CMN 552
Module 3
Primary Study Guide
University of South Alabama
, CMN 552
Module 3 Primary Study Guide
DSM-V
(Section II: Obsessive-Compulsive & Trauma Disorders)
● Obsessive-Compulsive Disorder: Diagnostic Criteria (F42.2)
A. Presence of obsessions, compulsions, or both:
O 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).
o 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 perform 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
distress, 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 neutralize 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
appearance, as in body dysmorphic disorder; difficulty discarding or parting with
possessions, 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; preoccupation 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 disorders; guilty ruminations, as in major depressive disorder; thought
insertion or delusional preoccupations, as in schizophrenia spectrum and other
psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
● With good or fair insight: The individual recognizes that obsessive-compulsive disorder
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 insight/delusional beliefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Specify if:
● Tic-related: The individual has a current or past history of a tic disorder.
● Obsessive-Compulsive Disorder: Specifiers
○ Individuals with obsessive-compulsive disorder (OCD) vary in the degree of
insight they have about the accuracy of the beliefs that underlie their obsessive-
compulsive symptoms
○ Many individuals have good or fair insight (e.g., the individual believes that the
house definitely will not, probably will not, or may or may not burn down if the
stove is not checked 30 times).
○ Some have poor insight (e.g., the individual believes that the house will probably
burn down if the stove is not checked 30 times), and a few (4% or less) have
absent insight/delusional beliefs (e.g., the individual is convinced that the house
, will burn down if the stove is not checked 30 times).
○ Insight can vary within an individual over the course of the illness. Poorer insight
has been linked to worse long-term outcome.
○ Up to 30% of individuals with OCD have a lifetime tic disorder.
○ This is most common in men with onset of OCD in childhood.
○ These individuals tend to differ from those without a history of tic disorders in
the themes of their OCD symptoms, comorbidity, course, and pattern of familial
transmission
● Obsessive-Compulsive Disorder: Associated Features Supporting
○ Sensory phenomena, defined as physical experiences (e.g., physical sensations,
just-right sensations, and feelings of incompleteness) that precede compulsions,
are common in OCD.
■ Up to 60% of individuals with OCD report these phenomena
○ Individuals with OCD experience a range of affective responses when confronted
with situations that trigger obsessions and compulsions
■ For example, many individuals experience marked anxiety that can
include recurrent panic attacks.
■ Others report strong feelings of disgust.
■ While performing compulsions, some individuals report a distressing
sense of “incompleteness” or uneasiness until things look, feel, or sound
“just right.”
○ It is common for individuals with the disorder to avoid people, places, and things
that trigger obsessions and compulsions.
■ For example, individuals with contamination concerns might avoid public
situations (e.g., restaurants, public restrooms) to reduce exposure to
feared contaminants; individuals with intrusive thoughts about causing
harm might avoid social interactions.
○ Many individuals with OCD have dysfunctional beliefs.
○ These beliefs can include an inflated sense of responsibility and the tendency to
overestimate 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
○ These beliefs, however, are not specific to OCD
○ The involvement of family or friends in compulsive rituals, termed
accommodation, can exacerbate or maintain symptoms and is an important
target in treatment, especially in children.
● Obsessive-Compulsive Disorder: Development and Course
○ In the United States, the mean age at onset of OCD is 19.5 years, and 25% of
cases start by age 14 years
○ Onset after age 35 years is unusual but does occur.
Module 3
Primary Study Guide
University of South Alabama
, CMN 552
Module 3 Primary Study Guide
DSM-V
(Section II: Obsessive-Compulsive & Trauma Disorders)
● Obsessive-Compulsive Disorder: Diagnostic Criteria (F42.2)
A. Presence of obsessions, compulsions, or both:
O 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).
o 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 perform 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
distress, 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 neutralize 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
appearance, as in body dysmorphic disorder; difficulty discarding or parting with
possessions, 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; preoccupation 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 disorders; guilty ruminations, as in major depressive disorder; thought
insertion or delusional preoccupations, as in schizophrenia spectrum and other
psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
● With good or fair insight: The individual recognizes that obsessive-compulsive disorder
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 insight/delusional beliefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Specify if:
● Tic-related: The individual has a current or past history of a tic disorder.
● Obsessive-Compulsive Disorder: Specifiers
○ Individuals with obsessive-compulsive disorder (OCD) vary in the degree of
insight they have about the accuracy of the beliefs that underlie their obsessive-
compulsive symptoms
○ Many individuals have good or fair insight (e.g., the individual believes that the
house definitely will not, probably will not, or may or may not burn down if the
stove is not checked 30 times).
○ Some have poor insight (e.g., the individual believes that the house will probably
burn down if the stove is not checked 30 times), and a few (4% or less) have
absent insight/delusional beliefs (e.g., the individual is convinced that the house
, will burn down if the stove is not checked 30 times).
○ Insight can vary within an individual over the course of the illness. Poorer insight
has been linked to worse long-term outcome.
○ Up to 30% of individuals with OCD have a lifetime tic disorder.
○ This is most common in men with onset of OCD in childhood.
○ These individuals tend to differ from those without a history of tic disorders in
the themes of their OCD symptoms, comorbidity, course, and pattern of familial
transmission
● Obsessive-Compulsive Disorder: Associated Features Supporting
○ Sensory phenomena, defined as physical experiences (e.g., physical sensations,
just-right sensations, and feelings of incompleteness) that precede compulsions,
are common in OCD.
■ Up to 60% of individuals with OCD report these phenomena
○ Individuals with OCD experience a range of affective responses when confronted
with situations that trigger obsessions and compulsions
■ For example, many individuals experience marked anxiety that can
include recurrent panic attacks.
■ Others report strong feelings of disgust.
■ While performing compulsions, some individuals report a distressing
sense of “incompleteness” or uneasiness until things look, feel, or sound
“just right.”
○ It is common for individuals with the disorder to avoid people, places, and things
that trigger obsessions and compulsions.
■ For example, individuals with contamination concerns might avoid public
situations (e.g., restaurants, public restrooms) to reduce exposure to
feared contaminants; individuals with intrusive thoughts about causing
harm might avoid social interactions.
○ Many individuals with OCD have dysfunctional beliefs.
○ These beliefs can include an inflated sense of responsibility and the tendency to
overestimate 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
○ These beliefs, however, are not specific to OCD
○ The involvement of family or friends in compulsive rituals, termed
accommodation, can exacerbate or maintain symptoms and is an important
target in treatment, especially in children.
● Obsessive-Compulsive Disorder: Development and Course
○ In the United States, the mean age at onset of OCD is 19.5 years, and 25% of
cases start by age 14 years
○ Onset after age 35 years is unusual but does occur.
