OCD and Christianity

Since 1952, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has been the official manual for diagnosing mental disorders in the United States. It provides the specific criteria that are used in clinics and hospitals to diagnose various mental disorders. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications.

The most recent edition of the Diagnostic and Statistical Manual, the DSM-5-TR published in 2022, is a minor update of 2013’s DSM- 5. The DSM-5 itself was a significant revision of the previous manual. Modifications were made in the criteria used to identify a number of disorders, and a few new disorders were added. An important change was made in the classification of OCD. It was removed from the category of anxiety disorders, and put in a separate category. OCD’s diagnostic criteria were also somewhat broadened to include cases that would not have been diagnosed as OCD in the past. A number of noted OCD researchers did not agree with these changes. I think that removing OCD from the category of anxiety disorders was a mistake, because OCD has always been categorized as such, and, after all, OCD is first and foremost a disorder of fearful thoughts.


A.  Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.  Note: young children may not be able to articulate the aims of these behaviors or mental acts.

B.  the obsessions or compulsions are time-consuming (e.g., take more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C.  The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D.  The disturbance is not better explained by the symptoms of another mental disorder.