OCD and Related Disorders Due to Medical Condition

Certain medical conditions can cause symptoms of OCD and related disorders. The Diagnostic and Statistical Manual for Mental Health, Fifth Edition (DSM-5) recognizes this by creating a new category for Obsessive- Compulsive and Related Disorders Due to Another Medical Condition. This category appears in the chapter on typical obsessive-compulsive and related disorders.

Obsessive-compulsive disorder is a mental illness in which you have unwanted, intrusive and repetitive thoughts and feelings called obsessions. These obsessions cause severe anxiety and may make you feel driven to perform ritualistic behaviors called compulsions.

OCD and Related Disorders Caused by Medical Conditions

Some physical diseases can cause symptoms of OCD and its related disorders, such as excoriation (compulsive skin picking) and trichotillomania (compulsive hair pulling). Before giving a diagnosis of OCD or related disorder, it's critical that the doctor consider all possible causes in order to give appropriate and effective treatment.

Compulsive skin picking can develop due to organic illnesses, including:

• Anemia – can lead to poor circulation and poor oxygenation of extremities causing itching sensations
• Liver disease
• Uremia (kidney failure)
• Allergic reaction causing rash
• Acne vulgaris
• Other skin conditions

Trichotillomania, or compulsive hair pulling, can develop due to a number of medical illnesses or conditions, including:

• Tinea capitis – a fungal infection of the scalp commonly referred to as ringworm can result in itchiness, irritation, and noticeable hair loss.
• Scalp acne – irritation of the scalp area caused by cystic acne can cause individuals to pick at their scalp, pulling out noticeable clumps of hair in the process
• Psoriasis
• Seborrheic dermatitis
• Other scalp conditions

Obsessive-compulsive disorder symptoms can also be caused by certain illnesses, including:

PANDAS – Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). A simple strep throat infection can cause this disorder, one of the symptoms of which is obsessive-compulsive disorder (OCD). A formerly happy, social, athletic, well-adjusted child may begin to exhibit many or all of these symptoms:

• Sudden onset of OCD
• Challenges with eating
• Intense sensory issues with textures, sound, light
• Deterioration of small motor skills
• Tics
• ADHD
• Sudden onset of severe anxiety associated with OCD and panic attacks
• Severe separation anxiety
• Intense fear of germs and contamination associated with pure OCD

Find more information about PANDAS in the International OCD Foundation webpage detailing sudden and severe onset of OCD. Researchers are studying the validity of treating this type of OCD with antibiotics in addition to the traditional OCD treatments that include antidepressants and behavioral therapy.

Wilson's Disease – an inherited neurodegenerative disorder that includes liver disease and/or psychiatric disorders, such as isolated OCD. Typical OCD therapies have not worked for this OCD, but when used in conjunction with chelating (removal of toxins from the blood) and behavioral therapy, doctors have seen improvement.

Pica – Pica is an illness in which individuals compulsively hunger for non-nutritive substances like dirt, chalk, sand, or clay. Common in those with brain injuries, developmental disabilities, or autism, it also occurs in some people with epilepsy. Many cases report that their pica occurs as a compulsive behavior compelled by obsessive thoughts to relieve severe anxiety. While other OCD symptoms and behaviors are lessened by traditional OCD therapies, the pica behavior was not significantly affected. Although more research is needed, some experts believe pica may represent a manifestation of OCD.

Other mental illnesses, like postpartum depression or schizophrenia, can mimic the symptoms of OCD, so before a doctor or mental health professional gives a diagnosis, it's important to rule out organic illnesses or other mental health issues.

Treatment of OCD and Related Disorders Due to Another Medical Condition

If an individual's OCD behavior arises due to a treatable organic illness, such as tinea capitis, acne vulgaris, or other skin or scalp condition, symptoms usually disappear once the underlying problem is treated. When the OCD occurs because of PANDAS, Wilson's Disease, Pica, or other organic illness that isn't fully understood, treatment can prove more challenging.

If the causative organic illness goes away, the OCD symptoms often diminish as well. In cases where they do not, treatment of OCD continues after the underlying illness is gone. These treatments include medication therapy with selective serotonin uptake inhibitors (SSRIs) and cognitive behavioral therapy as both work to help people manage symptoms and compulsive urges.

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