pations with appearance, hoarding, hair pull ing, skin picking, or other body-focused
repetitive behaviors (Criterion A). The judgme nt that the symptoms are best explained by
the associated medical condition must be based on evidence from the history, physical ex-
amination, or laboratory findings (Criterion B). Additionally, it must be judged that the
symptoms are not better explained by another mental disorder (Criterion C). The diagno-
sis is not made if the obsessive-compulsive and related symptoms o ccur only during the
course of a delirium (Criterion D). The obsessive-compulsive and related symptoms must
cause clinically significant distress or impairment in social, occupa tional, or other impor-
tant areas of functioning (Criterion E).
In determining whether the ob sessive-compulsive and rela ted symptoms are attribut-
able to another medical condit ion, a relevant medical condition must be present. Further-
more, it must be established that obsessive-compulsive and related symptoms can be
etiologically related to the medical condit ion through a pathophysiological mechanism
and that this best explains the symptoms in the individual. Although there are no infallible
guidelines for determining whether the relationship between the obsessive-compulsive
and related symptoms and the medical conditio n is etiological, considerations that may
provide some guidance in making this diagno sis include the presence of a clear temporal
association between the onset, exacerbation, or remission of the medical condition and the
obsessive-compulsive and related symptoms; the presence of features that are atypical of
a primary obsessive-compulsive and related disord er (e.g., atypical age at onset or course);
and evidence in the literature that a known physiological mechanism (e.g., striatal dam-
age) causes obsessive-compulsive and rela ted symptoms. In addi tion, the disturbance