With hoarding symptoms: It hoarding predominates in the clinical presentation.
With hair-pulling symptoms: If hair pulling predominates in the clinical presentation.
With skin-picking symptoms: It skin picking predominates in the clinical presenta- tion.
Coding note: Include the name of the other medical condition in the name of the mental disorder (e.g., 294.8 [F06.8] obsessive-compulsive and related disorder due to cerebral infarction). The other medical condition should be coded and listed separately immediately before the obsessive-compulsive and related disorder due to the medical condition (e.g., 438.89 [l69.398] cerebral infarction; 294.8 [F06.8] obsessive-compulsive and related dis- order due to cerebral infarction).
The essential feature of obsessive-compulsive and related disorder due to another medical condition is clinically significant obsessive-compulsive and related symptoms that are judged to be best explained as the direct pathophysiological consequence of another med— ical condition. Symptoms can include prominent obsessions, compulsions, preoccu- pations with appearance, hoarding, hair pulling, skin picking, or other body-focused repetitive behaviors (Criterion A). The judgment that the symptoms are best explained by the associated medical condition must be based on evidence from the history, physical ex- amination, or laboratory findings (Criterion B). Additionally, it must be judged that the symptoms are not better explained by another mental disorder (Criterion C). The diagno- sis is not made if the obsessive-compulsive and related symptoms occur only during the course of a delirium (Criterion D). The obsessive—compulsive and related symptoms must cause clinically significant distress or impairment in social, occupational, or other impor- tant areas of functioning (Criterion E).
In determining whether the obsessive-compulsive and related symptoms are attribut— able to another medical condition, a relevant medical condition must be present. Further- more, it must be established that obsessive-compulsive and related symptoms can be etiologically related to the medical condition through a pathophysiological mechanism and that this best explains the symptoms in the individual. Although there are no infallible guidelines for determining whether the relationship between the obsessive-compulsive and related symptoms and the medical condition is etiological, considerations that may provide some guidance in making this diagnosis include the presence of a clear temporal association between the onset, exacerbation, or remission of the medical condition and the obsessive-compulsive and related symptoms; the presence of features that are atypical of a primary obsessive—compulsive and related disorder (e.g., atypical age at onset or course); and evidence in the literature that a known physiological mechanism (e.g., striatal dam- age) causes obsessive-compulsive and related symptoms. In addition, the disturbance cannot be better explained by a primary obsessive-compulsive and related disorder, a sub- stance/medication-induced obsessive-compulsive and related disorder, or another men- tal disorder.
There is some controversy about whether obsessive-compulsive and related disorders can be attributed to Group A streptococcal infection. Sydenham’s chorea is the neurolog- ical manifestation of rheumatic fever, which is in turn due to Group A streptococcal in- fection. Sydenham’s chorea is characterized by a combination of motor and nonmotor features. Nonmotor features include obsessions, compulsions, attention deficit, and emo- tional lability. Although individuals with Sydenham’s chorea may present with non- neuropsychiatric features of acute rheumatic fever, such as carditis and arthritis, they may present with obsessive-compulsive disorder—like symptoms; such individuals should be diagnosed with obsessive-compulsive and related disorder due to another medical condition.