DSM-5 Classification of OCD and Related Disorders
Obsessive-Compulsive Disorder (OCD)
Body Dysmorphic Disorder (BDD)
Hoarding Disorder
Trichotillomania (Hair-Pulling Disorder)
Excoriation (Skin-Picking) Disorder
Other Specified Obsessive-Compulsive and Related Disorders
Unspecified Obsessive-Compulsive and Related Disorder
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 (e.g.,
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 disorders; 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; or repetitive patterns of behavior, as in autism spectrum 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-reiated: The individual has a current or past history of a tic disorder.
Prevalence
The 12-month prevalence of OCD in the United States is 1.2%, with a similar prevalence
internationally (1.1%-1.8%). Females are affected at a shghtly higher rate than males in
adulthood, although males are more commonly affected in childhood.
Differential Diagnosis
Anxiety disorders
Major depressive disorder
Other obsessive-compulsive and related disorders
Eating disorders
Tics (in tic disorder) and stereotyped movements
Psychotic disorders
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 lool< 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/delusionai beliefs: The individual is completely convinced that the body
dysmorphic disorder beliefs are true.
Prevalence
The point prevalence among U.S. adults is 2.4% (2.5% in females and 2.2% in males).
Outside the United States (i.e., Germany), current prevalence is approximately 1.7%-1,8%,
with a gender distribution similar to that in the United States. The current prevalence is 9%-
15% among dermatology patients, 7%-8% among U.S. cosmetic surgery patients, 3%- 16%
among international cosmetic surgery patients (most studies), 8% among adult orthodontia
patients, and 10% among patients presenting for oral or maxillofacial surgery.
Differential Diagnosis
Eating disorders
Other obsessive-compulsive and related disorders
Illness anxiety disorder
Major depressive disorder
Anxiety disorders
Psychotic disorders
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/deiusionai 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.
Differential Diagnosis
Other medical conditions
Neurodevelopmental disorders
Schizophrenia spectrum and other psychotic disorders
Major depressive episode
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 non-suicidal self-injury).
