Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V
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BACKGROUND: Since the publication of the DSM-IV in 1994, research on obsessive-compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. METHODS: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. RESULTS: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). CONCLUSIONS: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses.
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Tic-like compulsions do not respond well to exposure and response prevention, and may respond better to augmentation with dopamine antagonists.
“Tic-like compulsions do not respond well to exposure and response prevention, and may respond better to augmentation with dopamine antagonists 83 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [83]
In Results > OCD Subtypes (page unavailable), the review says tic-related OCD may benefit from neuroleptic augmentation of an SSRI. It does not say tic-like compulsions respond poorly to exposure and response prevention; instead, it reports that children with OCD and a chronic tic disorder respond equally well to cognitive-behavioral interventions. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOCD patients with poor insight may be less likely to access or respond to pharmacotherapy and psychotherapy.
“OCD patients with poor insight may be less likely to access or respond to pharmacotherapy and psychotherapy 83 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [83]
Results, Criterion B describes poor insight as a feature of OCD, while Results, OC Symptom Dimensions discusses treatment response by symptom type. Neither passage links poor insight to reduced access to or response to pharmacotherapy or psychotherapy. Searches for poor insight, treatment response, and treatment access found no passage making that link. (LLM, conf=0.73)
Experimental — accuracy not yet measuredStudies assessing OCD symptom dimensions have been inconsistent due to different methodologies and varying sample sizes.
“In the current literature, studies assessing OCD symptom dimensions have been inconsistent due to the use of different methodologies and varying sample sizes9.”
From Is impaired response inhibition independent of symptom dimensions in obsessive-compulsive disorder? Evidence from ERPs (2015) · cites this paper as [9]
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Self-citation
- Authors
- Leckman, J. F., Denys, D., Simpson, H. B., Mataix-Cols, D., Hollander, E., Saxena, S., Miguel, E. C., Rauch, S. L., Goodman, W. K., Phillips, K. A., & Stein, D. J.
- Affiliations
- Royal Netherlands Academy of Arts and Sciences (NL)
- Albert Einstein College of Medicine (US)
- University of California San Diego (US)
- Harvard University (US)
- Icahn School of Medicine at Mount Sinai (US)
- Brown University (US)
- University of Cape Town (ZA)
- Corresponding author
- Leckman, James F.
- Denys, Damiaan
- Simpson, H. Blair
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2010-03-09
- Volume
- 27
- Issue
- 6
- Pages
- 507-527
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- PMC
- PMC3974619
- OpenAlex
- W2073503031
- Cited by
- 411
- References
- 183
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 18 · 2023: 18 · 2022: 17 · 2021: 30 · 2020: 57 · 2019: 24 · 2018: 18 · 2017: 15 · 2016: 24 · 2015: 42 · 2014: 31 · 2013: 35 · 2012: 27
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute of Mental Health (K24MH063975, T32MH018268)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, diagnostic criteria, DSM-V, disease classification, obsessions and compulsions, lack of insight, differential diagnosis, symptom dimensions
- MeSH terms
- Brain, Humans, Neuropsychological Tests, Obsessive-Compulsive Disorder, Selective Serotonin Reuptake Inhibitors, Diagnostic and Statistical Manual of Mental Disorders
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