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It's B. Major depressive disorder.

Explanation: Psychiatric comorbidity is common in OCD, with the Epidemiologic Catchment Area (ECA) study finding that two-thirds of patients with OCD met criteria for at least one other psychiatric illness during their lifetime (Karno et al. 1988). The most common comorbid psychiatric diagnosis is major depressive disorder. Approximately one-third of individuals with OCD are currently experiencing a major depressive episode, and two-thirds will have a major depressive episode during their lifetime. Other commonly comorbid psychiatric illnesses include anxiety disorders, eating disorders, and substance use disorders.

The differential diagnosis includes the ruminations of depression, the delusions of psychosis, anxiety symptoms associated with other anxiety disorders, and severe obsessive-compulsive personality disorder (OCPD). OCPD is defined as a rigid, perfectionistic personality type. A general rule of thumb is that whereas OCPD tends to be experienced as ego-syntonic, the obsessions and compulsions of OCD are experienced as ego-dystonic. Despite the similarity of their names, OCPD is clearly a separate disorder from OCD and does not respond to the treatments used for OCD.

Muskin PR and Dickerman AL, eds. A Study Guide for the Psychiatry Board Examination. Arlington, VA: American Psychiatric Association Publishing; 69, 301-302. Click here to purchase. Members can purchase at a discount.