7 Key Insights on OCD and Related Disorders from a Therapist
Obsessive-Compulsive Disorder (OCD) and its related conditions are among the most misunderstood and stigmatised mental health issues. These disorders manifest in various ways and can significantly disrupt daily life for those affected. Mental health professionals refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to provide clarity and enhance the accuracy of diagnoses.
But how does DSM-5 define OCD and related disorders? And what should individuals, students, and professionals understand about these classifications? This article explores how OCD and related disorders are currently classified in the DSM-5, offering a detailed overview of their diagnostic criteria, associated specifiers, and updates from previous editions.
Read on if you’re looking for clarity about these disorders, how they fit into the DSM framework, and their implications for treatment.
What is the DSM-5, and Why Does It Matter?
The DSM-5 is a critical tool in psychology and psychiatry for diagnosing and classifying mental disorders. Published by the American Psychiatric Association (APA), it provides standardised criteria that mental health professionals rely on to identify and treat conditions effectively.
The fifth edition, released in 2013, introduced significant updates, particularly the decision to classify OCD and related disorders as their distinct category. Previously, OCD was grouped under anxiety disorders in the DSM-IV, a shift that underscores the evolving understanding of these conditions.
Now, let’s break down the major disorders categorised under the OCD spectrum in DSM-5.
OCD in DSM-5: Diagnostic Criteria and Specifiers
The hallmark of Obsessive-Compulsive Disorder is the presence of obsessions, compulsions, or both. Here’s what DSM-5 specifies:
Diagnostic Criteria for OCD
- Obsessions are intrusive, recurring thoughts, images, or urges that cause significant distress. Individuals attempt to suppress or neutralise these thoughts with another action (a compulsion).
- Compulsions are repetitive behaviours (e.g., handwashing, checking, organising) or mental acts (e.g., praying, counting) aimed at reducing distress or preventing a feared event. These actions are often not logically connected to the feared event they intend to prevent.
- The obsessions or compulsions are time-consuming (e.g., taking more than one hour per day) or cause significant distress or impairment in social, occupational, or other important areas of functioning.
- Symptoms are not attributable to the physiological effects of a substance or another medical condition.
Specifiers for OCD
The DSM-5 allows practitioners to specify certain factors that may influence the diagnosis, including:
- With good or fair insight: The individual recognises their OCD beliefs are not true or may not be true.
- With poor insight: The individual believes their OCD beliefs are probably true.
- With absent insight/delusional beliefs: The person is completely convinced their OCD-related beliefs are true.
- Tic-related: The individual has a current or past history of a tic disorder.
Body Dysmorphic Disorder (BDD)
Body Dysmorphic Disorder is also classified within the OCD spectrum, as individuals experience obsessive preoccupation with perceived flaws in their appearance that others may not observe.
Diagnostic Criteria for BDD
- Preoccupation with one or more perceived defects or flaws in physical appearance.
- Repetitive behaviours include mirror checking, excessive grooming, or mental acts like comparing one’s appearance to others.
- Significant distress or impairment in functioning due to these preoccupations.
- The preoccupation is not better explained by concerns with body fat or weight (as in an eating disorder).
Specifiers for BDD
- With muscle dysmorphia: Preoccupation that one’s body build is too small or insufficiently muscular.
- Insight levels: With good, poor, or absent insight/delusional beliefs (similar to OCD).
Hoarding Disorder
Hoarding Disorder is characterised by persistent difficulty discarding possessions, regardless of their value. The behaviour results in clutter that compromises living spaces and creates serious functional issues.
Diagnostic Criteria for Hoarding Disorder
- Persistent difficulty discarding or parting with possessions, regardless of their actual value.
- Perceived need to save items and distress associated with discarding them.
- Accumulation of objects leads to cluttered living spaces that are unsafe or unusable.
- Symptoms cause significant distress or impair social, occupational, or other important areas of functioning.
Specifiers for Hoarding Disorder
- With excessive acquisition: Difficulty discarding items is accompanied by excessive acquisition of items not needed or with no space for them.
- Insight levels (good, poor, or absent).
Trichotillomania (Hair-Pulling Disorder)
Trichotillomania involves recurrent, compulsive hair-pulling, leading to hair loss. It’s often a response to emotional triggers like anxiety or boredom.
Diagnostic Criteria for Trichotillomania
- Recurrent pulling out of hair, resulting in hair loss.
- Repeated attempts to decrease or stop hair-pulling.
- Significant distress or impairment in functioning.
- Symptoms are not attributable to another medical condition or mental disorder.
Excoriation (Skin-Picking Disorder)
Excoriation Disorder is similar to Trichotillomania but involves compulsive skin-picking that results in damage.
Diagnostic Criteria for Excoriation
- Recurrent skin-picking resulting in skin lesions.
- Repeated attempts to decrease or stop the behaviour.
- Significant distress or impairment in functioning.
- Symptoms are not better explained by another mental disorder or medical condition.
Other Specified and Unspecified OCD-Related Disorders
The DSM-5 allows for diagnoses of Other Specified Obsessive-Compulsive and Related Disorders when symptoms don’t fully meet the diagnostic criteria for any specific condition but still cause significant distress or impairment.
Examples include body-focused repetitive behaviours (e.g., nail-biting, lip-biting) or obsessional jealousy. Unspecified Disorders are used when these disorders meet clinical attention, but insufficient information is available for a more precise diagnosis.
Key Changes from DSM-IV to DSM-5
The DSM-5 brings several important changes to OCD classification. Most notably, OCD and related disorders have been elevated out of the “anxiety disorders” category to form their own chapter. This organisational shift reflects a deeper understanding of the unique mechanisms and symptomatology of OCD compared to anxiety conditions.
Additionally, conditions like Hoarding Disorder, previously considered a subset of OCD, have been given standalone status. Excoriation Disorder was also officially recognised as a distinct diagnosis in the DSM-5.
What This Means for Diagnosis and Treatment
The DSM-5 classification offers greater precision in diagnosing OCD-related disorders, which significantly impacts treatment options. By recognising varied insight levels, clinicians can tailor therapies like Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), or pharmacological interventions such as Selective Serotonin Reuptake Inhibitors (SSRIs) to a patient’s specific needs.
Furthermore, separating OCD-related disorders into their own category reduces the stigma associated with misdiagnosis and offers patients validation that their experiences are understood at a deeper clinical level.
Empowering Treatment Through Understanding
OCD and related disorders can significantly impact the quality of life, but advances in their classification and understanding are leading to better outcomes for countless people. Whether you’re navigating these conditions personally, advancing your mental health education, or providing support as a professional, understanding the DSM-5 classifications is essential.
If you’re experiencing OCD-related symptoms, or if you’re a mental health professional seeking tailored treatment strategies, consider consulting a therapist or psychiatrist familiar with the DSM-5 updates.
By deepening our understanding of these disorders, we can provide more humane, effective care and ultimately empower those affected to live fuller, healthier lives.