New Chapter in DSM-5: Obsessive-Compulsive and Related Disorders

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In DSM-5, OCD is included in a new “obsessive-compulsive and related disorders” chapter. In DSM-IV, OCD was in the “anxiety disorders” chapter.

The new chapter was added to “reflect the increasing evidence of these disorders’ relatedness to one another and distinction from other anxiety disorders, as well as to help clinicians better identify and treat individuals suffering from these disorders,” according to a fact sheet released by the APA. “Disorders grouped in this new chapter have features in common such as obsessive preoccupation and repetitive behaviors.” Disorders in the new chapter include OCD, body dysmorphic disorder, and trichotillomania (hair-pulling disorder), as well as several new disorders (see below).

Specifiers Clarified

In DSM-5, the “with poor insight” specifier for OCD has been modified to enable finer distinctions regarding individuals with different degrees of insight: good or fair insight, poor insight, and absent insight/delusional beliefs—in other words, “complete conviction that OCD beliefs are true.” A “tic-related” specifier for OCD reflects a growing body of research showing that comorbidity with a tic disorder may have “clinical implications in OCD.”

New Disorders

A number of new disorders are included in the chapter:

  • Hoarding disorder
  • Excoriation (skin-picking) disorder
  • Substance/medication-induced obsessive-compulsive and related disorder
  • Obsessive-compulsive and related disorder due to another medical condition
  • Other specified obsessive-compulsive and related disorder

In DSM-IV, hoarding was considered a possible symptom of OCD. However, research didn’t bear this out, so DSM-5 has moved it to its own disorder. The addition of substance/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition, “reflect the recognition that substances, medications, and medical conditions can present with symptoms similar to primary obsessive-compulsive and related disorders.”

In another change, trichotillomania is now listed as trichotillomania (hair-pulling disorder) in DSM-5 and has been moved from the impulse-control disorders not elsewhere classified chapter to the new obsessive-compulsive and related disorders chapter.
Also added: other specified obsessive-compulsive and related disorder. This disorder includes any of a number of conditions, such as body-focused repetitive behavior disorder (eg, nail biting, lip biting, or cheek chewing) and obsessional jealousy.

Information in this article was obtained from American Psychiatric Publishing, “Highlights of Changes from DSM-IV-TR to DSM-5” and the newly published DSM-5.