sight as the basis for specifiers; in each of these disorders, insight ranges from ”good or fair insight” to ”poor insight" to "absent insight/delusional beliefs” with respect to disorder- related beliefs. For individuals whose obsessive-compulsive and related disorder symp- toms warrant the “with absent insight/delusional beliefs” specifier, these symptoms should not be diagnosed as a psychotic disorder.
Diagnostic Criteria 300.3 (F42)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance. as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
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 individual feels driven to per- form in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or dis- tress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neu- tralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
B. 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.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g.. excessive worries. as in generalized anxiety disorder; preoccupation with ap- pearance, as in body dysmorphic disorder; difficulty discarding or parting with posses- sions, 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; preoc- cupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct dis- orders; guilty ruminations, as in major depressive disorder; thought insertion or delu- sional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify it:
With good or fair insight: The individual recognizes that obsessive-compulsive dis- order 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 insightldeiuslonai beiiets: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
Specify it:
Tic-related: The individual has a current or past history of a tie disorder.
Many individuals with obsessive-compulsive disorder (OCD) have dysfunctional beliefs.
These beliefs can include an inﬂated sense of responsibility and the tendency to overesti- mate threat; perfectionism and intolerance of uncertainty; and over—importance of thoughts (e.g., believing that having a forbidden thought is as bad as acting on it) and the need to control thoughts.