There may also be a practical clinical explanation for these findings. As these comorbidities have phenomenological overlap with OCD—repetitive thoughts/urges/behaviours in tics, OCRDs, anorexia nervosa and OCPD; distressing anxiety in panic disorder—clinicians may be more likely to subsume comorbid symptoms under the OCD diagnosis in those with a severe illness. For example, if an individual's panic attacks are understood as resulting from the excessive anxiety triggered by obsessions, they might not be identified as a distinct comorbidity. Similarly, certain motor or vocal tics may be mistaken for compulsive behaviours triggered by sensory phenomena, while cognitions driving OCRDs, anorexia nervosa and OCPD may be identified as obsessive in nature. On the other hand, clinicians who conceptualise these disorders as distinct comorbid phenomena may rate a lower severity for OCD when contributions from comorbidities are disregarded. It is implied that diagnostic evaluation be done over multiple consultations and repeated in follow-up for clarity on phenomenological and comorbidity profile.
