Obsessive-Compulsive Disorder

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), published by the American Psychiatric Association, establishes five diagnostic criteria used by clinicians in diagnosing obsessive-compulsive disorder. First, the individual must have either obsessions or compulsions described as follows: obsessions are recurrent, persistent thoughts that are intrusive and cause marked anxiety. These thoughts and images are not merely excessive worrying about “real” problems and originate from the individual. The individual makes an attempt to suppress the thoughts and images with another action. Compulsions are defined as repetitive behaviors or mental acts that an individual feels compelled to perform in response to an obsession even though the acts are not connected in a clear way to the obsession. Second, the person comes to the realization at some point in the course of the disorder that his or her behaviors are excessive. Third, the obsessions and compulsions become time consuming and significantly disrupt routine activities. Finally, the obsessive-compulsive behavior is not limited to another Axis I diagnosis if present nor is the behavior directly linked to the effects of another substance (e.g., drugs or medication).

Epidemiology, Cause, and Clinical Features

Obsessive-compulsive disorder affects over 2 million adult Americans and has a lifetime prevalence of 2 to 3 percent in the United States. These rates are consistent with those in Europe, Africa, Canada, and the Middle East, while estimated rates in Asian countries are slightly lower.

Although obsessive-compulsive disorder is a lifetime illness, its prevalence in young adults is twice that seen in older adults. Obsessive-compulsive disorder often appears in childhood, adolescence, or young adulthood and may be accompanied by other anxiety disorders such as eating disorders. In fact, disorders whose features are shared with obsessive-compulsive disorder (e.g., somatoform disorders, neurologic disorders, eating disorders, and impulse control disorders) have been categorized as “obses-sive-compulsive spectrum disorders.”

Obsessive-compulsive disorder affects men and women in different proportions, depending on the age of onset. Of those individuals whose onset is in childhood or early adolescence, males are disproportionately affected. Women have a slightly higher prevalence of obsessive-compulsive disorder in the adult population.

Specific obsessions that occur commonly in ob-sessive-compulsive disorder include contamination fears and pathological doubt (irrational fears that something is wrong). The need for symmetry, fears of endangerment to self or to others, and sexual concerns occur less often.

...