What Does OCD DSM-5 Even Mean?

Obsessive-compulsive disorder (OCD) involves unpleasant or upsetting thoughts, images and/or urges that affect multiple areas of your life. And, although these obsessions typically involve anxiety and fear, guilt and shame can also be present. For instance, a man with OCD may become obsessed with tormenting his ex-wife because she left him for another man. This obsession could center on running her over with his car, stalking or cyberstalking her, kidnapping her, catfishing her, trolling her online, etc.

These negative thoughts can cause this man to feel anxious, depressed, out-of-control, ashamed, and embarrassed. This man’s angst stems from his shocking thoughts and feelings. As a result, he feels compelled to perform a routine or ritual to ease his stress and anxiety.

The hope is that if he performs certain actions, the intrusive thoughts will lessen or go away. It is common for people with OCD to exhibit both obsessions and compulsions, however, an individual can exhibit one or the other. If you have OCD you may be well-aware that your actions (rituals and routines) are unnecessary and illogical, but find it difficult to stop performing them. And, because OCD is a “hidden” condition, it often goes undiagnosed.

In fact, it is common for people with undiagnosed OCD to refuse to seek mental health treatment for fear of being judged or criticized. As a result, these individuals do not receive the treatment they need to effectively manage this condition. Thus, the first step in the treatment process is seeking help. Mental health professionals can accurately make a OCD diagnosis by using the Diagnostic and Statistical Manual of Mental Disorders (DSM).

With a proper diagnosis and treatment, you can achieve your goals and have the life you’ve always wanted.

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How is OCD Diagnosed?

According to the most recent version of the DSM – DSM-5, OCD criteria can be used as a “guide” for mental health professionals, when officially diagnosing OCD. It is important to understand that mental health conditions, like OCD, are diagnosed differently than physical health conditions. More specifically, mental health conditions aren’t typically diagnosed through x-rays, bloodwork, or urine analysis.

Labs, physical exams, and ultrasounds are generally used to corroborate (back-up) a professional opinion or “hunch.” Before a mental health professional officially diagnoses OCD, he or she assesses you using a variety of psychological and physical tests. As mentioned above, this may include labs and/or ultrasounds.

During the physical exam, the doctor may take the following vitals:

  • Heart rate
  • Blood pressure
  • Body temperature
  • Heart and lung function
  • Abdominal area exam
  • Height & weight

If your doctor orders a blood test it may be to determine if there are drugs and alcohol in your system. Drugs and alcohol can cause a person to behave uncharacteristically. More specifically, they can alter your brain chemistry and function, triggering OCD-like behaviors, aggravating OCD symptoms, or mimicking OCD when the issue lies elsewhere.

Your doctor may also check your thyroid levels to ensure that you aren’t suffering from a thyroid condition that is causing you to have OCD-like symptoms. However, to be diagnosed with DSM-V OCD diagnosis, a mental health professional (i.e. psychotherapist or psychiatrist) will need to give you a psych exam to see if you meet the criteria for the condition.

During the exam, you’ll be asked a variety of questions about your health and well-being, such as:

  • What are you currently thinking?
  • How do you feel when the intrusive thoughts, feelings, and emotions arise?
  • How do you feel before, during, and after performing certain rituals and routines?
  • What are your current symptoms? And, when did they begin?
  • How severe are your symptoms (from your viewpoint)?
  • How do these symptoms impact your daily life – i.e. self-esteem and self-confidence, job performance, relationships, etc.?
  • Have you had similar symptoms or episodes in the past? And, if so, when is the last time they occurred?
  • Have you ever thought of hurting yourself or others, or committing suicide? If so, when was the last time those thoughts crossed your mind and how did you cope with them?

Keep in mind that your friends and family may also be interviewed so your doctor can gain a better understanding of what is actually happening to you and why (perhaps, others in your family struggle with mental illness or OCD). These interviews will help him or her develop the right treatment plan for you.

What is the DSM-V?

The DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides mental health clinicians with standard definitions of and criteria for diagnosing a variety of mental health conditions. Some experts may not agree with DSM-V guidelines, however, it is still universally-accepted throughout the US.

DSM-V Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)

Only a qualified mental health professional can officially diagnose you with OCD. And, to receive this diagnosis, you must meet the diagnostic criteria set-forth in the DSM-V. What is this criteria? Well, according to the DSM-V, your obsessions and compulsions must negatively impact your daily life – i.e. daily functioning, relationships, and/or job performance. You must also truly believe that your obsessions and compulsions are logical and reasonable – when they are not.

Lastly, you must be unaware of the effect your obsessions and compulsions are having on your life. So, if you receive an OCD diagnosis, it means you have a chronic mental health condition that will most likely require “symptom management” for the rest of your life. However, the good news is there are effective ways to treat and manage OCD, so you can live a long, happy, and productive life.

  • Presence of obsessions, compulsions or both

    A. Obsessions

    1. Recurring and unrelenting thoughts and/or urges that are “experienced” or “perceived” as “unpleasant” or “annoying.” These thoughts and urges may accompany emotional distress, depression, and/or anxiety.

    2. An attempt to “ignore,” “censor,” or “muffle,” the intrusive thoughts, urges, or images only proves successful after performing a specific ritualistic action (compulsion).

    In Review

    Your obsessions must meet the following criteria:

    • Disturbing, recurring and constant thoughts, images, or urges that cause emotional distress
    • Thoughts that do not actually pertain to real-life problems
    • An unsuccessful attempt to “muffle” or “ignore” the troubling thoughts, images, or urges
    • An “unawareness” that your thoughts, images, and urges do not pose a real threat to you or a loved one.
  • Compulsions
    • Repetitive behaviors (i.e. hand-washing, re-organizing, re-checking, etc.) or mental actions (i.e. constant praying, counting, or repeating words in your mind) because of an urge or desire to perform an action in response to an obsession.
    • Engaging in behaviors or mental acts designed to prevent or reduce your anxiety or emotional distress, and/or prevent a dreadful or dangerous event or situation. Keep in mind that these excessive behaviors are not realistically connected to the thoughts, images, or urges you are trying to “cancel out” or stop.

    In Review

    Your compulsions must meet specific criteria:

    • Excessive and repetitive ritualistic behaviors that you feel you must perform to prevent something “bad” from happening. These behaviors may involve repetitive hand-washing, counting, mental acts, checking the oven, door locks, etc.
    • The compulsions (ritualistic behaviors) consume at least one hour of your life each day.
    • Performing specific rituals, routines, or mental acts eases the stress and anxiety triggered or worsened by the obsessive thoughts, images, and urges.

What are the Specifications for a DSM-V Diagnosis?

Listed below are the specifications for a DSM-V diagnosis:

  • Your obsessions or compulsions must be laborious (i.e. consume at least 60-minutes of your day) or trigger significant emotional distress or psychological impairment in your personal, social, or work lives, cause problems in your relationships, and/or disrupt your daily functioning. Drugs, alcohol or an unrelated health condition must not contribute to your OCD symptoms
  • Your symptoms cannot be explained by another mental disorder like:
  • Unwarranted worries (generalized anxiety disorder (GAD))
  • A preoccupation with your physical appearance (body dysmorphic disorder (BDD)
  • An inability to let go of your possessions (hoarding disorder)
  • Hair-pulling behaviors (trichotillomania or hair-pulling disorder (HPD)
  • Skin-picking behaviors (excoriation or skin-picking disorder (SPD))
  • Stereotypies (stereotypic movement disorder (SMD))
  • “Ritualized” eating tendencies (eating disorders like anorexia, bulimia, or binge-eating)
  • Preoccupation with substances or gambling (substance-related and addictive disorders)
  • A preoccupation with being “illness” (illness anxiety disorder (IAD))
  • Unrelenting sexual urges or fantasies (paraphilic disorders)
  • Uncontrollable impulses or urges (impulse-control disorder)
  • Conduct disorders and constant feelings of guilt and shame (major depressive disorder)
  • Delusional preoccupations (schizophrenia spectrum)
  • Cyclical patterns of behavior (autism spectrum disorder)

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Are There Any Special Considerations When Making a DSM-5 Diagnosis of OCD?

Yes.

Mental health clinicians often encounter difficulties when making a OCD DSM diagnosis. Why? Because OCD symptoms can mimic the symptoms of other mental health conditions, such as schizophrenia, anxiety disorder, and clinical depression, etc. Conversely, some prescription medications and health conditions can mimic the symptoms of OCD, so assigning an “official” OCD diagnosis to an individual can be tricky. Thus, it is imperative that your mental health provider cautiously assess your lab reports and psychological exam to determine if you have OCD or another mental health condition.

Has Anything Changed Since DSM-IV?

Yes, there have been changes since the last version of DSM.

Obsessive-compulsive disorder (OCD) categorization has significantly changed since DSM-IV. More specifically, in 2013, the American Psychiatric Association (APA) updated, revised, and changed OCD criteria and included the new information in the DSM-V. These changes were enacted to improve the accuracy of an OCD diagnosis, so the most effective treatments could be offered to individuals struggling with the condition.

The changes are listed below:

  • An updated OCD section was added to the DSM-V. The section includes a wide-range of disorders that were not previously listed in the DSM or that were not previously classified under other diagnoses. These disorders are now categorized as “Related Conditions” and can be located under the OCD heading.
  • The DSM-V now lists OCD, body dysmorphic disorder (BDD), and trichotillomania (hair -pulling disorder or HPD) together and now includes hoarding disorder and excoriation (skin-picking) disorder.
  • The APA removed OCD from the anxiety category and created a new section just for OCD and related disorders.
  • In previous versions of the DSM, body dysmorphic disorder (BDD) and trichotillomania (hair-pulling disorder or HPD), could be found in a variety of different sections, however, the DSM-V moved these disorders to the OCD section.
  • Hoarding and excoriation, previously listed solely as a possible symptoms of OCD or other disorders, were given specific criteria for a diagnosis.
  • The word “impulse” was replaced with the word “urge” to more accurately depict the function of obsessions.
  • The word “inappropriate” was replaced with the word “unwanted” to describe OCD-related obsessions. This was changed because the meaning of the word “inappropriate” varies between demographics – i.e. cultures, genders, ages, etc.
  • Some of the DSM-IV criteria were removed from the OCD classification, specifically, criteria requiring that individuals be aware that their obsessions and compulsions are excessive, illogical, or unreasonable.

In Summary

Obsessions and compulsions can negatively affect your personal and social lives, and even your job performance. These behaviors not only require a large amount of time and effort, they also impact your daily functioning. In fact, people with severe OCD may spend 7 or 8 hours a day performing rituals and routines to ease their anxiety and stress.

Sadly, society often views people with OCD as “odd,” “strange,” “weird,” or defective, which could not be further from the truth. Still, a stigma is often unfairly attached to having a mental illness like OCD. As a result, these individuals tend to”hide” their obsessions and compulsion from others. This is made worse when the condition goes undiagnosed or is misdiagnosed. That is why the DSM is so important.

The purpose of the DSM is to help mental health providers properly diagnose mental health conditions like OCD. The recent version of the DSM (DSM-V) contains the most updated information since the year 2000. The DSM-V now includes a “self-awareness” component that is key to accurately diagnosing OCD and ensuring that individuals with OCD receive the proper treatment.

It is important to understand that OCD treatment is not a cure-all. Still, it can help you better manage your symptoms so you can live a happy and productive life. Keep in mind, however, that some people may need on-going, long-term, or more intensive treatment to get control of the condition. The good news is the most common treatments involve outpatient counseling and/or medication. Thus, you can have the life you’ve always wanted. But, the first step is getting a proper DSM-V diagnosis.

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