A 28-year-old woman presents with recurrent, unwanted thoughts about accidentally leaving her gas stove on, which she finds deeply distressing and ego-dystonic. To neutralize the anxiety, she checks the stove 15–20 times before leaving home, a ritual that consumes over 2 hours each morning. She recognizes the thoughts as excessive but cannot resist the urge to check. What is the most likely diagnosis?

• A Generalized anxiety disorder
• B Obsessive-compulsive personality disorder
• C Specific phobia
• D Obsessive-compulsive disorder ✓

Explanation

Obsessive-compulsive disorder (OCD) is characterized by obsessions — recurrent, intrusive, ego-dystonic thoughts that generate significant anxiety — and compulsions — repetitive, purposeful behaviors performed to reduce the anxiety generated by obsessions. A key distinction from OCPD is that in OCD the individual recognizes their obsessions and compulsions as excessive or unreasonable (insight preserved), while OCPD involves ego-syntonic traits of perfectionism and rigidity without true obsessions or compulsions. The 2-hour daily time consumption also satisfies the criterion of significant functional impairment.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.