Obsessive-Compulsive Disorder (OCD) is an Axis I Anxiety Disorder in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV). Also common are washing rituals, which serve to remove “contamination” or “dirt” and thereby prevent a feared disaster (e.g., disease).
The primary diagnostic criteria are the existence of obsessions or compulsions, some degree of recognition of the irrationality of the behavior, and significant interference with everyday functioning. Other common compulsions include repeating compulsions or magical rituals in which ordinary actions (such as crossing a threshold or lifting an object) are repeated to prevent harm from occurring (e.g., a loved one dying in an accident).
Often, patients report more than one type of obsession and ritual, and sometimes the content of the obsession or compulsion changes (e.g., cleaning to checking).
The content of obsessions and compulsions vary considerably from patient to patient, sharing only the disturbing nature of the intrusions and the ritualistic efforts to neutralize the obsessions.
For males, the mean age of onset is 14 to 19 years, while for females it is 21.7 to 22.0 years.
Most patients develop symptoms before age 25 (65%), and only a small number (15%) develop symptoms after age 35.Despite limited research on prediction of treatment outcome, mild or atypical symptoms, a short duration of symptoms, and a good premorbid personality appear to predict a good outcome.On the other hand, early onset in males, symmetry or exactness-related symptoms, symptoms of hopelessness, delusions or hallucinations, a family history of OCD, and the presence of tics suggest a poor prognosis.Individuals who did not recognize the irrationality of their thoughts were considered either psychotic or “overvalued” in their ideas about the obsessions.Recent research demonstrates that patients vary on this characteristic from complete awareness to complete lack of awareness of the rationality of the symptoms, with most having at least some insight.This criterion has changed somewhat in DSM-IV in that patients must have insight at least at some point in the disorder.DSM-IV added a category of “poor insight” for patients with OCD who do not recognize the unreasonableness of their behavior.Culture-specific beliefs, as illustrated by koro (a fear of penile shrinkage found exclusively in Chinese cultures), also suggest the influence culture has on the expression of OCD symptoms.However, while these cultural variables may influence the symptom expression in OCD, there is little evidence to suggest they contribute to the development of the disorder.Epidemiological studies of community samples estimate the annual and lifetime prevalence rates to be considerably higher than previously thought (annual, 0.8 to 2.3%; lifetime, 1.9 to 3.3%).Prevalence rates in this range have been replicated in a variety of studies throughout the world.