While the specific content of obsessions and compulsions varies among individuals, certain symptom dimensions are common in 0CD, including those of cleaning (contami- ing, ordering, and counting compulsions); forbidden or taboo thoughts (e.g., aggressive, sexual, and religious obsessions and related compulsions); and harm (e.g., fears of harm to oneself or others and related checking compulsions). The tic-related specifier of 0CD is used when an individual has a current or past history of a tic disorder.
Body dysmorphic disorder is characterized by preoccupation with one or more per- ceived defects or ﬂaws in physical appearance that are not observable or appear only slight to others, and by repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (e.g., comparing one’s appearance with that of other people) in response to the appearance concerns. The appearance preoccupations are not better explained by concerns with body fat or weight in an individual with an eat- ing disorder. Muscle dysmorphia is a form of body dysmorphic disorder that is character— ized by the belief that one’s body build is too small or is insufficiently muscular.
Hoarding disorder is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, as a result of a strong perceived need to save the items and to distress associated with discarding them. Hoarding disorder differs from normal collecting. For example, symptoms of hoarding disorder result in the accumula- tion of a large number of possessions that congest and clutter active living areas to the ex- tent that their intended use is substantially compromised. The excessive acquisition form of hoarding disorder, which characterizes most but not all individuals with hoarding dis- order, consists of excessive collecting, buying, or stealing of items that are not needed or for which there is no available space.
Trichotillomania (hair-pulling disorder) is characterized by recurrent pulling out of one's hair resulting in hair loss, and repeated attempts to decrease or stop hair pulling.
Excoriation (skin-picking) disorder is characterized by recurrent picking of one’s skin re- sulting in skin lesions and repeated attempts to decrease or stop skirt picking. The body- focused repetitive behaviors that characterize these two disorders are not triggered by ob- sessions or preoccupations; however, they may be preceded or accompanied by various emotional states, such as feelings of anxiety or boredom. They may also be preceded by an increasing sense of tension or may lead to gratification, pleasure, or a sense of relief when the hair is pulled out or the skin is picked. Individuals with these disorders may have vary- ing degrees of conscious awareness of the behavior while engaging in it, with some indi- viduals displaying more focused attention on the behavior (with preceding tension and subsequent relief) and other individuals displaying more automatic behavior (with the be- haviors seeming to occur without full awareness).
symptoms that are due to substance intoxication or withdrawal or to a medication. Obses- sive-compulsive and related disorder due to another medical condition involves symptoms characteristic of obsessive-compulsive and related disorders that are the direct pathophysio- logical consequence of a medical disorder. Other specified obsessive-compulsive and related disorder and unspecified obsessive-compulsive and related disorder consist of symptoms that do not meet criteria for a specific obsessive—compulsive and related disorder because of atypical presentation or uncertain etiology; these categories are also used for other specific syndromes that are not listed in Section [I and when insufficient information is available to di- agnose the presentation as another obsessive—compulsive and related disorder. Examples of specific syndromes not listed in Section II, and therefore diagnosed as other specified obses— sive-compulsive and related disorder or as unspecified obsessive—compulsive and related disorder include body—focused repetitive behavior disorder and obsessional jealousy.