title: Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V.
abstract: 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.
authors.affiliation: Departments of Pediatrics and Psychology, Yale University, Child Study Center, New Haven, Connecticut, USA. james.leckman@yale.edu
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
authors.forename: Damiaan
authors.initials: D
authors.lastname: Denys
authors.forename: H Blair
authors.initials: HB
authors.lastname: Simpson
authors.forename: David
authors.initials: D
authors.lastname: Mataix-Cols
authors.forename: Eric
authors.initials: E
authors.lastname: Hollander
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Saxena
authors.forename: Euripedes C
authors.initials: EC
authors.lastname: Miguel
authors.forename: Scott L
authors.initials: SL
authors.lastname: Rauch
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Goodman
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Phillips
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: 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
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors