OCD in DSM-5-TR and ICD-11
Both systems agree on the core of OCD: intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that cause distress and interfere with life. The differences show up in how insight is graded, how the tic-related presentation is captured, and how the whole obsessive-compulsive spectrum is grouped. This is what actually differs.
DSM-5-TR Obsessive-compulsive disorder ICD-10-CM F42.2
ICD-11 Obsessive-compulsive disorder 6B20
Side by side
| What | DSM-5-TR | ICD-11 |
|---|---|---|
| Core structure Aligned. | Presence of obsessions, compulsions, or both. | Same. |
| Obsessions definition Aligned. | Recurrent and persistent thoughts, urges, or images experienced as intrusive and unwanted, that cause marked anxiety or distress. The person attempts to ignore or suppress them or to neutralize them with a compulsion. | Same core definition. Emphasizes intrusive quality and the associated distress. |
| Compulsions definition Aligned. | Repetitive behaviors or mental acts the person feels driven to perform in response to an obsession or according to rigid rules, aimed at preventing or reducing distress or a feared event. | Same. |
| Time and functional threshold Same threshold. | Obsessions or compulsions are time-consuming (more than 1 hour per day) or cause clinically significant distress or impairment. | Symptoms take up considerable time (typically more than an hour a day) or cause significant impairment. |
| Insight specifier Different granularity. DSM-5-TR carves out the delusional level explicitly; ICD-11 collapses it into poor-to-absent. | Three-level specifier: good or fair insight, poor insight, absent insight / delusional beliefs. | Two-level specifier: with fair to good insight, with poor to absent insight. |
| Tic-related specifier Different. | Specifier: 'tic-related' when the person has a current or past history of a tic disorder. | No specific tic-related specifier at the diagnosis level. |
| Grouping in the manual Aligned. Both systems moved OCD out of the anxiety-disorders chapter (a change from DSM-IV / ICD-10). | OCD is in its own chapter: Obsessive-Compulsive and Related Disorders, alongside body dysmorphic, hoarding, trichotillomania, and skin-picking. | OCD is in its own chapter: Obsessive-compulsive or related disorders (6B20-6B2Y), with the same neighbors. |
| Age of onset Same. | Not part of the diagnosis. | Not part of the diagnosis. |
Key differences
- DSM-5-TR uses a three-level insight specifier including a distinct 'delusional' category. ICD-11 uses a two-level specifier.
- DSM-5-TR includes a 'tic-related' specifier when the person has current or past tic disorder. ICD-11 does not have this specifier at the diagnosis level.
- Both systems moved OCD out of the anxiety-disorders chapter and into a dedicated obsessive-compulsive and related disorders chapter. This was a shared change and reflects current understanding of the shared neurobiology across those conditions.
- The core clinical picture (obsessions, compulsions, time/distress threshold) is essentially identical across systems.
Clinical implications
- Cross-system agreement for OCD is high. Nearly everyone meeting one set of criteria will meet the other.
- The insight specifier can matter for treatment. Absent insight or delusional beliefs about the obsession sometimes need adjunctive antipsychotic medication in addition to SSRIs and ERP.
- The tic-related specifier in DSM-5-TR flags that these patients may respond somewhat differently to treatment (some studies suggest better response to antipsychotic augmentation). Absence of this specifier in ICD-11 doesn't mean the pattern isn't recognized clinically.
- First-line treatments are identical across systems: SSRIs at higher doses and exposure and response prevention (ERP).
## Why this crosswalk exists
OCD has high agreement across diagnostic systems, but the fine detail of specifiers (insight, tic-related) can matter clinically. This page names the exact differences so a clinician or patient using one system can translate to the other.
## Sources
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Section on Obsessive-Compulsive and Related Disorders. 2022.
- World Health Organization. International Classification of Diseases 11th Revision (ICD-11). Chapter 6, 6B20-6B2Y Obsessive-compulsive or related disorders. 2022.
- Stein DJ, Kogan CS, Atmaca M, et al. The classification of obsessive-compulsive and related disorders in the ICD-11. Journal of Affective Disorders. 2016;190:663-674.
- Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3-19.