## DSM-5 Diagnostic Criteria for OCD ### Core Diagnostic Requirements **Key Point:** DSM-5 criteria for OCD require the presence of obsessions and/or compulsions that are time-consuming (≥1 hour per day) and cause significant distress or functional impairment. ### Insight Spectrum in OCD **High-Yield:** DSM-5 explicitly recognizes that insight varies in OCD and is NOT a mandatory diagnostic criterion. The diagnostic manual includes a specifier for "insight level": - Good or fair insight: individual recognizes obsessions/compulsions are excessive - Poor insight: individual believes obsessions/compulsions are probably true - Absent insight/delusional beliefs: individual is convinced obsessions/compulsions are true **Clinical Pearl:** Many patients with OCD have poor insight or even delusional conviction about their obsessions, yet still meet full diagnostic criteria. Requiring "must have insight" would exclude a significant proportion of OCD patients. ### Valid DSM-5 Criteria (Present in Options 0, 2, 3) | Criterion | Details | |-----------|----------| | Time consumed | ≥1 hour per day on most days | | Distress/impairment | Clinically significant | | Exclusion criteria | Not due to substance, medical condition, or another disorder | | Insight | Specifier only — NOT required for diagnosis | **Warning:** The trap in this question is that clinicians often assume OCD patients must have insight ("ego-dystonic"). This is FALSE — OCD can present with poor insight or even delusional intensity. ### Why Option 1 Is the Answer Option 1 states the individual "must have insight that obsessions or compulsions are excessive or unreasonable." This is NOT a mandatory diagnostic criterion in DSM-5. Insight is a specifier that describes the severity of the patient's conviction, but its absence does not exclude an OCD diagnosis.
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