Obsessive-Compulsive Disorder: Why Is Misdiagnosis So Common?

Ever double-checked your door lock so many times you almost missed the bus, or scrubbed your hands long after the thought of germs has vanished, and thought, "Am I just over-anxious?" Those repeated rituals or intrusive, unrelenting thoughts might not be mere quirks. They could point towards Obsessive-Compulsive Disorder (OCD) which, despite being one of the most disabling mental illnesses, is notoriously misdiagnosed. Why does it happen? Partly because OCD used to be grouped with anxiety disorders, and its symptoms overlap with several other conditions-think ADHD, body-focused repetitive behaviours, or even depression. Add cultural taboos around expressing intrusive thoughts, and it becomes easy for GP visits to miss the mark.

To cut through the noise, let's take a deep dive into what OCD really is (as per DSM-5), explore how its symptoms overlap with other disorders, delve into why misdiagnosis happens so often, and share practical tips to help ensure accurate diagnosis.

What Is Obsessive Compulsive Disorder?

According to the Diagnostic and Statistical Manual of Mental Illnesses, Fifth Edition (DSM-5), OCD is defined by the presence of obsessions (persistent, unwanted thoughts, impulses, or images that cause marked anxiety) and/or compulsions (repetitive behaviours or mental acts performed to reduce the anxiety caused by those obsessions), which are time-consuming or cause significant distress or impairment.

In simple terms, think of it as a distress loop: obsessive worry triggers a repetitive act, like checking or cleaning, that temporarily soothes the anxiety, but actually reinforces the cycle.

Symptoms And Subtypes Of OCD

Symptoms of OCD typically involve the following:

• Obsessions: Like fears of contamination, symmetry, harm, blasphemy, or intrusive images.
• Compulsions: Like hand-washing, checking, arranging, counting, mental rituals like praying or seeking reassurance.

OCD presents in various subtypes including:

• Contamination-washing
• Harm/checking
• Purely obsessional (no visible compulsion)
• Symmetry/ordering
• Hoarding (now a separate diagnosis in DSM-5)

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Why OCD Symptoms Overlap With Other Disorders

Here's where it gets tricky. With similar symptoms across mental health conditions, OCD often gets mixed up with a number of other mental health disorders.

• ADHD can mimic OCD: both can involve excessive organizing or difficulty focusing, but ADHD stems from impulsivity, whereas OCD rituals are driven by anxiety and seek to prevent harm.
• OCD often coexists with anxiety, depression, or tic disorders, further muddying the clinical picture.
• In children, sudden OCD symptoms post-strep infection (PANDAS) can be misattributed to behavioural issues.

Why Misdiagnosis Is So Common

OCD is often misdiagnosed, and a number of studies underscore the pattern. One systematic review published in the Journal Of Obsessive-Compulsive And Related Disorders found that nearly 50.5% of OCD cases are misidentified. Another study in the Journal of Clinical Psychiatry states that misdiagnosis rates are higher when obsessions involve taboo topics like sexuality or aggression. A lack of clinician awareness and patient discomfort in articulating symptoms also play roles. This results in delayed treatment, unnecessary medications, and prolonged distress.

How To Avoid Misdiagnosis

Here are practical steps for patients and clinicians to get closer to the right diagnosis:

• Be specific about your habits. Describe your obsessive thoughts and the rituals you perform-how often they happen, how long they last, and the distress they cause.
• Know the difference with ADHD. Ask your clinician if behaviour arises from anxiety-driven rituals (OCD) or impulsivity/inattention (ADHD).
• Consult a specialist. Clinical psychologists or psychiatrists familiar with OCD subtypes and the DSM-5 categories can evaluate accurately.
• Use structured tools. Instruments like the Yale-Brown OCD Scale (Y-BOCS) help assess severity and track treatment outcomes.
• Seek a second opinion. If you feel misunderstood, it's valid to seek evaluation elsewhere-especially before starting or stopping treatment.

OCD may be hidden behind repetitive rituals or intrusive thoughts, but its ripple effects can be life-altering, especially when misdiagnosed. By understanding what OCD truly is, being aware of overlapping conditions like ADHD, and describing symptoms openly, individuals can steer clinicians toward accurate diagnosis, and timely, effective care.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.