(e.g., of violent or horrific scenes), or urges (e.g., to stab someone) . Importantly, obsessions
are not pleasurable or experi enced as voluntary: they ar e intrusive and unwanted and
cause marked distress or anxiety in most indi viduals. The individual attempts to ignore or
suppress these obsessions (e.g., avoiding tri ggers or using thought suppression) or to neu-
tralize them with another thought or ac tion (e.g., performing a compulsion). Compulsions
(or rituals) are repetitive behaviors (e.g., washing, checking) or mental acts (e.g., 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. Most individuals with OCD
have both obsessions and compulsions. Comp ulsions are typically performed in response
to an obsession (e.g., thoughts of contaminatio n leading to washing rituals or that some-
thing is incorrect leading to repeating rituals unt il it feels “just right”). The aim is to reduce
the distress triggered by obsessions or to pr event a feared event (e.g., becoming ill). How-
ever, these compulsions either are not connected in a realistic way to the feared event (e.g.,
arranging items symmetrically to prevent harm  to a loved one) or are clearly excessive
(e.g., showering for hours each day). Compulsions are not done for pleasure, although some
individuals experience relief from anxiety or distress. 
Criterion B emphasizes that obsessions and compulsions must be time-consuming (e.g.,
more than 1 hour per day) or cause clinically significant distress or impairment to warrant
a diagnosis of OCD. This criterion helps to distinguish the disorder from the occasional in-
trusive thoughts or repetitive behaviors that  are common in the general population (e.g.,