Diagnosis Primer: Obsessive-Compulsive Disorder (OCD)

OCD is a neuropsychological disorder characterized by intrusive and uncontrollable obsessions and compulsions. Obsessions are thoughts, urges, or images that the individuals experience as unwelcome and invasive. These obsessions cause discomfort to the individual with OCD including feelings of anxiety, guilt and/or disgust inducing. Those of us with OCD will actively try to avoid, subdue, or neutralize the obsession by engaging in avoidant or compulsive behaviours.


OCD is a Obsessive-Compulsive and Related Disorders class disorder. It’s characterised by obsessions and compulsive behaviours. Intrusive thoughts and oiages are also common experinces and

The other subcategories of the class include:

  • Body Dysmorphic Disorder (BDD)
  • Hoarding Disorder
  • Trichotillomania
  • 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
  • Unspecified Obsessive-Compulsive and Related Disorder

Diagnostic Criteria for Obsessive-Compulsive Disorder

A.    Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or impulses 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).

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.

(American Psychiatric Association, 2013)

ICD-11 Classification

OCD is listed under – Obsessive-compulsive or related disorders a category which includes:

  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Olfactory reference disorder
  • Hypochondriasis
  • Hoarding disorder
  • Body-focused repetitive behaviour disorders
  • Substance-induced obsessive-compulsive or related disorders
  • Secondary obsessive-compulsive or related syndrome
  • Other specified obsessive-compulsive or related disorders
  • Obsessive-compulsive or related disorders, unspecified

The draft ICD-11 states the following diagnostic criteria for Obsessive-Compulsive Disorder.

Obsessive-compulsive and related disorders is a group of disorders characterized by repetitive thoughts and behaviours that are believed to share similarities in etiology and key diagnostic validators. Cognitive phenomena such as obsessions, intrusive thoughts and preoccupations are central to a subset of these conditions (i.e., obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, and olfactory reference disorder) and are accompanied by related repetitive behaviours. Hoarding Disorder is not associated with intrusive unwanted thoughts but rather is characterized by a compulsive need to accumulate possessions and distress related to discarding them. Also included in the grouping are body-focused repetitive behaviour disorders, which are primarily characterized by recurrent and habitual actions directed at the integument (e.g., hair-pulling, skin-picking) and lack a prominent cognitive aspect. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

Obsessive-compulsive disorder
Obsessive-Compulsive Disorder is characterized by the presence of persistent obsessions or compulsions, or most commonly both. Obsessions are repetitive and persistent thoughts, images, or impulses/urges that are intrusive, unwanted, and are commonly associated with anxiety. The individual attempts to ignore or suppress obsessions or to neutralize them by performing compulsions. Compulsions are repetitive behaviors including repetitive mental acts that the individual feels driven to perform in response to an obsession, according to rigid rules, or to achieve a sense of ‘completeness’. In order for obsessive-compulsive disorder to be diagnosed, obsessions and compulsions must be time consuming (e.g., taking more than an hour per day), and result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Inclusions: anankastic neurosis, obsessive-compulsive neurosis

Obsessive-compulsive disorder with fair to good insight
All definitional requirements of obsessive-compulsive disorder are met. Much of the time, the individual is able to entertain the possibility that his or her disorder-specific beliefs may not be true and is willing to accept an alternative explanation for his or her experience. At circumscribed times (e.g., when highly anxious), the individual may demonstrate no insight.

Obsessive-compulsive disorder with poor to absent insight
All definitional requirements of obsessive-compulsive disorder are met. Most or all of the time, the individual is convinced that the disorder-specific beliefs are true and cannot accept an alternative explanation for their experience. The lack of insight exhibited by the individual does not vary markedly as a function of anxiety level.

(World Health Organization, 2019)



Obsessions are recurrent and persistent thoughts, impulses, or images that are distressing. Many people with OCD recognize that the obsession is a product of their minds. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessions with compulsions, ignore or suppress the obsessions, or distract themselves with other activities.

Common Topics of Obsessions:

  • Fear of getting contaminated by people or the environment
  • Disturbing sexual thoughts or images
  • Fear of blurting out obscenities or insults
  • Extreme concern with order, symmetry, or precision
  • Recurrent intrusive thoughts of sounds, images, words, or numbers
  • Fear of losing or discarding something important

(Colon-Rivera & Howland, 2020)


Compulsions are repetitive behaviours or mental acts that a person feels driven to perform in response to an obsession. The behaviours typically prevent or reduce a person’s distress related to an obsession. Compulsions may be excessive responses that are directly related to an obsession or actions that are completely unrelated to the obsession.

Trauma and OCD

Trauma and OCD are linked intensely. Many theories of OCD believe that it stems from chronic stress often in childhood. The intrusive thoughts and compulsions are manifestations of this traumatic stress.

Themes of trauma like disgust and betrayal are often at the root of traumatic feelings also show in many people with OCD. When trauma happens in childhood it can be linked to OCD in the traumatic schema that is made. The primary ideas of intrusive thoughts are based on how our psyche develops and the feeling of being responsible for our thoughts and the outside world. This responsibility idea is key in both OCD and general trauma responses.

However there is some belifes that OCD maybe more genitic but trama acts as a meditating factor in how OCD presHowever, some believe that OCD may be mostly genetic but trauma acts as a mediating factor in how OCD presents/if it presents. Others believe that trauma has no etiological connection to OCD, but the preponderance of the evidence shows a connection to trauma in its development.


PTSD and OCD are believed to be on a spectrum of presentation of traumatic stress. They share similar behaviours like avoidance of stressors, hypervigilance, repetitive behaviours and intrusive thoughts. Similar thought patterns to lack of control and believing the world is unsafe are common across these diagnoses as well.

The presentation differs as OCD avoidance and intrusive thoughts do not have to be directly related to specific traumatic events or events. The repetitive behaviours in OCD are also more prevalent and more directed to preventing future harm associated with the obsessions. Triggers for OCD are also not related to traumatic upheaval but more specific to a type of obsession had by those of us with OCD.


Colon-Rivera, H., & Howland, M. (Eds.). (2020). What is obsessive-compulsive disorder? psychiatry.org. Retrieved September 17, 2021, from https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder.

Dabel, T. (2019, July 16). Is OCD caused by childhood trauma? Bridges to Recovery. Retrieved September 20, 2021, from https://www.bridgestorecovery.com/blog/is-ocd-caused-by-childhood-trauma/.

Dykshoorn, K. L. (2014). Trauma-related obsessive–compulsive disorder: A Review. Health Psychology and Behavioral Medicine, 2(1), 517–528. https://doi.org/10.1080/21642850.2014.905207

Colon-Rivera, H., & Howland, M. (Eds.). (2020). What is obsessive-compulsive disorder? psychiatry.org. Retrieved September 17, 2021, from https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder.

Staff, Examining The differential diagnosis Between OCD and PTSD, Baylor College of Medicine, Retrieved September 20, 2021, https://www.mirecc.va.gov/visn16/docs/ocd-and-ptsd-fact-sheet.pdf


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