OCD DSM-5-TR Criteria 🧠

Diagnostic Framework

The DSM-5-TR describes OCD as a disorder involving obsessions, compulsions, or both. Diagnosis requires that the symptoms meet the criteria below and cause clinically significant distress or impairment. The criteria are presented in clinician-friendly language while preserving the DSM-5-TR diagnostic requirements.

A. Presence of Obsessions, Compulsions, or Both

Obsessions are defined by both of the following:

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 the thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by both of the following:

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, they are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Clinical note: Young children may not be able to articulate the aims of their compulsive behaviors or mental acts.

B. Time-Consuming, Distressing, or Impairing Symptoms

The obsessions or compulsions are time-consuming (e.g., taking more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Substance / Medical Exclusion

The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse or medication) or another medical condition.

D. Differential Diagnosis / Other Mental Disorder Exclusion

The disturbance is not better explained by the symptoms of another mental disorder. Differential considerations include:

• 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
• Repetitive patterns of behavior, as in autism spectrum disorder

DSM-5-TR Specifier: Insight

Specify the individual's level of insight regarding OCD beliefs:

• With good or fair insight: The individual recognizes that OCD beliefs are definitely or probably not true, or that they may or may not be true.
• With poor insight: The individual thinks OCD beliefs are probably true.
• With absent insight/delusional beliefs: The individual is completely convinced that OCD beliefs are true.

DSM-5-TR Specifier: Tic-Related

Specify tic-related when the individual has a current or past history of a tic disorder.

F Code / ICD-10-CM

F42 — Obsessive-compulsive disorder

Common F42 subcodes used for obsessive-compulsive and related disorders include:

• F42.2 — Mixed obsessional thoughts and acts — both obsessions and compulsions are present.
• F42.3 — Hoarding disorder
• F42.4 — Excoriation (skin-picking) disorder
• F42.8 — Other obsessive-compulsive disorder
• F42.9 — Obsessive-compulsive disorder, unspecified

When documenting the diagnosis, use the most specific applicable ICD-10-CM code and include applicable DSM-5-TR specifiers for insight and tic-related status as clinically appropriate.

Clinical Notes

• OCD symptoms may involve both observable compulsions and covert mental compulsions.
• Intrusive thoughts alone do not establish OCD; assessment should determine whether the thoughts are recurrent, persistent, intrusive, unwanted, distressing, and associated with attempts to suppress or neutralize them, when applicable.
• Compulsions may be behavioral or mental and may be difficult for others to observe.
• Avoidance and reassurance seeking may function as compulsive or neutralizing responses and should be assessed in the context of the individual's symptom pattern.
• A disturbing intrusive thought involving harm, sexuality, religion, illness, or another taboo theme does not by itself establish intent or risk.
• Differential diagnosis is essential when symptoms overlap with anxiety, depressive, psychotic, eating, neurodevelopmental, or related disorders.

Clinical Reminder: DSM-5-TR criteria support diagnostic assessment; they do not determine treatment goals. Treatment planning should be individualized to symptom function, impairment, developmental level, readiness, values, and clinical needs.