|The ICD-10 Classification of Mental and Behavioural
World Health Organization, Geneva, 1992
F42 Obsessive-Compulsive Disorder
The essential feature of this disorder is recurrent obsessional
thoughts or compulsive acts. (For brevity, "obsessional"
will be used subsequently in place of
"obsessive-compulsive" when referring to symptoms.)
Obsessional thoughts are ideas, images or impulses that enter the
individual's mind again and again in a stereotyped form. They are
almost invariably distressing (because they are violent or
obscene, or simply because they are perceived as senseless) and
the sufferer often tries, unsuccessfully, to resist them. They
are, however, recognized as the individual's own thoughts, even
though they are involuntary and often repugnant. Compulsive acts
or rituals are stereotyped behaviours that are repeated again and
again. They are not inherently enjoyable, nor do they result in
the completion of inherently useful tasks. The individual often
views them as preventing some objectively unlikely event, often
involving harm to or caused by himself or herself. Usually, though
not invariably, this behaviour is recognized by the individual as
pointless or ineffectual and repeated attempts are made to resist
it; in very long-standing cases, resistance may be minimal.
Autonomic anxiety symptoms are often present, but distressing
feelings of internal or psychic tension without obvious autonomic
arousal are also common. There is a close relationship between
obsessional symptoms, particularly obsessional thoughts, and
depression. Individuals with obsessive-compulsive disorder often
have depressive symptoms, and patients suffering from recurrent
depressive disorder may develop obsessional thoughts during their
episodes of depression. In either situation, increases or
decreases in the severity of the depressive symptoms are generally
accompanied by parallel changes in the severity of the obsessional
Obsessive-compulsive disorder is equally common in men and
women, and there are often prominent anankastic features in the
underlying personality. Onset is usually in childhood or early
adult life. The course is variable and more likely to be chronic
in the absence of significant depressive symptoms.
For a definite diagnosis, obsessional symptoms or compulsive
acts, or both, must be present on most days for at least 2
successive weeks and be a source of distress or interference with
activities. The obsessional symptoms should have the following
(a) they must be recognized as the individual's own thoughts or
(b) there must be at least one thought or act that is still
resisted unsuccessfully, even though others may be present which
the sufferer no longer resists;
(c) the thought of carrying out the act must not in itself be
pleasurable (simple relief of tension or anxiety is not regarded
as pleasure in this sense);
(d) the thoughts, images, or impulses must be unpleasantly
* anankastic neurosis
* obsessional neurosis
* obsessive-compulsive neurosis
Differentiating between obsessive-compulsive disorder and a
depressive disorder may be difficult because these two types of
symptoms so frequently occur together. In an acute episode of
disorder, precedence should be given to the symptoms that
developed first; when both types are present but neither
predominates, it is usually best to regard the depression as
In chronic disorders the symptoms that most frequently persist
in the absence of the other should be given priority.
Occasional panic attacks or mild phobic symptoms are no bar to
the diagnosis. However, obsessional symptoms developing in the
presence of schizophrenia, Tourette's syndrome, or organic mental
disorder should be regarded as part of these conditions.
Although obsessional thoughts and compulsive acts commonly
coexist, it is useful to be able to specify one set of symptoms as
predominant in some individuals, since they may respond to
F42.0 Predominantly Obsessional Thoughts Or Ruminations
These may take the form of ideas, mental images, or impulses to
act. They are very variable in content but nearly always
distressing to the individual. A woman may be tormented, for
example, by a fear that she might eventually be unable to resist
an impulse to kill the child she loves, or by the obscene or
blasphemous and ego-alien quality of a recurrent mental image.
Sometimes the ideas are merely futile, involving an endless and
quasi-philosophical consideration of imponderable alternatives.
This indecisive consideration of alternatives is an important
element in many other obsessional ruminations and is often
associated with an inability to make trivial but necessary
decisions in day-to-day living.
The relationship between obsessional ruminations and depression
is particularly close: a diagnosis of obsessive-compulsive
disorder should be preferred only if ruminations arise or persist
in the absence of a depressive disorder.
F42.1 Predominantly Compulsive Acts (Obsessional Rituals)
The majority of compulsive acts are concerned with cleaning
(particularly hand-washing), repeated checking to ensure that a
potentially dangerous situation has not been allowed to develop,
or orderliness and tidiness. Underlying the overt behaviour is a
fear, usually of danger either to or caused by the patient, and
the ritual act is an ineffectual or symbolic attempt to avert that
danger. Compulsive ritual acts may occupy many hours every day and
are sometimes associated with marked indecisiveness and slowness.
Overall, they are equally common in the two sexes but hand-washing
rituals are more common in women and slowness without repetition
is more common in men.
Compulsive ritual acts are less closely associated with
depression than obsessional thoughts and are more readily amenable
to behavioural therapies.
ICD-10 copyright © 1992 by World Health Organization.
Psychiatry copyright © (www.azpsychiatry.info)
by Dr. Manaan Kar Ray