The co-occurrence of obsessions and compulsions in OCD

DSM-IV requires the presence of obsessions or compulsions, but not both, for a diagnosis of OCD. While earlier research suggested the existence of a “pure obsessional” subtype, studies now suggest individuals with OCD experience both obsessions and compulsions, with some compulsions being covert. The current retrospective study sought to replicate and extend this finding within a treatment-seeking sample with a wide range of symptom severity, and with children and adolescents as well as adults. One thousand eighty-six individuals admitted to an intensive outpatient or residential treatment program for OCD were given a battery of symptom measures as well as a clinical interview. Both obsessions and compulsions were ultimately identified in all cases. These findings suggest that to be empirically consistent, the forthcoming DSM-5 should include the presence of both obsessions and compulsions as diagnostic criteria for OCD.

► Most participants endorsed both obsessions and compulsions (94.4%) upon admission.
► Evidence of obsessions and compulsions was found upon chart review for all participants.
► We suggest that both obsessions and compulsions be required for an OCD diagnosis.