Guide
Guide | Reference

32  Predominant Compulsivity Prototypes

32.1 Summary

  • Prototypes dominated by intrusive thoughts, repetitive behaviors, and difficulty disengaging from loops.

32.2 Included Prototypes (Guide exemplars)

  • OCD Pattern Prototype (exemplar).
  • Illness Anxiety Pattern Prototype (exemplar).
  • Full catalog appears in the Clean Reference.

32.3 How to Use This Cluster

  • Start with the Atlas entry for obsessions/compulsions.
  • Rate the Compulsivity and Perseveration domain.
  • Apply a prototype label only when it improves communication or documentation.

32.4 Boundary Markers

  • What it is: repetitive, distress-driven loops that consume time or function.
  • What it is not: habits or preferences without distress or impairment.

32.5 Common Overlap

  • Anxiety and threat sensitivity.
  • Somatic distress or interoceptive sensitivity.

32.6 OCD Pattern Prototype (Exemplar)

32.6.1 Summary

  • A pattern of intrusive thoughts or urges paired with repetitive rituals or mental acts aimed at reducing distress.

32.6.2 Prototype Features

  • Obsessions or intrusive doubts that feel unwanted.
  • Compulsions, checking, or mental rituals.
  • Temporary relief followed by return of distress.

32.6.3 Threshold Guidance

  • Use when obsessions/compulsions are recurrent and impairing.

32.6.4 Expected Domain Profile

  • Compulsivity and Perseveration: moderate to high.
  • Anxiety and Threat Sensitivity: variable, often elevated.

32.6.5 Time-Course and Trajectory

  • Chronic with fluctuating intensity.
  • Trigger-linked spikes.

32.6.6 Differential and Red Flags

  • Psychosis with fixed delusional beliefs.
  • Trauma intrusions without rituals.
  • Substance effects or neurologic contributors.

32.6.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.

32.7 Illness Anxiety Pattern Prototype (Exemplar)

32.7.1 Summary

  • A pattern of persistent health-related fear with checking, reassurance seeking, or avoidance despite limited objective findings.

32.7.2 Prototype Features

  • Excessive health worry or fear of serious illness.
  • Reassurance seeking, checking, or avoidance of medical settings.
  • Persistent doubt despite evaluations.

32.7.3 Threshold Guidance

  • Use when health anxiety is persistent and impairs function or care engagement.

32.7.4 Expected Domain Profile

  • Compulsivity and Perseveration: moderate.
  • Somatic Distress and Interoception: variable, often elevated.
  • Anxiety and Threat Sensitivity: moderate.

32.7.5 Time-Course and Trajectory

  • Chronic with flare-ups during stress or symptom changes.

32.7.6 Differential and Red Flags

  • Actual medical illness explaining symptoms.
  • Trauma-related hypervigilance to bodily cues.
  • Somatic symptom burden without health fear.

32.7.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.