What are the characteristic symptoms of obsessive‑compulsive disorder and the minimum duration required for a diagnosis?

OCD Diagnostic Criteria: Symptoms and Duration

For a diagnosis of OCD, patients must have obsessions and/or compulsions that are time-consuming (taking more than 1 hour per day) or cause clinically significant distress or functional impairment, with no minimum duration explicitly specified in DSM-5 criteria. 1

Core Symptom Requirements

Obsessions Must Include:

• Recurrent and persistent thoughts, urges, or impulses that are experienced as intrusive and unwanted, causing marked anxiety or distress 1
• The individual attempts to ignore, suppress, or neutralize these thoughts with some other thought or action (by performing a compulsion) 1
• These are ego-dystonic—meaning they feel intrusive and unwanted, not like genuine concerns 2

Compulsions Must Include:

• Repetitive behaviors (handwashing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform 1
• These behaviors are performed in response to an obsession or according to rigid rules that must be applied 1
• The behaviors aim to prevent or reduce anxiety or distress, but are not connected in a realistic way with what they're designed to neutralize, or are clearly excessive 1

Five Primary Symptom Dimensions

The factor-analytic research consistently identifies these patterns 1:

• Contamination dimension: Concerns about dirt, germs, and cleanliness with washing/cleaning compulsions 1, 2
• Harm-related dimension: Thoughts of harm to self or others with checking compulsions 1, 2
• Forbidden thoughts dimension: Intrusive aggressive, sexual, or religious obsessions with mental rituals or praying 1, 2
• Symmetry dimension: Symmetry obsessions with ordering, straightening, repeating, or counting compulsions 1, 2
• Hoarding dimension: Hoarding concerns with related compulsions (though hoarding disorder is now a separate diagnosis) 1

Time and Functional Impairment Criteria

The obsessions or compulsions must be time-consuming (taking more than 1 hour per day) OR cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 1 This is an "or" criterion—either time consumption or functional impairment qualifies, not necessarily both. In children specifically, rituals taking more than 1 hour per day signal impairment 2.

Critical Exclusion Criteria

The diagnosis requires ruling out 1:

• Symptoms attributable to substance effects (drugs of abuse or medications) or another medical condition
• Symptoms better explained by another mental disorder (generalized anxiety disorder, body dysmorphic disorder, hoarding disorder, trichotillomania, eating disorders, substance-related disorders, illness anxiety disorder, paraphilic disorders, or impulse-control disorders)

Key Differentiating Features

OCD is distinguished from normal development and other conditions by 2:

• Distress and resistance: The child recognizes behaviors are excessive and wishes for more control
• Rigid, repetitive patterns: Compulsions follow strict rules rather than flexible preferences
• Anxiety-reducing function: Behaviors are performed to prevent dreaded outcomes, not for gratification

Critical pitfall: Do not confuse OCD compulsions with impulsive behaviors, which are ego-syntonic (experienced as consistent with one's desires) and fundamentally different from the anxiety-reducing, ego-dystonic nature of OCD compulsions 2, 3.

Duration Specification

Notably, DSM-5 criteria do not specify a minimum duration for OCD symptoms, unlike many other psychiatric disorders 1. The diagnosis hinges on the presence of qualifying obsessions/compulsions that meet the time-consumption or functional impairment threshold, regardless of how long symptoms have been present. This contrasts with disorders like major depressive disorder (2 weeks) or generalized anxiety disorder (6 months) that have explicit duration requirements.

Age-Specific Considerations

Nearly 25% of males with OCD have symptom onset before age 10, and OCD begins before age 18 in as many as 80% of cases 2, 4. The disorder follows a chronic, unremitting course when untreated 4.