This is not a nonâreal-life concern and the content is not odd, irrational, or of a seemingly magical nature. It may appear that these are “obsessions.” In both of these examples, we can consider that the source of threat-illness and vomiting-is the same. In a specific phobia, there may be recurrent thoughts about a specific topic or item. She counts the number of seconds she washes to make sure she feels that she has completed her cleaning task. She engages in excessive and ritualized hand washing to prevent illness, and her hands are chapped and raw as a result. He avoids being near sick people and runs away when he hears that someone in his class has been ill. While DSM 5 does not require that the individual recognize that the behaviors are irrational, the criteria still clearly states “these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.” There are instances in which the obsessions are about something rational however, in these cases, there are often rituals or compulsions that are not rational responses to the thought. DSM-5 added the possibility that an individual may not recognize that the beliefs are possibly untrue, and in this case, there is a specifier “with absent insight/delusional beliefs.”Ģ. According to DSM, the presence or absence of “non-real-life concerns” or content that is “odd, irrational, or of a seemingly magical nature” can often indicate OCD. The source of threat can help distinguish between the various anxiety disorders.

The Source of Threat and Nature of the Thoughts. Two helpful considerations when determining whether recurrent thoughts are obsessions as defined within the framework of OCD are the source of the threat and the nature of the thoughts as well as presence or absence of compulsive behaviors.ġ. Patients often come in describing that they are “obsessing,” or having persistent thoughts, yet, these descriptions do not necessarily indicate the presence of OCD and may be indicative of ruminations or fears more consistent with an anxiety disorder. While the diagnostic criteria spell out differences between the categories, phenotypically, the presentations of OCD and anxiety disorders, such as social anxiety disorder and specific phobias, can appear very similar.ĭSM defines obsessions as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.” This marked anxiety or distress leads to an urge to complete compulsions. In 2013, DSM-5 separated OCD from anxiety disorders by creating a distinct category of Obsessive Compulsive and Related Disorders. 4 Differentiating between these attributes can guide treatment choices and goals for OCD as well as non-OCD anxiety disorders. While anxiety disorders and OCD are often comorbid, and have overlapping symptoms, there are some key distinguishing factors that lead to diagnostic clarity. 3 OCD and anxiety disorders present differently from child to child, and it can be challenging to distinguish between the various anxiety disorders and OCD. 2 This number increases when considering lifetime prevalence, and up to one-third of the population will suffer from an anxiety disorder at some point. 1 Anxiety disorders are the most common emotional difficulty for children, and in the in the US, 7.1% of children (aged 3-17 years) have been diagnosed with an anxiety disorder. The disorder affects about 2% of the population, with incidence peaks in both pre-adolescent children, and young adults. OCD manifests as recurrent and persistent obsessive thoughts, and/or repetitive compulsive behaviors. SPECIAL REPORT: OCD AND RELATED DISORDERS

General thoughts on anxiety