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Dual Diagnosis in Youth: OCD and an Anxiety Disorder

father reading book to son who is covering eyes

If your child is experiencing intrusive thoughts, extreme fears, urges, or rituals, they may be displaying some of the common symptoms of obsessive-compulsive disorder, or OCD. Between 1-3% of children and adolescents are diagnosed with OCD.

Kids with OCD also have a higher likelihood of having a dual diagnosis or comorbidity. About 70% of children and youth with OCD face other mental health conditions. Common comorbid psychiatric disorders in children with OCD are anxiety disorders, depression, attention deficit disorder, or a tic disorder.

The most common comorbidity is an anxiety disorder. A dual diagnosis of OCD and an anxiety disorder can make life complicated for both parent and child. But with love, support, and a helping hand from your healthcare provider, a lot can be done.

Can You Have OCD and an Anxiety Disorder?

Around 75.8% of those with OCD also have a comorbid anxiety disorder. This can include separation anxiety, phobias, and generalized anxiety disorder (GAD), which are often characterized by excessive and uncontrollable worry about different events and activities. Some kids may have two or more anxiety disorders along with OCD.

The most common symptoms in children with a dual diagnosis of an anxiety disorder and OCD can include:

This comorbid diagnosis can cause significant distress, interfere with school and play activities, and affect how children interact with their family and friends.

What Parents Need to Know About Comorbid Anxiety Disorders and OCD

Co-occurring anxiety disorders and OCD in kids can make treatment more challenging.

Mistaking Symptoms

Some symptoms of these two conditions may seem similar, and as a parent, it can be hard to distinguish these symptoms. For example, some of the worries in GAD can be confused with the obsessions in OCD. What differentiates them is that worries are usually more realistic in nature, while obsessions tend to be more irrational and not consistent with the individual’s self-perception.

Symptom Severity

One study showed that comorbid OCD and anxiety disorders in youth is associated with greater OCD severity. The consequences may have a higher impact on children’s everyday activities and relationships.

Potential Impact on the Family Dynamic

Parents of children who have comorbid OCD and anxiety disorders also report higher levels of family conflict. This dual-diagnosis can also lead to a decreased quality of life for the child and the whole family. Fortunately, there are a variety of treatment options that can mitigate the consequences of the dual-diagnosis.

Treating Comorbid OCD and Anxiety Disorders

Children with psychiatric comorbidity often benefit from several treatment options. This often includes therapy such as talk therapy or cognitive-behavioral therapy (CBT).

A dual-diagnosis of an anxiety disorder and OCD in kids and adolescents is also associated with a higher need for pharmacological treatment due to an increase in OCD severity.

The most commonly used meds to treat comorbid OCD and anxiety disorders are serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and fluoxetine (Prozac). They act by increasing the amount of serotonin available in the brain. SSRIs can help control obsessions and compulsions and may also be used to treat anxiety. Children with comorbid OCD often need higher doses of SSRI, which may increase the chances of having side effects.


When treating comorbid psychiatric diseases, it may be necessary to use multiple medications; a practice called polypharmacy. Your child’s healthcare provider may pay close attention to potential drug-drug interactions to reduce the risk of adverse effects.

How Can DNA Testing Help Kids With OCD?

Not every person reacts the same way to medications. This can be due to differences in each person’s genetic profile. Gene variants may influence how your child responds to treatment, and co-occurring anxiety and OCD may also affect how their body reacts to different medications.

Pharmacogenetic (PGx) testing can help your family’s provider determine which medications and dosing may be most appropriate, based on your child’s genetic profile. By providing valuable insights into how your child’s body may respond to and metabolize medications, PGx testing is designed to minimize the risk of trial and error and side effects when prescribing medications.

For example, if your teenager is a rapid metabolizer of CYP2C19, certain SSRIs like escitalopram (Lexapro) may have a greater risk of inefficacy in treating anxiety disorders and OCD due to suboptimal levels of the drug. Because of this, your healthcare provider may recommend a different treatment option that goes through an alternative pathway.

With this information, your child’s healthcare provider can make more informed treatment decisions.

Genetic Testing for Medications

Genomind’s pharmacogenetic testing looks at 24 genes related to mental health treatment, including the CYPC219 gene. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:

  • Which medications may be more or less likely to be effective
  • Which medications may be more or less likely to have side effects
  • How your child metabolizes medications for personalized dosing guidance

In addition to genetic testing, your healthcare provider will want to determine when two drugs may not work well together. Genomind’s Precision Medicine Software looks at both gene-drug and drug-drug interactions for 99% of the most commonly prescribed medications. This offers providers a more complete picture and helps avoid potentially harmful interactions. Designed to work with Genomind’s PGx testing, the software allows healthcare providers to evaluate safer prescribing options with speed and precision. Learn more about the suite of solutions offered by Genomind.

The Genomind PGx test can be done at a clinician’s office—or from the comfort of your home. It requires a prescription, and Genomind can help connect you with a verified Genomind provider near you. Get started by filling out this form.

Managing a Dual Diagnosis

Dealing with a dual diagnosis of OCD and an anxiety disorder can be difficult, and treatment may be more complex. However, PGx testing for OCD and anxiety medication can help with this process, giving your child’s healthcare provider valuable information when making prescribing decisions.

If your child is diagnosed with OCD and an anxiety disorder, consider discussing PGx testing with their healthcare provider. For more tips, check out this article.

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