The resulting problems may include medical issues such as infections, skin lesions, scarring, and physical disfigurement. The four specifiers mentioned earlier were also added to hoarding disorder.Įxcoriation (skin-picking) disorder is a new condition added to the DSM-5-TR.Īt the time of publication, the DSM-5-TR estimated that between 2% to 4% of the population could be diagnosed with this condition, though more recent statistics suggest the numbers may be closer to 2% to 3%. Hoarding behaviors were characterized in the DSM-IV-TR as obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), or anxiety disorder not otherwise specified.īy recognizing hoarding disorder as a distinct condition with its own criteria and treatments, the APA hopes to improve identification, research, and awareness of the condition. Symptoms can be impairing and distressing, often compromising physical safety due to excessive clutter, fall risk, and fire hazards. Hoarding disorder is characterized by the persistent difficulty of discarding or parting with possessions, regardless of the value others may attribute to these possessions. Hoarding disorder graduates from being listed as just one symptom of obsessive-compulsive personality disorder in the DSM-IV-TR to an individually recognized condition in the DSM-5-TR.Īfter the DSM-5 OCD working group examined the research literature on hoarding, they found little support to suggest this was simply a variant of a personality disorder or a component of another mental health condition. In the DSM-5-TR, the APA included the new tic-related specifier for obsessive-compulsive disorder to acknowledge a growing body of clinical and research evidence showing a link between these types of conditions. This change was also made to emphasize that absent insight or delusional beliefs may warrant a diagnosis of the relevant obsessive-compulsive or related disorder, rather than schizophrenia spectrum and other psychotic disorders. These same insight specifiers have been included for body dysmorphic disorder and hoarding disorder. The decision to add these specifiers was made in an effort to emphasize that some OCD and related disorders can present with a wide range of patient insight. absent insight/delusional obsessive-compulsive disorder beliefs (complete conviction that obsessive-compulsive disorder beliefs are true).The new specifiers in the DSM-5-TR for these conditions are: The old DSM-IV-TR specifier “with poor insight”- the only specifier in that edition for OCD disorders - has been modified to allow for diagnosis on a spectrum of awareness. Insight and tic specifiers for OCD and related disorders Inclusion of a new specifier indicating if there is a current or past history of a tic disorder. Inclusion of new “insight” specifiers related to the level of obsessive-compulsive belief awareness.Rewording of criteria that reflects DSM-IV-TR to DSM-5-TR changes for other differential and comorbid diagnoses, such as generalized anxiety disorder, substance use disorders, and schizophrenia spectrum disorders.The elimination of criteria stating the person, at some time, has recognized obsessions and compulsions are unreasonable or excessive.The elimination of criteria stating the person recognizes obsessions are the product of their own mind. The elimination of criteria stating obsessions aren’t simply excessive worries about real-life problems.The inclusion of “unwanted” as a defining factor for intrusive thoughts, urges, and images.Under a chapter of their own, OCD and related disorders received some diagnostic criteria updates: Obsessions These conditions were previously labeled “anxiety disorders” in the DSM-IV-TR.īut increasing evidence since the DSM-IV-TR has demonstrated a common thread running through a number of OCD-related disorders is that obsessive thoughts or repetitive behaviors are not just anxiety. According to the APA, the publisher of the DSM-5-TR, the major change for obsessive-compulsive disorder is the fact that it and related disorders now have their own chapter.
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