Disorders That May Co-exist with OCD

When two diagnoses occur in the same individual, they’re referred to as “comorbid” disorders.  According to the most recent, large-scale community study of mental health in adults across the United States, 90% of the adults who reported OCD at some point in their lives also had at least one other comorbid condition, including anxiety, mood, AD/HD, oppositional-defiant, and substance use disorders.  A trained mental health professional can diagnose and provide appropriate treatment for these conditions as well as OCD.

Following are some of the disorders that are frequently comorbid with OCD (descriptions of the disorders are based upon information provided in the DSM-5):

ANXIETY DISORDERS.  Anxiety disorders that may occur with OCD include Separation Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder (panic attacks), Social Anxiety Disorder and Specific Phobias, such as fear of snakes or heights. All of these disorders share features of excessive fear and anxiety as well as related behavioral disturbances.  But because each disorder is different, symptoms can be quite varied. 

MAJOR DEPRESSIVE DISORDER.  Symptoms of depression may include a persistent, sad, empty or hopeless mood, loss of interest in usually pleasurable activities (such as sports, hobbies, or sex), decreased energy, difficulty concentrating, insomnia or oversleeping, irritability, weight gain or loss, and thoughts of death or suicide.  Symptoms must be present for at least a 2-week period and represent a change from previous functioning.

BIPOLAR DISORDERS.  Bipolar disorders are marked by extreme changes in mood, thought, energy and behavior.  Bipolar I Disorder is characterized by the presence of a manic episode (abnormally elevated or irritable mood and increased energy lasting for at least 1 week).  Bipolar II Disorder involves the presence of both a hypomanic episode (elevated mood and energy lasting for 4 consecutive days; episode is not severe enough to cause marked impairment in functioning) and a major depressive episode.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (AD/HD).  There are three types of AD/HD: (1) Predominantly inattentive presentation; (2) Predominantly hyperactive/impulsive presentation; and (3) Combined presentation.  Criteria for AD/HD require that some symptoms of AD/HD be present before the age of 12 and that several symptoms be present in two or more settings (e.g. home, school, work).

FEEDING/EATING DISORDERS.  These disorders involve serious disturbances in eating or eating-related behaviors.  They include anorexia nervosa: a persistent limiting of food intake that leads to significantly low body weight, fear of gaining weight (or behavior that interferes with weight gain), and a disturbance in self-perceived weight or shape; bulimia nervosa: binge eating with compensatory behavior such as self-induced vomiting, misuse of laxatives, excessive exercising, and self-evaluation overly influenced by body shape and weight; and binge-eating disorder: recurrent overeating that is not accompanied by compensatory behavior.

AUTISM SPECTRUM DISORDER (ASD).  People with ASD have difficulties with social communication and social interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities; these symptoms cause significant impairment in functioning.  Although symptoms must be present in the early developmental period, they may not become fully manifest until later in life. ASD is categorized by severity levels, based upon the amount of support needed due to challenges with social communication and restricted interests and repetitive behaviors.

TIC DISORDERS/TOURETTE SYNDROME (TS).  Tics are sudden, rapid, recurrent, nonrhythmic motor movements (such as blinking, shrugging shoulders) or vocalizations (such as sniffing or grunting).  Persistent (Chronic) Motor or Vocal Tic Disorder involves either motor or vocal tics only.  TS involves both motor and vocal tics that have been present for more than a year.  Symptoms occur prior to 18 years of age in tic disorders and TS.  

Several disorders that tend to co-exist with OCD share many similarities with OCD and are listed in same DSM-5 category as OCD: OCD and Related Disorders.  These conditions should also be treated by a qualified mental health therapist.  They include:

BODY DYSMORPHIC DISORDER (BDD).  People with BDD are preoccupied with one or more perceived flaws or defects in various areas of the body (e.g., skin, hair, nose).  Although these flaws are not visible or appear only slight to others, individuals with BDD may think of themselves as ugly and are often obsessed with the perceived defect.  Excessive, repetitive behaviors or mental acts are performed in response to these preoccupations (e.g., excessively grooming, skin picking, repeatedly checking perceived deficits in mirrors).   

HOARDING DISORDER.  Hoarding Disorder involves a persistent difficulty parting with or discarding one’s possessions (e.g., newspapers, clothing, books) due to a belief that the items are useful or have aesthetic value, even though many individuals would deem them useless or of limited value.  Individuals with Hoarding Disorder may also have a strong sentimental attachment to their possessions.  The need to save these possessions and the distress associated with discarding them results in an accumulation of items that clutter and obstruct living areas, preventing them from being used as intended. Difficulties discarding items and/or clutter causes impairment in functioning, including maintaining a safe environment for self and others.

TRICHOTILLOMANIA (HAIR-PULLING DISORDER).  Trichotillomania is characterized by the recurrent pulling out of one’s own hair from any region of the body in which hair grows, resulting in hair loss, as well as repeated attempts to reduce or stop hair pulling.  Common areas of pulling include the eyebrows, scalp, and eyelids.  Hair pulling may be preceded or accompanied by feelings of anxiety or boredom; it may also be preceded by an increasing sense of tension or lead to gratification or a sense of relief when the hair is pulled out. 

EXCORIATION (SKIN-PICKING) DISORDER .  Excoriation Disorder is characterized by recurrent skin picking that results in noticeable (or hidden) damage to the skin (e.g., scabs, sores).  As with Trichotillomania, (1) the individual with Excoriation Disorder has made repeated attempts to reduce or stop skin picking, and (2) skin picking may be triggered by feelings of anxiety or boredom; it may also be preceded by an increasing sense of tension or lead to gratification or a sense of relief when the skin or a scab has been picked. 

OTHER SPECIFIED OBSESSIVE-COMPULSIVE AND RELATED DISORDERS. Examples of these disorders include obsessional jealousy, which is characterized by a nondelusional preoccupation with a partner’s infidelity and repetitive behaviors or mental acts performed in response to these infidelity concerns; and body-focused repetitive behavior disorders such as nail biting, lip biting, and cheek chewing, which are accompanied by attempts to decrease or stop the behavior.

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