DSM IV Definition of Obsessive-Compulsive Disorder

"The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions that are severe enough to be time-consuming or cause marked distress or impairment (DSM-IV)."

Diagnostic Criteria:

A. Either obsessions or compulsions
B. At some point during the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not necessarily apply to children
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day) or significantly interfere with a person’s normal routine, occupational (or academic) functioning, or usual social activities and relationships.
D. If another Axis I disorder (psychiatric disorder) is present, the content of the obsessions or compulsions is not restricted to it.
E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Further explanation of OCD’s definition:

Obsessions or compulsions are the main element of OCD. Obsessions are "persistent" ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress (DSM-IV)." Thus a pleasant recurrent thought would not be considered an obsession, even if it took up a large amount of time, because an obsession is defined as being unpleasant. Compulsions are "repetitive behaviors or mental acts the goal of which is to reduce anxiety or distress, not to provide pleasure or gratification. In most cases, the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event or situation (DSM-IV)." However, many children can only say that they must repeat the compulsion until "it feels right." The source of children’s compulsions may not necessarily be a specific obsession. As with obsessions, if an individual enjoys a repetitive behavior such as counting, or a mental act such as praying, then it would not be described as a compulsion, even though it might take up a lot of time. Both must be deemed unpleasant in order to qualify as obsessions or compulsions.

The diagnostic criteria for OCD only require that an individual have one obsession or compulsion, but it is common for people to have more than one. For some individuals the obsessions and compulsions may be inter-related, but for others they are not. A typical example of an interrelated obsession and compulsion is a person who obsesses about germs and compulsively washes her hands. This person reduces her anxiety caused by the fear of germs through her repetitive hand-washing.

Adults with OCD must recognize at some point that their obsessions or compulsions are not reasonable. However, this insight may not always be present. Thus an adult who is not currently washing her hands compulsively should recognize at some point that this compulsion is excessive, but she may not be able to maintain this insight during an actual hand-washing episode. The insight requirement does not apply to children, because children may not have the necessary cognitive understanding to gain this type of discernment.

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