Obsessive-compulsive and related disorder (i.e., not induced by a substance). Sub- stance/ medication-induced obsessive-compulsive and related disorder is judged to be etiologically related to the substance/medication. Substance/medication-induced obses- sive-compulsive and related disorder is distinguished from a primary obsessive-compul- sive and related disorder by considering the onset, course, and other factors with respect to substances/ medications. For drugs of abuse, there must be evidence from the history, physical examination, or laboratory findings for use or intoxication. Substance/medica— tion-induced obsessive-compulsive and related disorder arises only in association with in- toxication, whereas a primary obsessive-compulsive and related disorder may precede the onset of substance/medication use. The presence of features that are atypical of a primary obsessive-compulsive and related disorder, such as atypical age at onset of symptoms, may suggest a substance-induced etiology. A primary obsessive-compulsive and related disorder diagnosis is warranted if the symptoms persist for a substantial period of time (about 1 month or longer) after the end of the substance intoxication or the individual has a history of an obsessive-compulsive and related disorder.
Obsessive-compulsive and related disorder due to another medical condition. If the obsessive-compulsive and related disorder symptoms are attributable to another medical condition (i.e., rather than to the medication taken for the other medical condition), obses- sive-compulsive and related disorder due to another medical condition should be diag- nosed. The history often provides the basis for judgment. At times, a change in the treatment for the other medical condition (e.g., medication substitution or discontinua- tion) may be needed to determine whether or not the medication is the causative agent (in which case the symptoms may be better explained by substance/medication-induced ob- sessive-compulsive and related disorder). If the disturbance is attributable to both another medical condition and substance use, both diagnoses (i.e., obsessive-compulsive and related disorder due to another medical condition and substance/medication-induced obsessive- compulsive and related disorder) may be given. When there is insufficient evidence to de- termine whether the symptoms are attributable to either a substance/medication or an- other medical condition or are primary (i.e., attributable to neither a substance/medication nor another medical condition), a diagnosis of other specified or unspecified obsessive- compulsive and related disorder would be indicated.
Delirium. If obsessive-compulsive and related disorder symptoms occur exclusively during the course of delirium, they are considered to be an associated feature of the delir- ium and are not diagnosed separately.
Due to Another Medical Condition
Diagnostic Criteria 294.8 (F06.8)
A. Obsessions, compulsions. preoccupations with appearance, hoarding, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorder predominate in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder.
Obsessive-Compulsive and Related Disorder Due to Another Medical Condition 261
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
Specify it:
With obsessive-compulsive disorder—like symptoms: It obsessive-compulsive dis- order—like symptoms predominate in the clinical presentation.
With appearance preoccupations: If preoccupation with perceived appearance de- fects or flaws predominates in the clinical presentation.