Primer
Obsessive-Compulsive and Related Disorder Due to Another Medical Condition is an obsessive-compulsive and related disorder diagnosis where there is a prominent and persistent period of obsessive-compulsive symptoms thought to be related to the direct physiological effects of another medical condition.
Prognosis
Diagnostic Criteria
Criterion A
Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorder predominate in the clinical picture.
Criterion B
There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
Criterion C
The disturbance is not better explained by another mental disorder.
Criterion D
The disturbance does not occur exclusively during the course of a delirium.
Criterion E
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specifiers
Specifier
Specify if:
With obsessive-compulsive disorder-like symptoms: If obsessive-compulsive disorder-like symptoms predominate in the clinical presentation.
With appearance preoccupations: If preoccupation with perceived appearance defects or flaws predominates in the clinical presentation.
With hoarding symptoms: If hoarding predominates in the clinical presentation.
With hair-pulling symptoms: If hair pulling predominates in the clinical presentation.
With skin-picking symptoms: If skin picking predominates in the clinical presentation.
Signs and Symptoms
Pathophysiology
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Sydenham's chorea is the neurological presentation of rheumatic fever, which is characterized by a combination of motor and non-motor features. Non-motor features include obsessions, compulsions, attention deficit, and emotional lability. Although individuals with Sydenham's chorea may present with non-neuropsychiatric features of acute rheumatic fever (e.g. - carditis and arthritis), they may also present with obsessive-compulsive disorder-like symptoms. These individuals should be diagnosed with obsessive-compulsive and related disorder due to another medical condition.
Striatal damage from
stroke is also known to cause obsessive-compulsive and related symptoms as a manifestation.
Differential Diagnosis
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Mixed presentation of symptoms (e.g. - mood and obsessive-compulsive and related disorder symptoms)
Substance/medication-induced obsessive-compulsive and related disorders
If there is evidence of recent or prolonged substance use (e.g. - medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin, a substance/medication-induced obsessive-compulsive and related disorder should be considered.
When a substance/medication-induced obsessive-compulsive and related disorder is being diagnosed in relation to drugs of abuse, it may be useful to obtain a urine drug screen or other laboratory tests. Symptoms that occur during or shortly after (i.e. - within 4 weeks) a substance intoxication or withdrawal or after medication use may be especially suggsetive of a substance/medication-induced obsessive-compulsive and related disorder.
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Obsessive-compulsive and related disorder due to another medical condition should be distinguished from a primary obsessive-compulsive and related disorder. In primary mental disorders, no specific and direct causative physiological mechanisms associated with a medical condition can be demonstrated. Late age at onset or atypical symptoms suggest the need for a thorough assessment to rule out the diagnosis of obsessive-compulsive and related disorder due to an other medical condition (e.g. - stroke).
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Associated feature of another mental disorder
Resources
For Patients
For Providers
Articles
Research
1)
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.