Why OCD can be confusing to diagnose and treat.
OCD can be difficult to treat but it’s also hard to diagnose sometimes. The reasons have to do with things that can be confused with OCD and things that can be related but are distinct from OCD.
It’s confusing, but here’s a quick summary:
Hoarding disorder involves wanting to keep and keeping and ordering objects (or placing them in a “collection”) and spending a significant amount of time on this. People with OCD are usually not okay with their own behavior around keeping and collecting, especially if it’s interfering with functioning, whereas those with hoarding disorder may not see the behavior as a problem.
Body Dysmorphia may involve obsessive “checking” of the body. This behavior may look like OCD but is distinct and completely body focused. Body Focused Repetitive Behaviors involve a lot of “checking” and doing a behavior (example and particular facial tic) and this behavior makes them feel better. Repeating the behavior is something they don’t necessarily want to do but the behavior allows them relief - what makes them distinct is with OCD, doing the behavior usually decreases anxiety for a little while whereas the BFRB provides relief, but the relief is extremely temporary.
OFS is a particular focus on odors. Although it may look like OCD, if the behavior regards only smells, it’s probably not OCD. Misophonia happens only in regard to specific sounds (again, like OFS, if the only behaviors noted related to a range of noise, and not any other obsession or compulsion, it’s probably not OCD).
Emetophobia is the fear of throwing up - and like hearing particular noises that are bothersome or smells, this is a specific fear focused on being afraid of getting sick and throwing up.
To make it even more confusing there are other disorders that could look like they are related to OCD or that may make a clinician suspect OCD but are actually unrelated disorders. These include: Tic Disorder/Tourette’s, Impulse Control Disorders, Obsessive Compulsive Personality Disorder, Autism Spectrum Disorder, and Psychotic Disorders/Schizophrenia/Psychosis.
Okay so what makes these distinct?
OCD and tic disorders both involve repetitive behaviors but with a tic disorder performing the action feels “right” whereas with OCD the repetitive behavior helps them manage a thought. Impulse Control Disorders are distinct due to the disorder creating a euphoric feeling or producing excitement whereas with OCD behaviors are meant to alleviate distress.
Obsessive Compulsive Personality Disorder is one we don’t talk about a lot. Both of these diagnoses have in common perfectionism and making excessive lists as possible traits. However, with OCD you may not have perfectionism, and people with OCD know their symptoms are interfering with their lives. People with OCPD often see no problem with their symptoms.
Autism can have a component of obsessive interest in something or repetitive behavior and routines. But OCD is distinct in that the thoughts are typically unwanted.
With Psychosis the distinction is that the person usually can’t tell their thoughts are untrue. With OCD the person is in touch with the reality that the obsessive thoughts are not logical.
To make things even more complex, OCD could be diagnosed along with another condition and that comorbidity may make it even harder to be sure about the correct diagnosis. Which is why when you’re dealing with OCD you’re almost always going to need a clinician to help you figure out the proper treatment along with accurate diagnosis.