OBSESSIVE-COMPULSIVE AND

RELATED DISORDERS
 OBSESSIVE-COMPULSIVE DISORDER

A. A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):
A. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as
intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
B. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some
other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (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 behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded
event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are
designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
 OBSESSIVE-COMPULSIVE DISORDER

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., a drug of abuse, a medication) or another medical
condition.
D. The disturbance is not better explained by the symptoms of another mental
disorder
 OBSESSIVE-COMPULSIVE DISORDER

 Specify if:
 With good or fair insiglit: The individual recognizes that obsessive-compulsive
disorder beliefs are definitely or probably not true or that they may or may not be
true.
 With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
probably true.
 With absent insight/deiusionai beiiefs: The individual is completely convinced
that obsessive-compulsive disorder beliefs are true.
 Specify if:
 Tic-related: The individual has a current or past history of a tic disorder.
 BODY DYSMORPHIC DISORDER

A. Preoccupation with one or more perceived defects or flaws in physical appearance that
are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive
behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking)
or mental acts (e.g., comparing his or her appearance with that of others) in response to
the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or
weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
 BODY DYSMORPHIC DISORDER

 Specify if:
 With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is
too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with
other body areas, which is often the case.
 Specify if:
 Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., “I look ugly” or
“I look deformed”).
 With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are
definitely or probably not true or that they may or may not be true.
 With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably
true.
 With absent insight/delusional beliefs: The individual is completely convinced that the body
dysmorphic disorder beliefs are true.
 HOARDING DISORDER

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.
B. This difficulty is due to a perceived need to save the items and to distress associated with discarding
them.
C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter
active living areas and substantially compromises their intended use. If living areas are uncluttered, it is
only because of the interventions of third parties (e.g., family members, cleaners, authorities).
D. The hoarding causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning (including maintaining a safe environment for self and others).
E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular
disease, Prader-Willi syndrome).
F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in
obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in
schizophrenia or another psychotic disorder, cognitive deficits in major neurocognitive disorder,
restricted interests in autism spectrum disorder).
 HOARDING DISORDER

 Specify if:
 With excessive acquisition: If difficulty discarding possessions is accompanied by excessive
acquisition of items that are not needed or for which there is no available space.
 Specify if:
 With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors
(pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.
 With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors
(pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic
despite evidence to the contrary.
 With absent insight/delusional beliefs: The individual is completely convinced that hoarding-
related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive
acquisition) are not problematic despite evidence to the contrary.
 TRICHOTILLOMANIA (HAIR-PULLING
DISORDER)
A. Recurrent pulling out of one’s hair, resulting in hair loss.
B. Repeated attempts to decrease or stop hair pulling.
C. The hair pulling causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a
dermatological condition).
E. The hair pulling is not better explained by the symptoms of another mental disorder
(e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic
disorder).
 EXCORIATION (SKIN-PICKING) DISORDER

A. Recurrent skin picking resulting in skin lesions.

B. Repeated attempts to decrease or stop skin picking.
C. The skin picking causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The skin picking is not attributable to the physiological effects of a substance (e.g.,
cocaine) or another medical condition (e.g., scabies).
E. The skin picking is not better explained by symptoms of another mental disorder (e.g.,
delusions or tactile hallucinations in a psychotic disorder, attempts to improve a
perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in
stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).
 SUBSTANCE/MEDICATION-INDUCED
OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
A. Obsessions, compulsions, skin picking, hair pulling, other body-focused
repetitive behaviors, or other symptoms characteristic of the obsessive-
compulsive and related disorders predominate in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings
of both (1)and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or
withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
 SUBSTANCE/MEDICATION-INDUCED
OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
C. The disturbance is not better explained by an obsessive-compulsive
and related disorder that is not substance/medication-induced. Such
evidence of an independent obsessive- compulsive and related
disorder could include the following: The symptoms precede the
onset of the substance/medication use; the symptoms persist for a
substantial period of time (e.g., about 1 month) after the cessation of
acute withdrawal or severe intoxication; or there is other evidence
suggesting the existence of an independent non-
substance/medication-induced obsessive-compulsive and related
disorder (e.g., a history of recurrent non-substance/medication
related episodes).
 SUBSTANCE/MEDICATION-INDUCED
OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Note: This diagnosis should be made in addition to a diagnosis of substance intoxication
or substance withdrawal only when the symptoms in Criterion A predominate in the
clinical picture and are sufficiently severe to warrant clinical attention.
SUBSTANCE/MEDICATION-INDUCED
OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
 SUBSTANCE/MEDICATION-INDUCED
OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
 Specify if (see Table 1 in the chapter “Substance-Related and Addictive Disorders” for
diagnoses associated with substance class):

 With onset during intoxication: If the criteria are met for intoxication with the
substance and the symptoms develop during intoxication.
 With onset during withdrawal: If criteria are met for withdrawal from the substance
and the symptoms develop during, or shortly after, withdrawal.
 With onset after medication use: Symptoms may appear either at initiation of
medication or after a modification or change in use.
 OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
DUE TO ANOTHER MEDICAL CONDITION
A. Obsessions, compulsions, preoccupations with appearance, hoarding, skin picking, hair
pulling, other body-focused repetitive behaviors, or other symptoms characteristic of
obsessive-compulsive and related disorder predominate in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings that the
disturbance is the direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 OBSESSIVE-COMPULSIVE AND RELATED
DISORDER
DUE TO ANOTHER MEDICAL CONDITION
Specify if:
 With obsessive-compulsive disorder-like symptoms: If obsessive-compulsive disorder- like
symptoms predominate in the clinical presentation.
 With appearance preoccupations: If preoccupation with perceived appearance defects or flaws
predominates in the clinical presentation.
 With hoarding symptoms: If hoarding predominates in the clinical presentation.
 With hair-pulling symptoms: If hair pulling predominates in the clinical presentation.
 With skin-picking symptoms: If skin picking predominates in the clinical presentation.
 Coding note: Include the name of the other medical condition in the name of the mental disorder
(e.g., 294.8 [F06.8] obsessive-compulsive and related disorder due to cerebral infarction). The
other medical condition should be coded and listed separately immediately before the obsessive-
compulsive and related disorder due to the medical condition (e.g.,438.89 [169.398] cerebral
infarction; 294.8 [F06.8] obsessive-compulsive and related disorder due to cerebral infarction).
 OTHER SPECIFIED OBSESSIVE-COMPULSIVE
AND RELATED DISORDER
 This category applies to presentations in which symptoms characteristic of an
obsessive-compulsive and related disorder that cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the
obsessive-compulsive and related disorders diagnostic class. The other specified
obsessive-compulsive and related disorder category is used in situations in which
the clinician chooses to communicate the specific reason that the presentation does
not meet the criteria for any specific obsessive-compulsive and related disorder. This
is done by recording “other specified obsessive-compulsive and related disorder”
followed by the specific reason (e.g., “body-focused repetitive behavior disorder”).
 OTHER SPECIFIED OBSESSIVE-COMPULSIVE
AND RELATED DISORDER
 Examples of presentations that can be specified using the “other
specified” designation include the following:
1. Body dysmorphic-like disorder with actual flaws: This is similar to body
dysmorphic disorder except that the defects or flaws in physical
appearance are clearly observable by others (i.e., they are more
noticeable than “slight”). In such cases, the preoccupation with these
flaws is clearly excessive and causes significant impairment or distress.
 OTHER SPECIFIED OBSESSIVE-COMPULSIVE
AND RELATED DISORDER
1. Body dysmorphic-like disorder without repetitive behaviors: Presentations that
meet body dysmorphic disorder except that the individual has not performed
repetitive behaviors or mental acts in response to the appearance concerns.
2. Body-focused repetitive behavior disorder: This is characterized by recurrent body
focused repetitive behaviors (e.g., nail biting, lip biting, cheek chewing) and
repeated attempts to decrease or stop the behaviors. These symptoms cause
clinically significant distress or impairment in social, occupational, or other
important areas of functioning and are not better explained by trichotillomania
(hair-pulling disorder), excoriation (skin picking) disorder, stereotypic movement
disorder, or nonsuicidal self-injury.
 OTHER SPECIFIED OBSESSIVE-COMPULSIVE
AND RELATED DISORDER
4. Obsessional jealousy: This is characterized by nondelusional preoccupation with
a partner’s perceived infidelity. The preoccupations may lead to repetitive
behaviors or mental acts in response to the infidelity concerns; they cause
clinically significant distress or impairment in social, occupational, or other
important areas of functioning; and they are not better explained by another
mental disorder such as delusional disorder, jealous type, or paranoid
personality disorder.
5. Shubo-kyofu: A variant of taijin kyofusho (see “Glossary of Cultural Concepts of
Distress” in the Appendix) that is similar to body dysmorphic disorder and is
characterizedby excessive fear of having a bodily deformity.
 OTHER SPECIFIED OBSESSIVE-COMPULSIVE
AND RELATED DISORDER
4. Koro: Related to dhat syndrome (see “Glossary of Cultural Concepts of
Distress” in the Appendix), an episode of sudden and intense anxiety
that the penis (or the vulva and nipples in females) will recede into
the body, possibly leading to death.
5. Jikoshu-kyofu: A variant of taijin l<yofusho (see “Glossary of Cultural
Concepts of Distress” in the Appendix) characterized by fear of
having an offensive body odor (also termed olfactory reference
syndrome).
 UNSPECIFIED OBSESSIVE-COMPULSIVE
AND RELATED DISORDER
 This category applies to presentations in which symptoms characteristic of an
obsessive-compulsive and related disorder that cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning
predominate but do not meet the full criteria for any of the disorders in the
obsessive-compulsive and related disorders diagnostic class. The unspecified
obsessive-compulsive and related disorder category is used in situations in which the
clinician chooses not to specify the reason that the criteria are not met for a specific
obsessive-compulsive and related disorder, and includes presentations in which there
is insufficient information to make a more specific diagnosis (e.g., in emergency room
settings).