OBSESSIVE-COMPULSIVE and

RELATED DISORDER

DR. VITA CAMELLIA, M.KED., SP. KJ

OBSESSIVE-COMPULSIVE DISORDER
Diagnostic Criteria
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. 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.
2. 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.
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
 Excessive worries, as in generalized anxiety disorder
 Preoccupation with appearance, as in body dysmorphic disorder;
 Difficulty discarding or parting with possessions, as in hoarding disorder
 Hair pulling, as in trichotillomania [hair-pulling disorder]
 Skin picking, as in excoriation [skin-picking] disorder
 Stereotypies, as in stereotypic movement disorder
 Ritualized eating behavior, as in eating disorder
 Preoccupation with substances or gambling, as in substance-related and addictive disorders
 Preoccupation with having an illness, as in illness anxiety disorder
 Sexual urges or fantasies, as in paraphilic disorders
 Impulses, as in disruptive, impulse-control, and conduct disorders
 Guilty ruminations, as in major depressive disorder
 Thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic
disorders
Specify if:
 Withgood or fair insight: 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.
 Withabsent insight/delusional beliefs: 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
Diagnostic Criteria
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
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
Diagnostic Criteria

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).
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)
Diagnostic Criteria

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
Diagnostic Criteria
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
Diagnostic Criteria

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.
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/medicationrelated episodes).
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.
Coding note: The ICD-9-CM and ICD-10-CM codes for the [specific substance/medication]- induced
obsessive-compulsive and related disorders are indicated in the table below. Note that the ICD-10-CM
code depends on whether or not there is a comorbid substance use disorder present for the same class of
substance. If a mild substance use disorder is comorbid with the substance-induced obsessive-compulsive
and related disorder, the 4th position character is “1,” and the clinician should record “mild [substance] use
disorder” before the substance-induced obsessive-compulsive and related disorder (e.g., “mild cocaine use
disorder with cocaine-induced obsessive-compulsive and related disorder”). If a moderate or severe
substance use disorder is comorbid with the substance-induced obsessive- compulsive and related disorder,
the 4th position character is “2,” and the clinician should record “moderate [substance] use disorder” or
“severe [substance] use disorder,” depending on the severity of the comorbid substance use disorder. If
there is no comorbid substance use disorder (e.g., after a one-time heavy use of the substance), then the 4th
position character is “9,” and the clinician should record only the substance-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
Diagnostic Criteria
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.
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 [I69.398] 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 obsessivecompulsive 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”).
 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.
2. 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.
3. Body-focused repetitive behavior disorder: This is characterized by recurrent bodyfocused 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 (skinpicking) disorder, stereotypic movement
disorder, or nonsuicidal self-injury.
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 characterized by excessive fear of having a bodily deformity.
6. 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.
7. Jikoshu-kyofu: A variant of taijin kyofusho (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).