Differential Diagnosis and Comorbidity in Pediatric OCD – Overlapping and Differentiating Features and Mechanisms

To identify the most common comorbid diagnoses and differential diagnosis questions with pediatric obsessive-compulsive disorder (OCD), as well as present features and mechanisms that can help clinicians distinguish between OCD and commonly co-occurring problems.

This review follows a developmental progression, first presenting comorbid diagnoses that commonly onset in childhood (e.g., neurodevelopmental domains such as autism, attention-deficit/hyperactivity disorder, and tic disorders) and then moving through anxiety disorders, to other obsessive compulsive related disorders (e.g., body-focused repetitive behaviors, body dysmorphic disorder), depression, and eating disorders, conditions that are more likely to onset in adolescence. We include both recent research and case examples to help support our practical suggestions for differential diagnosis.

OCD frequently presents with comorbid conditions; thus, comprehensive assessment of OCD in youth populations should include a detailed and nuanced evaluation of the features described in this review to best understand differential diagnosis versus comorbidity.