9.3: Obsessive-Compulsive and Related Disorders - Comorbidity

Learning Objectives

• Describe the comorbidity of OCD.
• Describe the comorbidity of body dysmorphic disorder.
• Describe the comorbidity of hoarding disorder.

OCD

There is a high comorbidity between OCD and other anxiety disorders. Nearly 76% of individuals with OCD will be diagnosed with another anxiety disorder, most commonly panic disorder, social anxiety disorder, generalized anxiety disorder, or a specific phobia. Additionally, due to the nature of OCD and its symptoms, nearly 41% of those with OCD will also be diagnosed with a depressive or bipolar disorder (APA, 2022).

There is a high comorbidity between OCD and tic disorder, particularly in males with an onset of OCD in childhood. Children presenting with early-onset OCD typically have a different presentation of symptoms than traditional OCD. Research has also indicated a strong triad of OCD, tic disorder, and ADHD in children. Due to this psychological disorder triad, it is believed there is a neurobiological mechanism at fault for the development and maintenance of the disorders.

It should be noted that there are several disorders—schizophrenia, bipolar disorder, eating disorders, body dysmorphic disorder, and Tourette’s disorder – that OCD is much more common in. Therefore, clinicians who have a patient diagnosed with one of the disorders should also routinely assess patients for OCD (APA, 2022).

Finally, OCD has a mean rate of lifetime suicide attempts of 14.2%, a mean rate of lifetime suicidal ideation of 44.1%, and a mean rate of current suicidal ideation of 25.9%. Severity of OCD, the symptom dimension of unacceptable thoughts, a history of suicidality, and severity of comorbid depressive and anxiety symptoms are predictors of greater suicide risk (APA, 2022).

Body Dysmorphic Disorder

Major depressive disorder is the most common comorbid psychological disorder with body dysmorphic disorder and typically occurs after the onset of body dysmorphic disorder. Additionally, there are some reports of social anxiety disorder, OCD, and substance-related disorders (likely related to muscle enhancement; APA, 2022). Those with body dysmorphic disorder are four times more likely to have experienced suicidal thoughts and 2.6 times more likely to have made suicide attempts compared to healthy control subjects and those diagnosed with eating disorders, OCD, or any anxiety disorder.

Hoarding Disorder

Of those diagnosed with hoarding disorder, about 75% have a comorbid mood or anxiety disorder with major depressive disorder, social anxiety disorder, and generalized anxiety disorder being the most common comorbid conditions. Additionally, nearly 20% also meet the criteria for OCD (APA, 2022).

Key Takeaways

You should have learned the following in this section:

• OCD is shown to have a high comorbidity with anxiety and depressive disorders as well as tic disorder and ADHD in children.
• Body dysmorphic disorder has a high comorbidity with major depressive disorder.
• Hoarding disorder has a high comorbidity with mood and anxiety disorders.

Review Questions

1. What are the most common comorbidities for OCD? Be specific.
2. This section discussed the OCD triad in children. What two other disorders complete this triad?
3. Which disorder is body dysmorphic disorder most comorbid with?
4. What can we say about comorbidities with hoarding disorder?