Not all behaviors that appear to be obsessive-compulsive disorder (OCD) are truly OCD.  It is important to consider other diagnoses that may mimic OCD behaviors so that unnecessary assessments/testing can be avoided and the appropriate care provided. 

• Normal behavior:  certain repetitive or ritualistic behaviors are expected during certain stages of a child’s development.  Such behaviors usually resolve after a period of time (several months) whereas OCD symptoms will typically persist.
• Anxiety:  anxious thoughts especially those involving fears about bad things happening to them or their loved ones can appear similar to OCD.  However, anxiety often lacks the compulsions (actions performed to relieve the anxiety) seen in OCD.
• Early onset psychosis:  in older adolescents and adults, their insight into the unrealistic nature of their obsessions can distinguish between OCD (aware) and psychosis (not aware).  However, in younger children, it may be more difficult to assess their understanding and awareness.  Lack of any response to treatment can indicate underlying psychosis.  
• Autism spectrum disorder:  children with autism often have repetitive and stereotypic behaviors and can even have obsessive and compulsive behaviors associated with their autism.  In autism, these behaviors are usually mild and not preceded by anxiety as they often are in OCD.  
• Tic disorder:  some tics appear similar to compulsions, especially complex motor tics which often lead to repeating certain actions a defined number of times.  However, whereas tics result from urges or uncomfortable feeling preceding the action, true compulsions are preceded by a specific anxious thought or a fear of negative consequences of not acting upon an obsessive thought.

This publication was written by the CPCMG Behavioral Mental Health Committee

Reviewed by:  HB M.D., PL M.D.  | 04/2024