Obsessive–compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V


  • Disclosure for James F. Leckman for the past 3 years: NIH (salary and research funding), Tourette Syndrome Association (research funding), Klingenstein Third Generation Foundation (medical student fellowship program), John Wiley and Sons (book royalties), McGraw Hill (book royalties), Oxford University Press (book royalties). Disclosure for Damiaan Denys for the past 3 years: NWO, The Netherlands Organisation for Scientific Research (research funding), Tourette Syndrome Association (research funding), Medtronic (research funding), De Tijdstroom (book royalties). Disclosure for H. Blair Simpson for the past 3 years: NIMH (salary and research funding), NARSAD (research funding), Janssen Pharmaceuticals (medication for NIMH-funded study), Neuropharm Ltd (research funding), Pfizer (Scientific Advisor Board), Jazz Pharmaceuticals (Scientific Advisory Board), Cambridge University Press (potential future book royalties). Disclosure for David Mataix-Cols for the past 3 years: NIHR Biomedical Research Centre for Mental Health (research funding), NIHR Research for Patient Benefit programme (research funding), University of London Central Fund (research funding), The Life Foundation (research funding). Disclosure for Eric Hollander for the past 3 years: NIH (research funding), FDA (research funding), National Alliance for Research in Schizophrenia and Affective Disorders (research funding), American Psychiatric Publishing (publication honoraria), and Transcept and Lundbeck (consulting). Disclosure for Sanjaya Saxena for the past 3 years: NIH (salary and research funding). Disclosure for Euripedes C. Miguel for the past 3 years: CNPq and FAPESP (Brazilian Foundations for research Research Funding); Novartis (research funding), Lundbeck and Solvay Pharma (honorarim for presentation); Artes Medicas and Guanabara Koogan Press (publication honorarium). Disclosure for Scott L. Rauch for the past 3 years: Dr. Rauch has received honoraria and/or consultation fees from Neurogen, Sepracor, Novartis and Medtronics. He has also participated in research funded by Medtronic, Cyberonics, Cephalon and Northstar Neuroscience. Disclosure for Wayne K. Goodman for the past 3 years: NIMH (salary and research funding) and Medtronic (speaking fee). Dr. Katharine A. Phillips and Dan J. Stein for the past 3 years: NIMH (salary and research funding), FDA (research funding), American Foundation for Suicide Prevention (research funding), Forest Laboratories (medication for NIMH-funded study), UCB Pharma (research funding for an investigator-initiated study), American Psychiatric Association (research mentoring), American Psychiatric Publishing (publication honoraria), Current Psychiatry (publication honorarium), Cambridge University Press (publication honorarium), Merck Manual (publication honorarium), Oxford University Press (book royalties), Guilford Press and The Free Press (potential future book royalties), research grants and/or consultancy honoraria from Astrazeneca, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Takeda, Tikvah, and Wyeth.


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. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.