Obsessive-compulsive Disorder and Obsessive-compulsive and Related Disorders

• A.

  Presence of obsessions, compulsions, or both:

  Obsessions are defined by (1) and (2):

  • 1.

    Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

  • 2.

    The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or actions (i.e., by performing a compulsion).

  Compulsions are defined by (1) and (2):

  • 1.

    Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

  • 2.

    The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or at preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

  Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

• B.

  The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• C.

  The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

• D.

  The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

• With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

• With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably ture.

• With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

• Tic-related: The individual has a current or past history of a tic disorder.

• A.

  Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

• B.

  At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.

• C.

  The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• D.

  The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Specify if:

• With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.

Specify if:

Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g. “I look ugly” or “I look deformed”).

• With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.

• With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.

• With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.

• A.

  Recurrent pulling out of one's hair resulting in hair loss.

• B.

  Repeated attempts to decrease or stop hair pulling.

• C.

  The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• D.

  The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition).

• E.

  The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).

• A.

  Persistent difficulty discarding or parting with possessions, regardless of their actual value.

• B.

  This difficulty is due to a perceived need to save items and to the distress associated with discarding them.

• C.

  The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).

• D.

  The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

• E.

  The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

• F.

  The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder, restricted interests in autism spectrum disorder).

Specify if:

• With excessive acquisition : If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space.

Specify if:

• With good or fair insight : The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

• With poor insight : The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

• With absent insight/delusional beliefs : The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary.

• A.

  Recurrent skin picking resulting in skin lesions:

• B.

  Repeated attempts to decrease or stop skin picking.

• C.

  The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• D.

  The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies).

• E.

  The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, sterotypes in stereotypic movement disorder, or intention to harm oneself in non-suicidal self-injury).