A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3) and (4):
- Recurrent and persistent thoughts, impulses or images that are experienced, at some time during the disturbance, as intrusive and inappropriate, and that cause marked anxiety or distress.
- The thoughts, impulses or images are not simply excessive worries about real-life problems.
- The person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action.
- The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from without as in thought insertion).
Compulsions as defined by (1) and (2):
- Repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
- The behaviour or mental acts are aimed at preventing or reducing distress, or preventing some dreaded event or situation. However, these behaviour or mental acts either are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive.
B. At some point during the course of the disorder the person has recognised that the obsessions or compulsions are excessive or unreasonable. Note that this does not apply to children.
C. The obsessions or compulsions cause marked distress, are time-consuming (take more than 1 hour a day, or significantly interfere with the person’s normal routine, occupational (or academic) functioning or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g. preoccupation with food in the presence of an eating disorder; hair pulling in the presence of trichotillomania; concern with appearance in the presence of body dysmorphic disorder; preoccupation with drugs in the presence of a substance use disorder; preoccupation with having a serious illness in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a paraphilia; or guilty ruminations in the presence of major depressive disorder).
E. The disturbance is not caused by the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.