Obsessive-compulsive disorder

Abstract

Previously classified as an anxiety-related disorder, obsessive-compulsive disorder (OCD) was moved to a new "Obsessive-Compulsive and Related Disorders" section in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM - 5; American Psychiatric Association [APA], 2013). This section also includes body dysmorphic disorder (BDD), hoarding disorder (previously considered a subtype of OCD), trichotillomania (hair-pulling disorder), and excoriation (skin-picking disorder; APA 2013) (see Chap. x). In DSM - 5, OCD is characterized by the presence of obsessions and compulsions (Criterion A), which must be time-consuming or cause clinically significant distress or impairment (Criterion B; APA 2013, p. 238). Obsessions are egodystonic "repetitive and persistent thoughts, images, or urges" (APA 2013, p. 238), while compulsions are "repetitive behaviors … that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly" (APA 2013, p. 237). Whereas obsessions are strictly mental activities, compulsions can be observable (e.g., checking locks or washing hands) or covert (e.g., counting or mentally repeating certain words or phrases).