Chapter 21. Obsessive–Compulsive Disorder

DSM-IV-TR Diagnostic Criteria

1. Either obsessions or compulsions:

   • Obsessions as defined by (1), (2), (3), and (4):

     1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

   2. the thoughts, impulses, or images are not simply excessive worries about real-life problems

   3. the person attempts to ignore or suppress such thoughts, impulses, or images or neutralize them with some other thought or action

   4. the person recognizes that the thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

   • Compulsions as defined by (1) and (2):

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

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

2. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

   Note: This does not apply to children.

3. The obsessions or compulsions cause marked distress, are time consuming (takes more than 1 hour/day) or significantly interfere with the person's normal routine, occupation (or academic functioning), or usual social activities or relationships.

4. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it.

5. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify if:

With poor insight: if, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable.

(Reprinted, with permission, from Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Copyright. 1994. Washington DC: American Psychiatric Association, 2000.)

Obsessions are unwanted aversive cognitive experiences usually associated with feelings of dread, loathing, or a disturbing sense that something is not right. The individual recognizes (at some point in time) that these concerns are inappropriate in relation to reality and will generally attempt to ignore or suppress them. Compulsions are overt behaviors or covert mental acts performed to reduce the intensity of the aversive obsessions. They may occur as behaviors that are governed by rigid, but often irrelevant, internal specifications. They are inappropriate in nature or intensity in relation to the external circumstances that provoked them.

Epidemiology

Population Frequencies

Lifetime prevalence rates of obsessive–compulsive disorder (OCD) in the United States range between 2% and 3%, but may be slightly lower ...