Obsessive-Compulsive Disorder 241
The result can be few significant relationship s outside the family and a lack of autonomy
and financial independence from their family of origin. In addition, some individuals with
OCD try to impose rules and prohibitions on  family members beca use of their disorder
(e.g., no one in the family can have visitors to the house for fear of contamination), and this
can lead to family dysfunction. 
Differential Diagnosis
Anxiety disorders. Recurrent thoughts, avoidant behavi ors, and repetitive requests for
reassurance can also occur in anxiety disorders. Ho wever, the recurrent thoughts that are
present in generalized anxiety disorder (i.e., worries) are usually ab out real-life concerns,
whereas the obsessions of OCD usually do no t involve real-life concerns and can include
content that is odd, irrational, or of a se emingly magical nature; moreover, compulsions
are often present and usually linked to the obsessions. Like individuals with OCD, indi-
viduals with specific phobia can have a fear re action to specific objects or situations; how-
ever, in specific phobia the feared object is usually much more circ umscribed, and rituals
are not present. In social anxiety disorder (social phobia), the feared objects or situations
are limited to social interactions, and avoida nce or reassurance seeking is focused on re-
ducing this social fear.
Major depressive disorder. OCD can be distinguished from the rumination of major
depressive disorder, in whic h thoughts are usually mood-c ongruent and not necessarily
experienced as intrusive or distressing; mo reover, ruminations are not linked to compul-
sions, as is typical in OCD. 
Other obsessive-compulsive and related disorders. In body dysmorphic disorder, the