Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health

DSM-IV	DSM-5
Disorder Class: Anxiety Disorders	Disorder Class: Obsessive-Compulsive and Related Disorders

Either obsessions or compulsions:	Presence of obsessions, compulsions, or both:
Obsessions as defined by (1),(2), (3) and (4):	Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.	1. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.	DROPPED
3. The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.	2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).
4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as with thought insertion).	DROPPED

Compulsions as defined by (1) and (2):	Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.	1. SAME
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.	2. SAME

At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.	DROPPED

The obsessions and compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.	The obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder, hair pulling in the presence of trichotillomania; concern with appearance in the presence of body dysmorphic disorder: preoccupation with drugs in the presence of a substance use disorder: preoccupation with having a serious illness in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a paraphilia: or guilty ruminations in the presence or major depressive disorder).	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 possession, 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; 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).
The disturbance is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition.	SAME
Specify if: With poor insight: If, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable.	Specify if: With good or fair insight: The individual recognizes that obsessive-compulsive 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.

DSM-IV

DSM-5

Disorder Class: Anxiety Disorders

Disorder Class: Obsessive-Compulsive and Related Disorders

Either obsessions or compulsions:

Presence of obsessions, compulsions, or both:

Obsessions as defined by (1),(2), (3) and (4):

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.

1. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.

2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.

DROPPED

3. The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).

4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as with thought insertion).

DROPPED

Compulsions as defined by (1) and (2):

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.

1. SAME

2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

2. SAME

At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

DROPPED

The obsessions and compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.

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

If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder, hair pulling in the presence of trichotillomania; concern with appearance in the presence of body dysmorphic disorder: preoccupation with drugs in the presence of a substance use disorder: preoccupation with having a serious illness in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a paraphilia: or guilty ruminations in the presence or major depressive disorder).

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 possession, 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; 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).

The disturbance is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition.

SAME

Specify if:
With poor insight: If, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable.

Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive 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.

From: 3, Mental Illness

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Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet].

Table 3.13DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison

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