Obsessive-Compulsive Disorder.

A. Presence of obsession, compulsions, or both:

Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are
experiences, 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 neutralise them with some other thought or action (i.e., by
performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviours (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 behaviours or mental acts are aimed at preventing or reducing
anxiety or distress, or preventing some dreaded even or situation;
however, these behaviours or mental acts are not connected in a realistic
way with what they are designed to neutralise or prevent, or are clearly
excessive (NOTE: Young children may be unable to articulate the aims of
these behaviours/ 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., drugs, medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental
disorder, such as:

- Excessive worries: GAD

- Preoccupations with appearance: Body Dysmorphic Disorder
- Difficulty discarding or parting with possessions: Hoarding Disorder
- Hair Pulling: Trichotillomania
- Skin picking: Excoriation Disorder
- Stereotypies: Stereotypic Movement Disorder
- Ritualised eating behaviour: Eating Disorders
- Preoccupation with substances or gambling: Substance-related & Addictive
Disorders
- Preoccupation with having an illness: Illness Anxiety Disorder
- Sexual urges or fantasies: Paraphillic Disorders
- Impulses: Disruptive, Impulse-control & Conduct Disorders
- Guilty Ruminations: Major Depressive Disorder
- Thought insertion or delusional preoccupations: Schizophrenia Spectrum &
Psychotic Disorders
- Repetitive patterns of behaviour: Autism Spectrum Disorder

Specifiers:
With good or fair insight: The individual recognises that OCD beliefs are definitely
or probably not true and that they may or may not be true.

With poor insight: The individual thinks OCD beliefs are probably true
With absent insight/ delusional beliefs: The individual is completely convinced
that OCD beliefs are true.
Specify if:
Tic-related: The individual has a current or past history of a tic disorder.

Differential
Anxiety Disorders

Why they look

similar
Avoidant behaviours &
repetitive requests for
assurance
GAD= recurrent
thoughts
Phobia= fear of specific
objects of situations

Major Depressive
Disorder

Ruminations

Other Obsessive
Compulsive & Related
Disorders

Eating Disorders

Tics (in Tic Disorder)

and Stereotyped
movements

Psychotic Disorders

Tic= sudden, rapid,

recurrent, non-rythmic
movement or
vocalisation
Stereotyped
movement= repetitive,
seemingly driven, nonfunctional motor
behaviour
OCD= may have poor

How to tell if its OCD

GAD= worry is about real life
concerns. No rituals
OCD= Not real life concerns,
can be odd, irrational or
magical. Compulsions are
present
Phobia= feared objects much
more restricted. No rituals
Soc Anx= fear is limited to
social situations. Avoidance/
reassurance seeking is
focussed on reducing the social
fear
MDD= thoughts are moodcongruent & not necessarily
intrusive & distressing. No
Compulsions
BDD= Obsessions &
compulsions limited to
concerns about physical
appearance
Hoarding= discarding or
parting with possessions- if this
hoarding is due to obsessions
typical of OCD, Dx OCD
instead!!
OCD= Obsessions and
compulsions are NOT limited to
concerns about weight and
food
Tics/Stereo Movements=
less complex than compulsions
and not aimed at neutralising
obsessions. Preceded by
premonitory sensory urges.
OCD= compulsions preceded
by obsessions.
Both can be Dxd togehter
OCD= have obsessions and

insight to the point of

delusional OCD beliefs

compulsions. Do NOT have

extra psychotic synmptoms

Other Compulsive-like
behaviours

Sometimes behaviours
(like substance use or
gambling) may appear
compulsive

OCPD

They have similar names

Behaviours=The person usually

gets pleasure from these
activities and mayv wish to
resist it only for harmful
consequences
OCPD= no intrusive thoughts,
images, urges, or repetitive
behaviours.
Both can be Dxd together