Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V.
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.
Leckman
James F
JF
Departments of Pediatrics and Psychology, Yale University, Child Study Center, New Haven, Connecticut, USA. james.leckman@yale.edu
Denys
Damiaan
D
Simpson
H Blair
HB
Mataix-Cols
David
D
Hollander
Eric
E
Saxena
Sanjaya
S
Miguel
Euripedes C
EC
Rauch
Scott L
SL
Goodman
Wayne K
WK
Phillips
Katharine A
KA
Stein
Dan J
DJ
D001921:Brain / Q000503:physiopathology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D017367:Selective Serotonin Reuptake Inhibitors