## DSM-5 Diagnostic Criteria for OCD **Key Point:** The core diagnostic requirement for OCD is that obsessions and/or compulsions must cause clinically significant distress OR lead to impairment in occupational, social, or other important areas of functioning. This distinguishes OCD from normal intrusive thoughts that many people experience. ### Essential Diagnostic Elements | Criterion | Requirement | |-----------|-------------| | **Obsessions** | Recurrent, unwanted, intrusive thoughts, urges, or images that cause anxiety/distress | | **Compulsions** | Repetitive behaviors or mental acts performed to reduce distress from obsessions | | **Insight** | Person recognizes obsessions/compulsions are excessive or unreasonable (at least at some point) | | **Duration** | Symptoms present for ≥4 weeks (not just 2 weeks) | | **Functional Impact** | **Clinically significant distress or functional impairment** — THIS IS KEY | | **Exclusion** | Not attributable to substance use, medical condition, or another mental disorder | **High-Yield:** The presence of obsessions or compulsions alone is NOT sufficient for diagnosis — they must cause significant distress or functional impairment. This is what separates pathological OCD from the normal intrusive thoughts that 80–90% of the general population experiences. **Clinical Pearl:** Many patients with OCD initially present with poor insight (believing their obsessions are true), but insight typically improves with treatment. The criterion requires only that insight is present "at some point," not necessarily at baseline. [cite:DSM-5 OCD Diagnostic Criteria] 
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