DSM-5-TR - Obsessive-Compulsive and Related Disorders

Obsessive-Compulsive Disorder

Core: Obsessions (intrusive, unwanted thoughts/urges/images) and/or compulsions (repetitive behaviors/mental acts to reduce anxiety or prevent harm; unrealistic/excessive).

Criteria:

Time-consuming (≥1 hr/day) or cause distress/impairment.

Not due to substance/medical condition.

Not better explained by another disorder.

Specifiers:

Insight: good/fair, poor, absent/delusional.

Tic-related: current/past tic disorder.

Common Themes: Contamination/cleaning, symmetry/ordering, harm/checking, taboo thoughts.Features: Sensory "not just right" feelings, inflated responsibility, perfectionism, thought-action fusion, avoidance, family accommodation.

Prevalence/Course: 1.2% US (similar worldwide); onset ~19 yrs, 25% before 14; chronic course; remission uncommon without treatment. Men earlier onset; women slightly higher adult prevalence.

Risk: Temperamental (negative emotionality, inhibition), environmental (trauma, perinatal issues), genetic (~40% heritable).Suicide: High risk (ideation ~44%, attempts ~14%), esp. with severe/taboo symptoms, comorbid depression, PTSD, substance use.

Impact: Major social/occupational impairment, avoidance, health issues (e.g., skin damage from washing), family dysfunction.

Diff Dx: GAD (real-life worries), MDD (rumination), BDD/trichotillomania/hoarding, eating disorders, tics/stereotypies, psychosis, OCPD (rigidity, no obsessions/compulsions).

Comorbidity: Anxiety (76%), depression/bipolar (63%), impulse-control (56%), substance use (39%), tic disorders (30%), OCPD (23-32%), ↑ in schizophrenia, bipolar, eating disorders, Tourette's.

Substance/Medication-Induced Obsessive-Compulsive

and Related Disorder

Core: Obsessions, compulsions, skin-picking, hair-pulling, or other repetitive behaviors predominate after substance intoxication, withdrawal, or medication exposure.

Criteria:

Symptoms develop during/soon after substance use/withdrawal/medication.

Substance/medication capable of producing symptoms.

Not better explained by primary OCD/related disorder (e.g., symptoms precede use or persist >1 month after cessation).

Not exclusive to delirium.

Cause distress/impairment.

Specifiers:

With onset during intoxication

With onset during withdrawal

With onset after medication use

Coding varies by substance (e.g., stimulants, cocaine, other/unknown) + comorbid use disorder severity (mild, moderate/severe, none).

Features:

Symptoms usually remit days-weeks after stopping substance/medication.

Must be clinically significant beyond typical intoxication/withdrawal effects.

Associated Substances/Toxins:

Stimulants (cocaine, amphetamines), other/unknown substances.

Heavy metals, toxins (e.g., pesticides, solvents).

Some prescribed medications (e.g., dopaminergic agents).

Prevalence: Rare in general population; more likely in clinical contexts.

Differential Dx:

Substance intoxication/withdrawal (diagnose only if symptoms predominate and are severe).

Primary OCD/related disorder (if onset precedes use or persists >1 month).

OCD/related disorder due to another medical condition (if due to illness, not medication).

Delirium (exclude if symptoms only during delirium).