Obsessive-Compulsive and Related Disorder Due to Another Medical Condition

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.

• The development and course of any obsessive-compulsive and related disorder due to another medical condition generally follows the course of the underlying medical illness.^[1]

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.

There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

The disturbance is not better explained by another mental disorder.

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• Evidence that suggests a medical etiology includes the presence of features that are atypical of a primary obsessive-compulsive and related disorder (e.g. - atypical age at onset or course) or evidence in the literature of a known physiological mechanism (e.g. - striatal damage) that causes obsessive-compulsive and related symptoms.

• There is some controversy about whether obsessive-compulsive and related disorders can be attributed to Group A streptococcal infection (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)).
• 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.^[2]

• Delirium
  • A separate diagnosis of obsessive-compulsive and related disorder due to an other medical condition is not given if the disturbance occurs exclusively during the course of a delirium.
• Mixed presentation of symptoms (e.g. - mood and obsessive-compulsive and related disorder symptoms)
  • If the presentation includes a mix of different types of symptoms, the specific mental disorder due to another medical condition depends on which symptoms predominate in the clinical picture.
• 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.
• Obsessive-compulsive and related disorders (primary)
  • 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).
• Illness anxiety disorder
  • Illness anxiety disorder is characterized by a preoccupation with having or acquiring a serious illness. In the case of illness anxiety disorder, individuals may or may not have a diagnosed medical condition.
• Associated feature of another mental disorder
  • Obsessive-compulsive and related symptoms may be an associated feature of another mental disorder (e.g. - schizophrenia, or anorexia nervosa).