Unwanted, persistent intrusive thoughts and impulses and repetitive actions intended to suppress them. (Presence of obsessions, compulsions or both).
Obsessions can be defined by:
- Recurrent and persistent thoughts, impulses, or images
- More than just excessive worries about real-life problems
- Attempts to ignore, suppress, or neutralize them
To be diagnosed with OCD, the patient must have:
- Compulsions in the form of repetitive behaviors/mental acts the person feels driven to perform these in response to the obsession or according to rigid rules.
- The patient must recognize that these obsessions and compulsions are excessive or unreasonable.
- The thoughts, impulses, or behaviors cause marked distress, consume more than an hour a day, OR cause marked impairment in functioning
Another type of way to categorize OCD by isolating two types of OCD:
Autogenous Obsessions - Highly aversive and unacceptable (ego-dystonic) mental intrusions (thoughts, images, or impulses) that tend to be perceived as threatening in their own right;
- Usually contain repulsive themes concerning unacceptable sexual behavior, aggression, sacrilege
- Threat perceptions focused on the intrusions themselves
- Can occur w/o clear antecedents or be triggered by stimuli that are unrealistically or remotely related to the content of the intrusion
- Often show a loose conceptual match between the perceived threat and neutralizing compulsion. I.e. touching the corners in a room will translate to your parents being safe.
- Reactive Obsessions - More realistic aversive thoughts, doubts, or concerns in which the perceived threat is not the obsession itself, but rather the trigger of the obsession or some associated negative consequence that is possible (but improbable);
- Examples include thoughts, concerns, or doubts about contamination, mistakes, accidents, asymmetry.
- They are perceived as relatively realistic and likely to come true , thus prompting corrective actions aimed at altering the situation back to a safe or desired state;
- They are more likely to occur in response to explicit cues;
- There is a more realistic link between the obsessions and the cues that trigger them.
- More likely to show a stronger conceptual match between the perceived threat and neutralizing compulsion. I.e. hitting bumps on the road likely leads to problems with your car.
One or more non-bizarre delusions. Life functioning is not markedly impaired and hallucinations not prominent. Delusions are beliefs that are contrary to reality and not generally held by other members of society.
- Delusions, which are situations that can occur in real life, such as being followed and watched, deceived by spouse, having a rare disease, or grandiose ideas. In some cases the delusions might be bizarre
- Have never had schizo symptoms
> not likely to have hallucinations, disorganized speech, disorganized/catatonic behavior, or negative symptoms
- Functioning is not badly impaired apart from the delusions—persecutory, grandiose, jealousy or somatic
Specifier: Bizarre Delusions
A severe psychotic disorder that involves the presence of two or more positive, negative and psychomotor symptoms for at least one month, but should not be diagnosed unless present for six months
> May have the following:
- Delusions (persecution, reference, grandeur)
- Hallucinations (auditory, visual)
- Disorganized speech (neologisms, clanging, word salad)
- Disorganized or catatonic behavior
- Negative symptoms
- Psychomotor symptoms
> Symptoms cause severe dysfunction in several domains of life—social, occupational, primary.
> Duration: Symptoms last at least 6 months, which includes at least 1 month of characteristic symptoms
> In DSM-5 the subtypes of schizophrenia have been eliminated (paranoid, disorganized, catatonic), but there is a catatonia specifier.