Differential Diagnosis for Anxiety and Intrusive Thoughts

• Single most likely diagnosis
  • Obsessive-Compulsive Disorder (OCD): Characterized by recurring, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that the individual feels driven to perform. The symptoms of anxiety and intrusive thoughts are hallmark features of OCD, making it the most likely diagnosis.
• Other Likely diagnoses
  • Post-Traumatic Stress Disorder (PTSD): Intrusive thoughts, often in the form of flashbacks or nightmares, are common in PTSD, along with significant anxiety. The intrusive thoughts in PTSD are typically related to a traumatic event.
  • Generalized Anxiety Disorder (GAD): While GAD is primarily characterized by excessive worry about everyday things, it can also include symptoms of anxiety and, to a lesser extent, intrusive thoughts that are not as prominent as in OCD but can still be distressing.
  • Panic Disorder: This disorder involves sudden feelings of terror that strike repeatedly and without warning, and can include intrusive thoughts about having another panic attack. Anxiety is a key feature, though the intrusive thoughts may be more focused on the panic attacks themselves.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Psychotic Disorders: In some cases, what appears to be intrusive thoughts could actually be command hallucinations or delusional thinking, particularly if the thoughts are of a violent or self-destructive nature. Missing a psychotic disorder could have severe consequences.
  • Neurodegenerative Diseases: Certain neurodegenerative diseases, like frontotemporal dementia, can present with obsessive or intrusive thoughts, and missing these could lead to delayed diagnosis and treatment of a potentially devastating condition.
• Rare diagnoses
  • Trichotillomania and other Body-Focused Repetitive Behaviors: These disorders involve recurrent, irresistible urges to pull out hair or engage in other self-grooming behaviors, which can be accompanied by anxiety and intrusive thoughts about performing these behaviors.
  • Neurodevelopmental Disorders: Certain neurodevelopmental disorders, such as autism spectrum disorder, can sometimes present with repetitive thoughts or behaviors that might resemble intrusive thoughts, though the context and nature of these thoughts can be quite different from those seen in OCD or other anxiety disorders.