Obsessive-Compulsive Spectrum Disorders
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Diagnosis: Obsessive-Compulsive Symptoms Due to Other Factors

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C. E. Zupanick, Psy.D.

Before diagnosing an obsessive-compulsive or related disorder (OCRDs), it is important to rule-out other possible causes of obsessive-compulsive symptoms. Obsessive-compulsive symptoms can be due to: 1) a medical condition; 2) the use of, or withdrawal from, alcohol and other drugs; and 3) another psychiatric condition (including another OCRD).

female doctorObsessive-Compulsive and Related Disorders (OCRDs) Due to Another Medical Condition

Certain medical conditions can cause psychiatric symptoms. Therefore, a medical evaluation should be performed to rule out a medical condition that might be causing the psychiatric symptoms. For example, children with obsessive-compulsive disorder (OCD) should be tested for infections to rule-out Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). PANDAS may lead to a sudden onset of obsessions, compulsions, and/or tics in a sub-set of children. Obsessive-compulsive symptoms have also been associated with Group A streptococcal infections such as Sydenham's chorea. When obsessions, compulsions, and/or body-focused repetitive behaviors are the direct effect of a medical condition, the correct diagnosis is obsessive-compulsive and related disorder due to another medical condition.

Substance/Medication-Induced Obsessive-Compulsive and Related Disorder

When obsessive-compulsive symptoms are a direct result of a prescription drug, over-the-counter drug, or street drug, then the correct diagnosis is substance/medication-induced obsessive-compulsive and related disorder. The proper and customary use of a drug may cause the symptoms. Alternatively, the symptoms may be caused by misuse, intoxication, or withdrawal from a particular substance or drug. In these cases, the obsessive-compulsive symptoms will abate with the cessation of the drug or substance use.

Some over-the-counter and prescription drugs have side effects that include obsessions, compulsions, or body-focused repetitive behaviors. Certain stimulant drugs containing amphetamines may cause these side effects. Some examples are Benzedrine®, Dexedrine®, and Ritalin®. Likewise, the use and withdrawal from several street drugs can precipitate or worsen symptoms. These include cocaine (including "crack") and methamphetamine ("meth"). Non-drug toxins and heavy metals may also induce obsessive-compulsive symptoms. This list is not all-inclusive. If you experience any unusual symptoms while taking a drug, be sure to discuss this with your healthcare provider, or pharmacist.

Obsessive-Compulsive Symptoms and Other Psychiatric Disorders

Obsessions and compulsions can be a symptomatic feature of other psychiatric disorders. Therefore, clinicians must determine if the diagnosis of an obsessive-compulsive or related disorder (OCRDs) can best account for the symptoms. In other words, the mere presence of obsessive-compulsive symptoms does not automatically indicate an OCRD. For example, someone who is obsessed with food, dieting, and exercise, because of an extreme fear becoming fat, would be diagnosed with an eating disorder; not a obsessive-compulsive disorder. Likewise, most of the substance use disorders (alcohol and other drugs) have some obsessive-compulsive features associated with obtaining and using the drug. Nonetheless, when the clinician considers all the symptoms together, a substance use disorder might be the most appropriate. To complicate things further, people can receive two or more diagnoses. For instance, a person could have both an eating disorder and an OCRD. Similarly, someone could have both a substance use disorder (alcohol and other drugs) and an OCRD.

In order to receive a diagnosis of an OCRD, obsessions and compulsions must be the key and primary feature that cannot be better explained by something else (such as a medical condition, drug or alcohol use, or another psychiatric disorder).

Other Specified Obsessive-Compulsive and Related Disorders

So what happens if someone meets some of the diagnostic criteria for a disorder, but not all the criteria? In this case, the clinician uses a category called, "other specified obsessive-compulsive and related disorder." This category still requires that the symptoms cause distress or impairment. These other specified obsessive-compulsive diagnoses are:

Body dysmorphic like-disorder with actual flaws: Similar to BDD but with actual flaws considered more than slight with excessive preoccupation

Body dysmorphic like-disorder without repetitive behaviors: Similar to BDD except no repetitive behaviors or mental acts

Body-focused repetitive behavior disorder: Similar to trichotillomania and excoriation disorder but is characterized by another recurrent body-focused repetitive behavior such as nail biting

Obsessional jealousy: Preoccupation with a partner's perceived infidelity that is not delusional and characterized by repetitive behaviors or mental acts concerning the perceived infidelity

Shubo-kyofu: Similar to BDD with fear of having a bodily deformity

Koro: Anxiety that the penis, vulva, or nipples with retract into the body and may lead to death

Jikoshu-kyofu or olfactory reference syndrome: A fear of having body odor



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