Differential Diagnosis for Persistent Intrusive Thoughts without Acts

• Single most likely diagnosis
  • Obsessive-Compulsive Disorder (OCD): Characterized by recurrent, unwanted thoughts (obsessions) that are intrusive and cause distress, without the presence of compulsions (acts) to neutralize them. This diagnosis fits well with the description of persistent intrusive thoughts without acts.
• Other Likely diagnoses
  • Anxiety Disorder: Generalized anxiety, social anxiety, or specific phobias can sometimes manifest with intrusive thoughts, although these are typically not as persistent or distressing as those seen in OCD.
  • Post-Traumatic Stress Disorder (PTSD): Intrusive memories or thoughts about a traumatic event can occur without compulsive acts, especially in the context of PTSD.
  • Depression with Psychotic Features: In severe cases of depression, individuals may experience intrusive thoughts that are not necessarily part of OCD but are rather a symptom of their depressive disorder.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Psychotic Disorders (e.g., Schizophrenia): Although less common, it's crucial to differentiate between obsessive thoughts and psychotic symptoms, as the treatment and prognosis can be significantly different.
  • Neurodegenerative Diseases (e.g., Frontotemporal Dementia): Certain neurodegenerative diseases can present with changes in behavior or thought patterns that might resemble intrusive thoughts without acts.
• Rare diagnoses
  • Trichotillomania or other Body-Focused Repetitive Behaviors: While these disorders involve compulsive acts, in some cases, the focus might be more on the intrusive thoughts leading to these behaviors rather than the acts themselves.
  • Tourette Syndrome: Characterized by vocal and motor tics, some individuals with Tourette Syndrome may also experience intrusive thoughts or obsessive-compulsive symptoms.