Obsessive-Compulsive and Related Disorders: Introduction
Conditions which fall within the category of Obsessive-Compulsive and Related Disorders all share some key features of obsessions and compulsions. Obsessions are recurrent, persistent and intrusive anxiety provoking thoughts or images resulting in subsequent repetitive behaviors referred to as compulsions. Obsessions may include thoughts, feelings, ideas and sensations that compel a person to do specific behaviors or compulsions. Some of the more common obsessions include excessive counting, ruminating about physical flaws, hoarding and picking at one’s skin. Some of the resulting rituals which are common among individuals diagnosed with obsessive-compulsive disorder frequently include recurrent handwashing, frequently checking doors and locks and avoidance of specific situations. For an individual to be considered for a diagnosis of obsessive-compulsive disorder it must be disruptive to their daily existence and functioning. Disorders listed in this category all share the common feature of excessive preoccupation along with the subsequent engagement in repetitive behaviors.
Changes from the DSM-4 TR to the DSM-5:
There were significant changes from previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Obsessive-compulsive disorder was previously classified in the DSM-4 TR as an anxiety disorder. The new DSM-5 has created a standalone chapter separate from the other anxiety disorders. This also follows revisions within the ICD 10 CM which also classifies OCD separately from anxiety disorders. However, there should never be any confusion as to the close relationship between obsessive-compulsive disorders and anxiety disorders. When the separation of obsessive-compulsive disorder from anxiety disorders was anticipated prior to the publication of the new DSM-5, psychiatrists supported the move significantly more often than other mental health clinicians, with only 40% to 45% of other mental health professionals supporting the move to the new category. Many psychologists, counselors and other mental health professionals did not support the change because of the fact that most treatment protocols for obsessive-compulsive disorder are also similar for anxiety and other related disorders. As is the case with most anxiety related disorders and depression, comorbidity is frequently the rule rather than the exception.
Some of the new disorders that fall within this category include excoriation (skin picking) disorder, substance/medication -induced obsessive compulsive and related disorder, hoarding disorder and obsessive-compulsive and related disorder due to another medical condition. Also, the diagnosis of trichotillomania (hair pulling disorder) was moved from the DSM-4 TR classification of impulse control disorders to this new classification of Obsessive-Compulsive and Related Disorders in the DSM-5.
An important aspect of diagnosis is to differentiate obsessive-compulsive disorder from other mental health disorders by the key features of obsessive preoccupation and repetitive behaviors. Once this has been accomplished, diagnosis can proceed.
Diagnosis of obsessive-compulsive disorder can be challenging in that there is a high level of comorbidity with other diagnosis. It is very common for a person with this diagnosis to also exhibit
symptoms of anxiety disorders and depression; eating disorder; somatoform disorder; hypochondriasis; impulse-control disorder, especially kleptomania; and attention deficit hyperactivity disorder (ADHD). Also, there is a significant amount of literature considering the comorbidity between obsessive-compulsive disorder and Tourette’s syndrome.
It has been estimated that as many as one in 100 or 2 to 3 million adults currently have obsessive-compulsive disorder. Among children it is estimated that nearly one in 200 or 500,000 children and adolescents may receive this diagnosis. These estimates do not include other related disorders. Hoarding is believed to affect about 4% of the general population. Trichotillomania may affect as many as 2.5 million Americans, and as many as 3.8% of college students are believed to exhibit symptoms of excoriation.
Treatment for Obsessive-Compulsive and Related Disorders:
The most commonly reported treatments include a combination of medication and psychological treatments. Some studies have found cognitive behavioral therapy to be more effective than treatment with drugs or often has been found to be an appropriate replacement after the initial symptoms have been reduced. The International Obsessive-Compulsive Disorder Foundation has recommended exposure and response prevention (ERP), which is a type of cognitive behavioral therapy and has concluded that this type of therapy may reduce the symptoms by as much as 60% to 80% for active participants in therapy.
General information on obsessive-compulsive disorder can be found on subsequent pages along with information specific to each diagnosis within the new DSM-5 category of Obsessive-Compulsive and Related Disorders.
Obsessive-Compulsive and Related Disorders DSM-5 Diagnostic Codes:
300.3 (F42) Obsessive-Compulsive Disorder
Specify if: Tic-related
300.7 (F45.22) Body Dysmorphic Disorder
Specify if: With muscle dysmorphia
300.3 (F42) Hoarding Disorder
Specify if: With excessive acquisition
312.39 (F63.2) Trichotillomania (hair pulling disorder)
698.4 (L96.1) Excoriation (skin picking) Disorder
294.8 (F06.8) Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
Specify if: With obsessive-compulsive disorder-like symptoms, With appearance preoccupations, With hoarding symptoms, With hair pulling symptoms, With skin picking symptoms.
300.3 (F42) Other Specified Obsessive-Compulsive and Related Disorder
300.3 (F42) Unspecified Obsessive-Compulsive and Related Disorder
Diagnostic Information and Criterion for Obsessive-Compulsive and Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist