Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Obsessive-Compulsive Disorder

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In one line

·Unwanted, scary thoughts pop up over and over, and the person does the same behavior again and again to calm the fear — together these take at least an hour every day.

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Normal physiology

·In a healthy brain, circuits that detect threats work smoothly with circuits that plan, decide, and calm — so you notice real danger, respond, and then move on.

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What goes wrong

·The orbitofrontal cortex and the striatum get stuck in overdrive — they cannot tell the difference between a real threat and a false alarm. Serotonin and glutamate fall out of balance, so the gatekeeper fails and every stray thought feels dangerous. Stress, trauma, infection (like strep in kids), or genes can all tip the circuit into this locked loop.

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Hallmark signs

·Unwanted thoughts that come back over and over (obsessions)
·Repeating the same action again and again to feel safe (compulsions)
·Spending one hour or more every day on obsessions or compulsions
·Intense fear or discomfort if you try to stop the ritual
·Avoiding people, places, or things that trigger the obsessions
·Knowing the thoughts or rituals don't make sense, but feeling unable to stop
·Skin damage from excessive washing or other physical rituals
·Thoughts of harming yourself because the condition feels unbearable

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Red flags · escalate now

·Thoughts of suicide or a plan to harm yourself
·Unable to eat, sleep, or go to work or school because of obsessions or compulsions
·Physical injury from compulsions (bleeding skin, severe weight loss from food rituals, fainting from excessive cleaning)
·Sudden worsening after a throat infection in a child (may signal PANDAS, a separate condition needing urgent care)

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Workup

·Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
·PHQ-9 (Patient Health Questionnaire-9 for depression)
·GAD-7 (Generalized Anxiety Disorder-7 scale)
·Anti-streptolysin O (ASO) titer and anti-DNase B titer (if symptoms started suddenly in childhood after a sore throat)
·Thyroid-stimulating hormone (TSH) and free T4
·Urine drug screen (if history or exam raises concern for stimulant or substance use)
·Neuroimaging (MRI brain) only if there are focal neurologic signs, new-onset symptoms after head injury, or atypical features like seizures

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Treatment

·High-dose SSRI (fluoxetine 60–80 mg, sertraline 200 mg, paroxetine 60 mg, fluvoxamine 300 mg, or escitalopram 20–30 mg daily) plus Exposure and Response Prevention (ERP) therapy
·Clomipramine (a tricyclic antidepressant, 150–250 mg daily) if SSRI fails after 12 weeks at high dose
·Low-dose atypical antipsychotic (aripiprazole 5–15 mg, risperidone 1–3 mg, or quetiapine 150–300 mg daily) added to SSRI or clomipramine if symptoms remain severe after 12 weeks
·Cognitive-behavioral therapy focused on Exposure and Response Prevention (ERP), at least 12–20 weekly sessions
·Sleep optimization (consistent sleep-wake schedule, sleep hygiene), stable housing, and social support (peer support groups, family psychoeducation) on the same treatment plan as medication and therapy
·Deep brain stimulation (DBS) targeting the ventral capsule/ventral striatum or subthalamic nucleus, or repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area, for severe treatment-resistant OCD after failure of at least two adequate medication trials and intensive ERP

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NCLEX trap

·Obsessive-Compulsive Disorder is a medical brain circuit problem that causes real suffering — the obsessions (stuck, unwanted thoughts that won't leave your mind) and compulsions (repeated behaviors you feel forced to do to stop the fear) take over 1+ hour every day and wreck school, work, and relationships. Perfectionism is a personality style and does not hijack your day or hurt you this way.
·Compulsions are not a choice — they are the brain's survival reflex trying to shut off the alarm triggered by the obsessions. The orbitofrontal cortex (the brain's error-checking center) gets stuck signaling danger even when there is none, and the compulsion is the only way the person knows to quiet the alarm. You need high-dose SSRIs to calm the circuit AND Exposure and Response Prevention therapy (a type of talk therapy that teaches the brain to tolerate the fear without the compulsion) to break the loop safely. Willpower alone cannot fix a jammed brain circuit.
·Obsessive-Compulsive Disorder is a medical brain wiring problem, not a character flaw or sign of craziness. Most people with Obsessive-Compulsive Disorder have perfect insight — they KNOW the thoughts are false and ridiculous, but the thoughts won't leave and the anxiety is unbearable without the compulsion. They are not acting on the thoughts; they are trapped by them.
·Obsessive-Compulsive Disorder requires HIGH-dose SSRI — fluoxetine 60–80 mg daily or sertraline 200 mg daily — because the stuck brain circuit (orbitofrontal cortex, caudate nucleus, and thalamus loop) needs much more serotonin to quiet down than depression or other anxiety disorders do. Low doses fail in most patients. You also must wait 10–12 weeks to judge if it is working, because the brain circuit takes that long to rewire. Checking at 2 weeks is too early and will lead to wrong conclusions.
·In Obsessive-Compulsive Disorder, medicine (high-dose SSRI) AND Exposure and Response Prevention therapy work better together than either one alone. The SSRI calms the overactive brain circuit, and the therapy rewires the circuit by teaching the brain that the feared outcome will not happen even if you do not do the compulsion. Stopping therapy leaves half the treatment missing, and relapse is much more likely. Both together give the best chance of long-term control.
·Generalized anxiety disorder is worry about real-life problems (money, health, family) that feels hard to control but is still about real things. Obsessive-Compulsive Disorder is intrusive, unwanted thoughts (obsessions) that feel stuck and false, plus compulsions (repeated behaviors or mental rituals) done to stop the terrible anxiety the thoughts cause. Different brain circuits are broken — in generalized anxiety it is the amygdala (the brain's alarm center) and prefrontal cortex (the brakes on worry), and in Obsessive-Compulsive Disorder it is the orbitofrontal cortex, caudate nucleus, and thalamus loop (the error-checking circuit that gets jammed saying 'danger' over and over). Treatments are different too — generalized anxiety responds to lower-dose SSRIs or SNRIs plus general talk therapy, while Obsessive-Compulsive Disorder needs high-dose SSRIs plus the specific therapy called Exposure and Response Prevention.

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