Obsessive-Compulsive Disorder


Obsessive-Compulsive Disorder, Obsessions, Compulsions


Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both in the absence of another psychiatric disorder that better explains the symptoms ( Table 19.1 ). Obsessions are recurring intrusive thoughts, images, or impulses. Compulsions are repetitive, nongratifying behaviors that a person feels driven to perform in order to reduce or prevent distress or anxiety. In children, rituals or compulsive symptoms may predominate over worries or obsessions, and the child may attempt to ignore or neutralize an obsessive thought by performing compulsions. Symptoms may or may not be recognized as being excessive or unreasonable. Some of the most common examples of obsessions in children are fears of contamination, fears of dirt/germs, repeated doubts, a need for orderliness or precision, and aggressive thoughts. Common compulsions include grooming rituals (e.g., handwashing, showering, teeth brushing), ordering, checking, requesting or demanding reassurance, praying, counting, repeating words silently, and touching rituals.

TABLE 19.1

Diagnostic and Statistical Manual of Mental Disorders-5 Criteria for Diagnosis of Obsessive-Compulsive Disorder

  • A.

    Presence of either obsessions or 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., handwashing, 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 (taking >1 hour a 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 a general 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; skin picking, as in excoriation; stereotypies, as in stereotypical 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 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.

  • With absent 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.

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Jun 24, 2019 | Posted by in PEDIATRICS | Comments Off on Obsessive-Compulsive Disorder
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