Proposed criteria

These proposed criteria are probably not definitive. We work hard to make them operative and validated. They are inspired from those put forward by the team of Würzburg, those of Sigmund (1998, 1999) and DRC Budapest-Nashville (Pethö 1988). They are completed thanks to the seminars of Gerald Stöber and may be updated from day to day through a wiki page.

Click here to see the present state of the wiki page. Only members are allowed to directly modify the criteria but we encourage any contribution (send a mail).


To make a diagnosis:

  • Evolution criteria are to be fulfilled
  • Met clinical criteria
  • None of the exclusion criteria must be observed

Criteria of rank A are requiered for the diagnosis.
Criteria of rank B are not requiered but if prensent give further confidence in the diagnosis (inconsistent or too difficult to be reliabily observed to be mandatory - shifted to the right).
Clinical symptoms compatible with the diagnosis are just informative and are not part of the criteria.

Evolution criteria

  • Progressive installation of the cardinal symptoms (> 3 months, usually worsening over 2 to 15 years or more)
    • Processual symptoms to varying degrees, may be absent

Clinical criteria (have to be permanent)

  • Mannerism according to WKL, ie rigid behavioral rituals either positive (compulsive aspect) or negative (omission = loss of behavioral register). 3 of the 4 criteria must be present if no processual symptoms, 2 are sufficient if processual symptoms present:
    • No egodystonic feeling, symptoms accepted as normal (no insight) even if patients recognize them as meaningless
    • No attempt to fight against the compulsions (no conflict)
    • No obsessive idea congruent with rituals
    • Absence of anxiety in case the ritual can not be performed, simple irritation
  • Stiffening behavior (at least 2 criteria):
    • Stiffness of voluntary movements and/or posture
    • Reduction motor expression (mimic, prosody ...)
    • Reduction in the spectrum of activities
  • The ending of a ritual, the passage from one action to another, or the conclusion of an action can be promoted by prompting the patient
  • Optional
    • Slowness
    • Impulsive actions in the installation phase of mannerism
    • Difficulty in completing an action or a sentence. Movement or speech are like suspended, the patient can not finish them by himself
    • With the evolution: mutism, oppositionisme, posturing

Various, compatible with the diagnosis but WITHOUT being indicative for it

  • Anxiety unrelated to the obsessions or the compulsions

Exclusion criteria

Not secondary to

  • Drug intoxication or withdrawal
  • An organic disease
  • A reactive psychosis (reaction to a severe stressor)

Clinical (symptom that can not be observed)

  • Hypochondriacal complaints
  • Deep affective flattening
  • Ethical blunting
  • Persistence of other catatonic symptoms: parakinesia, negativism with ambitendancy, stereotypies or iterations, short-circuit responses.
  • Persistence of a thought or a language disorder, of a disorganized speech or illogicality
  • Persistence of psychotic symptoms (delusions, hallucinations)
  • Persistence of  genuine mood disorder.

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