obsessive-compulsive%20disorder
OBSESSIVE-COMPULSIVE DISORDER
Obsessive-compulsive disorder is characterized by the presence of either obsessions or compulsions, but more commonly by both symptoms that can cause marked impairment or distress.
Obsession is a recurrent, persistent, intrusive, unwanted thought, image or urge that cause distressing emotions (eg anxiety and disgust).
Compulsion is a repetitive behavior or mental act that the person feels driven to perform, in order to lessen the distress caused by the obsession.
Anxiety is the central feature of obsessive-compulsive disorder.

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
  • 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
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