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Diagnosis
- A clinical interview that elicits a history of intrusive thoughts or behavioral rituals is the primary method of establishing the diagnosis
- Obsessive-compulsive disorder diagnostic criteria based on DSM-5 are the presence of symptoms of obsessions,compulsions or both.
- Obsession symptoms include:
- Intrusive unnecessary thoughts, urges or images that are recurrent and persistent causing significant anxiety or distress in an individual
- The individual takes efforts of ignoring or suppressing such thoughts, urges or images or tries to neutralize them with some other thought or action (ie by performing compulsion)
- Compulsion symptoms include:
- The individual feels impelled to do repetitive behaviors (eg hand washing, ordering, checking) or mental acts (eg praying, counting, repeating words silently) as a response to an obsession or according to rules that must be strictly applied
- The behaviors or mental acts are done to prevent/reduce anxiety or distress or to prevent some dreaded event or situation but these acts are not associated in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
- Obsession symptoms include:
- Based on DSM-5 criteria the above disturbances should be:
- Time-consuming (>1 hour/day) or cause clinically serious distress or deterioration in social, occupational or other important areas of functioning
- Not secondary to any medication, substance of abuse or another medical condition
- Not associated with symptoms of other mental disorders (eg generalized anxiety disorder, body dysmorphic disorder, hoarding disorder, trichotillomania, excoriation disorder, stereotypic movement disorder, eating disorders, substance-related and addictive disorders, illness anxiety disorder, paraphilic disorders, disruptive impulse-control and conduct disorders, major depressive disorder, schizophrenia or autistic disorder)
- According to DSM-5, specify obsessive-compulsive disorder if:
- With good or fair insight when the patient knows that the disorder beliefs are definitely/probably not true or may or may not be true
- With poor insight when the patient thinks that the disorder beliefs are probably true
- With absent insight/delusional beliefs when the patient believes that the disorder beliefs are true
- The presence of a tic disorder prior to or during evaluation should be included when making the diagnosis
