A college student is brought to the student health center at the urging of his roommate. He has been missing class because he needs to check the room lock many times before he can leave. Once he stas to ride his bicycle to class, he frequently returns several times to lock the door. He repeats this ritual every morning and often when he leaves the house. He misses his appointments and his academic performance suffers. His hands are chafed. Which of the following is the most likely diagnosis?
Patients with obsessive compulsive disorder (OCD) suffer from obsessive thoughts and compulsive behaviors that impair everyday function. Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are intrusive, inappropriate, and cause anxiety and distress. Patients realize that these thoughts and images are a product of their own mind and they will attempt to suppress them. In addition to obsessions, patients experience compulsions. Compulsions are repetitive behaviors or mental acts that a person performs in accordance with an obsession. The behaviors are aimed at reducing distress or preventing some dreaded event or situation. Locking doors is a common compulsion, and thus this patient meets the diagnostic criteria for obsessive compulsive disorder. Generalized anxiety disorder is characterized by excessive anxiety and apprehensive expectation for a period greater than 6 months. Patients experience anxiety, cognitive vigilance, autonomic hyperactivity, motor tension, irritability, and poor concentration. Compulsions are not a pa of this disorder. Panic disorder is characterized by episodes of panic. Patients have a discrete period of intense fear with tachycardia, palpitations, sweating, trembling, shoness of breath, chest pain and tightening, abdominal discomfo, fear of dying, and paresthesias. Paranoid personality disorder is characterized by enduring patterns of personality characterized by distrust and suspiciousness of people. Ref: Hewlett W.A. (2008). Chapter 21. Obsessive-Compulsive Disorder. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.
Generalized anxiety disorder
Obsessive compulsive disorder
Panic disorder
Paranoid personality disorder