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Why OCD is Often Misdiagnosed
Most people picture obsessive-compulsive disorder (OCD) as excessive hand-washing or a need for perfectly straight picture frames. That narrow image leaves out most people who have it, and many go years without a correct diagnosis.
One study found people with OCD experience symptoms for an average of 13 years before receiving an accurate diagnosis.
At Mind Space Wellness, LLC, in Fort Lee, New Jersey, and on the Upper West Side of Manhattan, Caroline Bjorkman, DO, evaluates and treats OCD in patients aged 12 and older. Here’s why the condition slips past so many evaluations.
OCD looks different from its stereotype
OCD has two parts: obsessions, which are unwanted intrusive thoughts, images, or urges, and compulsions, which are the repetitive behaviors or mental acts people use to quiet the distress those thoughts create.
Contamination fears and cleaning rituals are real, but they’re only one part of the condition. Obsessions can center on:
- Fear of harming yourself or someone else
- Intrusive violent or sexual thoughts that feel deeply disturbing
- Doubts about your relationships, identity, or sexuality
- Religious or moral scrupulosity
- Needing things to feel “just right”
- Fear of making a catastrophic mistake
When symptoms don’t fit the tidy stereotype, people often don’t recognize what they’re dealing with, and neither do the providers they see.
Compulsions aren’t always visible
Plenty of compulsions happen entirely inside a person’s head. Mental rituals like replaying memories for reassurance, silently repeating phrases, counting, praying, or mentally checking whether you did something wrong all serve the same purpose as visible behaviors.
Someone spending hours a day on mental compulsions can look completely unremarkable from the outside. With no visible rituals to point to, patients and providers tend to look elsewhere for an explanation.
Conditions OCD gets confused with
OCD shares surface features with several other conditions, which is a major reason it gets misdiagnosed so often. The consequences go beyond a delay in care, since an inaccurate diagnosis can contribute to depression, psychosis, and suicidality, and the wrong medication can worsen symptoms rather than ease them. These conditions include:
Generalized anxiety disorder
Both conditions involve persistent worry, but the worries in OCD tend to be intrusive and irrational, and they come paired with compulsions meant to neutralize them. Generalized anxiety usually attaches to realistic concerns like money, work, or health.
Depression
Depression frequently develops alongside OCD, sometimes as a result of years spent battling symptoms. When someone shows up describing hopelessness and exhaustion, the depression can dominate the conversation while the OCD underneath goes unmentioned.
Attention-deficit/hyperactivity disorder (ADHD)
Mental compulsions eat up enormous amounts of attention, which can look a lot like distractibility or trouble focusing. A person consumed by internal rituals may be diagnosed with ADHD when something else is pulling their attention away.
What an accurate OCD evaluation involves
Diagnosing OCD means asking about the full range of obsessions and compulsions, including the ones patients are least likely to bring up on their own. Dr. Bjorkman explores the specific content of intrusive thoughts, how much time symptoms take up, and what mental or physical rituals follow them.
She also looks at your history, any conditions present alongside OCD, and how symptoms affect your daily functioning. Since OCD so often coexists with anxiety and depression, sorting out what’s driving what shapes the treatment plan.
Treatment depends on getting the diagnosis right
OCD responds to specific approaches. Psychotherapy for OCD often uses exposure and response prevention, which helps you face triggering thoughts without performing compulsions until the distress they cause fades.
Medication can lower symptom intensity too, though OCD sometimes calls for different dosing than anxiety or depression treatment. Approaches aimed at general anxiety often fall short for OCD, and some standard techniques like offering reassurance can feed the cycle rather than break it.
OCD evaluation and treatment in Fort Lee and Manhattan
Years of unexplained symptoms can end with an accurate diagnosis. Dr. Bjorkman can determine whether OCD accounts for what you’ve been experiencing and build treatment around it. Reach out to our Fort Lee, New Jersey, or Upper West Side location to book with Dr. Bjorkman and our team, either by phone or online.