their thoughts.
  • Have severe problems with social interactions

People with OCD:

  • Usually have thoughts and behaviors that focus on contamination violent/sexual themes checking, etc.
  • Try to stop their bad thoughts from happening

Psychotic Disorders/ Schizophrenia

People with Psychotic Disorders/Schizophrenia and people with OCD both may have:

  • Strange or bizarre thoughts. Thoughts that include sexual violent or religious themes
People with Psychotic Disorders/Schizophrenia:

  • Have delusions. Their thoughts aren’t based in reality but the person believes the thoughts to be true.

People with OCD:

  • Usually know that their obsessive thoughts don’t make sense even if they respond to them as though they are “true.”
  • Can stay in touch with reality in all other areas of their lives.