OCD can present with a wide variety of symptoms. Certain groups of symptoms typically occur together. These groups are sometimes viewed as dimensions or clusters that may reflect an underlying process. The standard assessment tool for OCD, the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), has 13 predefined categories of symptoms. These symptoms fit into three to five groupings. A meta analytic review of symptom structures found a four factor structure(grouping) to be most reliable. The observed groups included a "symmetry factor", a "forbidden thoughts factor", a "cleaning factor" and a "hoarding factor". The "symmetry factor" correlated highly with obsessions related to ordering, counting, symmetry as well as repeating compulsions. The "forbidden thoughts factor" correlated highly with intrusive and distressing thoughts of a violent, religious or sexual nature. The "cleaning factor" correlated highly with obsessions about contamination and compulsions related to cleaning. The "hoarding factor" only involved hoarding related obsessions and compulsions, and was identified as being distinct from other symptom groupings.

While OCD has been considered a homogenous disorder from a neuropsychological perspective, many of the putative neuropsychological deficits may be due to comorbid disorders. Furthermore, some subtypes have been associated with improvement in performance on certain tasks such as pattern recognition(washing subtype) and spatial working memory(obsessive thought subtype). Subgroups have also been distinguished by neuroimaging findings and treatment response. Neuroimaging studies on this have been too few, and the subtypes examined have differed too much to draw any conclusions. On the other hand, subtype dependent treatment response has been studied, and the hoarding subtype has consistently responded least to treatment.

Some people with OCD exhibit what is known as "overvalued ideas". In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such people because they may be unwilling to cooperate, at least initially. There are severe cases in which the person has an unshakeable belief in the context of OCD that is difficult to differentiate from psychotic disorders.

Body dysmorphic disorder is defined by an obsession with an imagined defect in physical appearance, and compulsive rituals in an attempt to conceal the perceived defect. Typical complaints include perceived facial flaws, perceived deformities of body parts and body size abnormalities. Some compulsive behaviors observed include mirror checking, ritualized application of makeup to hide the perceived flaw, excessive hair combing or cutting, excessive physician visits and plastic surgery. Body dysmorphic disorder is not gender specific and onset usually occurs in teens and young adults.

Hypochondriasis is excessive preoccupancy or worry about having a serious illness. These thoughts cause a person a great deal of anxiety and stress. The prevalence of this disorder is the same for men and women. Hypochondriasis is normally recognized in early adult age. Those that suffer with hypochondriasis are constantly thinking of their body functions, minor bumps and bruises as well as body images. Hypochondriacs go to numerous outpatient facilities for confirmation of their own diagnosis. Hypochondriasis is the belief that something is wrong but it is not known to be a delusion.

The signs and symptoms of impulse-control disorders vary based on the age of the persons suffering from them, the actual type of impulse-control that they are struggling with, the environment in which they are living, and whether they are male, female, or other.

Intermittent explosive disorder or IED is a clinical condition of experiencing recurrent aggressive episodes that are out of proportion of any given stressor. Earlier studies reported a prevalence rate between 1%-2% in a clinical setting, however a study done by Coccaro and colleagues in 2004 had reported about 11.1% lifetime prevalence and 3.2% one month prevalence in a sample of a moderate number of individuals (n=253). Based on the study, Coccaro and colleagues estimated the prevalence of IED in 1.4 million individuals in the US and 10 million with lifetime IED.

The main observed symptoms of OCPD are (1) preoccupation with remembering past events, (2) paying attention to minor details, (3) excessive compliance with existing social customs, rules or regulations, (4) unwarranted compulsion to note-taking, or making lists and schedules, and (5) rigidity of one's own beliefs, or (6) showing unreasonable degree of perfectionism that could eventually interfere with completing the task at hand.

OCPD's symptoms may cause varying level of distress for varying length of time (transient, acute, or chronic), and may interfere with the patient's occupational, social, and romantic life.

Obsessive–compulsive personality disorder (OCPD) is a personality disorder characterized by a general pattern of concern with orderliness, perfectionism, excessive attention to details, mental and interpersonal control, and a need for control over one's environment, at the expense of flexibility, openness to experience, and efficiency. Workaholism and miserliness are also seen often in those with this personality disorder. Persons affected with this disorder may find it hard to relax, always feeling that time is running out for their activities, and that more effort is needed to achieve their goals. They may plan their activities down to the minute—a manifestation of the compulsive tendency to keep control over their environment and to dislike unpredictable things as things they cannot control.

The cause of OCPD is unknown. This is a distinct disorder from obsessive–compulsive disorder (OCD), and the relation between the two is contentious. Some (but not all) studies have found high comorbidity rates between the two disorders, and both may share outside similaritiesrigid and ritual-like behaviors, for example. Hoarding, orderliness, and a need for symmetry and organization are often seen in people with either disorder. Attitudes toward these behaviors differ between people affected with either of the disorders: for people with OCD, these behaviors are unwanted and seen as unhealthy, being the product of anxiety-inducing and involuntary thoughts, while for people with OCPD they are egosyntonic (that is, they are perceived by the subject as rational and desirable), being the result of, for example, a strong adherence to routines, a natural inclination towards cautiousness, or a desire to achieve perfection.

OCPD occurs in about 2–8% of the general population and 8–9% of psychiatric outpatients. The disorder occurs more often in men.

For many years, hoarding has been listed as a symptom or a subtype of obsessive-compulsive disorder (OCD) and obsessive–compulsive personality disorder (OCPD). Obsessive-compulsive disorder is a type of anxiety disorder. People with OCD experience unwanted thoughts that incline them to do something repetitively. Some of these behaviors are excessive cleanliness and excessive toothbrushing. The current DSM says that an OCD diagnosis should be considered when:

- The hoarding is driven by fear of contamination or superstitious thoughts

- The hoarding behavior is unwanted or highly distressing

- The individual shows no interest in the hoarded items

- Excessive acquisition is only present if there is a specific obsession with a certain item

Compulsive hoarding does not seem to involve the same neurological mechanisms as more familiar forms of obsessive–compulsive disorder and does not respond to the same drugs, which target serotonin. In compulsive hoarding, the symptoms are presented in the normal stream of consciousness, and are not perceived as repetitive or distressing like in OCD patients. Despite statistics indicating that there is a prevalence of hoarding in 18% to 40% of patients with OCD, only 5% of compulsive hoarders experience symptoms of OCD. In another study, a sample of 217 patients diagnosed with significant hoarding, only 18% were diagnosed with OCD, as opposed to the 36% that were diagnosed with a major depressive disorder. There are significant differences and issues between the diagnostic features of compulsive hoarding and OCD which are being considered in a possible addition to the DSM-V of a new independent disorder such as compulsive hoarding. It is also said that there may be an overlap with a condition known as impulse control disorder (ICD), particularly when compulsive hoarding is linked to compulsive buying or acquisition behavior.

Recent findings suggest that there may be three types of hoarding: pure hoarding, hoarding plus OCD (i.e., co-morbid OCD), and OCD-based hoarding Given the aforementioned distinction, it was proposed to increase coverage of compulsive hoarding in the forthcoming Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), both by creating a distinct category for compulsive hoarding, provisionally named, Hoarding Disorder (either in the main manual under "obsessive-compulsive spectrum disorders" or in the appendix), and by including hoarding as a potential symptom of OCD.

Behaviors that are apparent in those with internalizing disorders include depression, withdrawal, anxiety, and loneliness. There are also behavioral characteristics involved with internalizing disorders. Some behavioral abnormalities include poor self-esteem, suicidal behaviors, decreased academic progress, and social withdrawal. Internalizing one's problems, like sadness, can cause the problems to grow into larger burdens such as social withdrawal, suicidal behaviors or thoughts, and other unexplained physical symptoms.

Compulsive hoarding in its worst forms can cause fires, unsanitary conditions (such as rat and roach infestations), and other health and safety hazards.

Listed below are possible symptoms hoarders may experience:

- They hold onto a large number of items that most people would consider useless or worthless, such as:

- Junk mail, old catalogs, magazines, and newspapers

- Worn out cooking equipment

- Things that might be useful for making crafts

- Clothes that might be worn one day

- Broken things or trash

- "Freebies" or other promotional products

- Their home is cluttered to the point where many parts are inaccessible and can no longer be used for intended purposes. For example:

- Beds that cannot be slept in

- Kitchens that cannot be used for food preparation

- Tables, chairs, or sofas that cannot be used for dining or sitting

- Unsanitary bathrooms

- Tubs, showers, and sinks filled with items and can no longer be used for washing or bathing.

- Their clutter and mess is at a point where it can cause illness, distress, and impairment. As a result, they:

- Do not allow visitors in, such as family and friends, or repair and maintenance professionals, because the clutter embarrasses them

- Are reluctant or unable to return borrowed items

- Keep the shades drawn so that no one can look inside

- Get into a lot of arguments with family members regarding the clutter

- Are at risk of fire, falling, infestation, or eviction

- Often feel depressed or anxious due to the clutter

Whereas vanity involves a quest to aggrandize the appearance, BDD is experienced as a quest to merely normalize the appearance. Although delusional in about one of three cases, the appearance concern is usually nondelusional, an overvalued idea.

The bodily area of focus can be nearly any, yet is commonly face, hair, stomach, thighs, or hips. Some half dozen areas can be a roughly simultaneous focus. Many seek dermatological treatment or cosmetic surgery, which typically do not resolve the distress. On the other hand, attempts at self-treatment, as by skin picking, can create lesions where none previously existed.

BDD shares features with obsessive-compulsive disorder, but involves more depression and social avoidance. BDD often associates with social anxiety disorder. Some experience delusions that others are covertly pointing out their flaws. Cognitive testing and neuroimaging suggest both a bias toward detailed visual analysis and a tendency toward emotional hyperarousal.

Most generally, one experiencing BDD ruminates over the perceived bodily defect up to several hours daily, uses either social avoidance or camouflaging with cosmetics or apparel, repetitively checks the appearance, compares it to that of other persons, and might often seek verbal reassurances. One might sometimes avoid mirrors, repetitively change outfits, groom excessively, or restrict eating.

BDD's severity can wax and wane, and flareups tend to yield absences from school, work, or socializing, sometimes leading to protracted social isolation, with some becoming housebound for extended periods. Social impairment is usually greatest, sometimes approaching avoidance of all social activities. Poor concentration and motivation impair academic and occupational performance. The distress of BDD tends to exceed that of either major depressive disorder or type-2 diabetes, and rates of suicidal ideation and attempts are especially high.

The internalizing disorders, with high levels of negative affectivity, include depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma and stressor-related disorders, and dissociative disorders. Others like bulimia, and anorexia also come under this category.

Trichotillomania is classified as compulsive picking of hair of the body. It can be from any place on the body that has hair. This picking results in bald spots. Most people who have mild Trichotillomania can overcome it via concentration and more self-awareness.

Those that suffer from compulsive skin picking have issues with picking, rubbing, digging, or scratching the skin. These activities are usually to get rid of unwanted blemishes or marks on the skin. These compulsions also tend to leave abrasions and irritation on the skin. This can lead to infection or other issues in healing. These acts tend to be prevalent in times of anxiety, boredom, or stress.

Body dysmorphic disorder (BDD) is a mental disorder characterized by the obsessive idea that some aspect of one's own appearance is severely flawed and warrants exceptional measures to hide or fix it. In BDD's delusional variant, the flaw is imagined. If the flaw is actual, its importance is severely exaggerated. Either way, thoughts about it are pervasive and intrusive, occupying up to several hours a day. The "DSM-5" categorizes BDD in the obsessive–compulsive spectrum, and distinguishes it from anorexia nervosa.

BDD is estimated to affect up to 2.4% of the population. It usually starts during adolescence, and affects men and women roughly equally. The BDD subtype muscle dysmorphia, perceiving the body as too small, affects mostly males. Besides thinking about it, one repetitively checks and compares the perceived flaw, and can adopt unusual routines to avoid social contact that exposes it. Fearing the stigma of vanity, one usually hides the preoccupation. Commonly unsuspected even by psychiatrists, BDD has been underdiagnosed. Severely impairing quality of life via educational and occupational dysfunction and social isolation, BDD has high rates of suicidal thoughts and suicide attempts.

The affective spectrum is a spectrum of affective disorders (mood disorders). It is a grouping of related psychiatric and medical disorders which may accompany bipolar, unipolar, and schizoaffective disorders at statistically higher rates than would normally be expected. These disorders are identified by a common positive response to the same types of pharmacologic treatments. They also aggregate strongly in families and may therefore share common heritable underlying physiologic anomalies.

Affective spectrum disorders include:

- Attention deficit hyperactivity disorder

- Bipolar disorder

- Body dysmorphic disorder

- Bulimia nervosa and other eating disorders

- Cataplexy

- Dysthymia

- Generalized anxiety disorder

- Hypersexuality

- Irritable bowel syndrome

- Impulse-control disorders

- Kleptomania

- Migraine

- Major depressive disorder

- Obsessive-compulsive disorder

- Oppositional defiant disorder

- Panic disorder

- Posttraumatic stress disorder

- Premenstrual dysphoric disorder

- Social anxiety disorder

- Fibromyalgia

The following may also be part of the spectrum accompanying affective disorders.

- Chronic pain

- Intermittent explosive disorder

- Pathological gambling

- Personality disorder

- Pyromania

- Substance abuse and addiction (includes alcoholism)

- Trichotillomania

Also, there are now studies linking heart disease.

Many of the terms above overlap. The American Psychiatric Association's definitions of these terms can be found in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM).

Many people experience the type of bad or unwanted thoughts that people with more troubling intrusive thoughts have, but most people can dismiss these thoughts. For most people, intrusive thoughts are a "fleeting annoyance". Psychologist Stanley Rachman presented a questionnaire to healthy college students and found that virtually all said they had these thoughts from time to time, including thoughts of sexual violence, sexual punishment, "unnatural" sex acts, painful sexual practices, blasphemous or obscene images, thoughts of harming elderly people or someone close to them, violence against animals or towards children, and impulsive or abusive outbursts or utterances. Such bad thoughts are universal among humans, and have "almost certainly always been a part of the human condition".

When intrusive thoughts occur with obsessive-compulsive disorder (OCD), patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing. The thoughts may become obsessions which are paralyzing, severe, and constantly present, and can range from thoughts of violence or sex to religious blasphemy. Distinguishing them from normal intrusive thoughts experienced by many people, the intrusive thoughts associated with OCD may be anxiety provoking, irrepressible, and persistent.

How people react to intrusive thoughts may determine whether these thoughts will become severe, turn into obsessions, or require treatment. Intrusive thoughts can occur with or without compulsions. Carrying out the compulsion reduces the anxiety, but makes the urge to perform the compulsion stronger each time it recurs, reinforcing the intrusive thoughts. According to Lee Baer, suppressing the thoughts only makes them stronger, and recognizing that bad thoughts do not signify that one is truly evil is one of the steps to overcoming them. There is evidence of the benefit of acceptance as an alternative to suppression of intrusive thoughts. A study showed that those instructed to suppress intrusive thoughts experienced more distress after suppression, while patients instructed to accept the bad thoughts experienced decreased discomfort. These results may be related to underlying cognitive processes involved in OCD. However, accepting the thoughts can be more difficult for persons with OCD. In the 19th century, OCD was known as "the doubting sickness"; the "pathological doubt" that accompanies OCD can make it harder for a person with OCD to distinguish "normal" intrusive thoughts as experienced by most people, causing them to "suffer in silence, feeling too embarrassed or worried that they will be thought crazy".

The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low. Patients who are experiencing intense guilt, anxiety, shame, and upset over these thoughts are different from those who actually act on them. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts and has never acted on them before is an excellent predictor that they will not act upon the thoughts. Patients who are not troubled or shamed by their thoughts, do not find them distasteful, or who have actually taken action, might need to have more serious conditions such as psychosis or potentially criminal behaviors ruled out. According to Lee Baer, a patient should be concerned that intrusive thoughts are dangerous if the person does not feel upset by the thoughts, or rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others do not see; or feels uncontrollable irresistible anger.

Compulsive checking can include compulsively checking items such as locks, switches, and appliances. This type of compulsion usually deals with checking whether harm to oneself or others is possible. Usually, most checking behaviors occur due to wanting to keep others and the individual safe.

People that suffer from compulsive counting tend to have a specific number that is of importance in the situation they are in. When a number is considered significant, the individual has a desire to do the behavior such as wiping ones face off the number of times that is significant. Compulsive counting can include instances of counting things such as steps, items, behaviors, and mental counting.

Compulsive repeating is characterized by doing the same activity multiple times over. These activities can include re-reading a part of a book multiple times, re-writing something multiple times, repeating routine activities, or saying the same phrase over and over.

Compulsive washing is usually found in individuals that have a fear of contamination. People that have compulsive hand washing behaviors wash their hands repeatedly throughout the day. These hand washings can be ritualized and follow a pattern. People that have problems with compulsive hand washing tend to have problems with chapped or red hands due to the excessive amount of washing done each day.

An intrusive thought is an unwelcome involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, posttraumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

Some of the fundamental components of kleptomania include recurring intrusive thoughts, impotence to resist the compulsion to engage in stealing, and the release of pressure following the act. These symptoms suggest that kleptomania could be regarded as an obsessive-compulsive type of disorder.

People diagnosed with kleptomania often have other types of disorders involving mood, anxiety, eating, impulse control, and drug use. They also have great levels of stress, guilt, and remorse, and privacy issues accompanying the act of stealing. These signs are considered to either cause or intensify general comorbid disorders. The characteristics of the behaviors associated with stealing could result in other problems as well, which include social segregation and substance abuse. The many types of other disorders frequently occurring along with kleptomania usually make clinical diagnosis uncertain.

There is a difference between ordinary theft and kleptomania: "ordinary theft (whether planned or impulsive) is deliberate and is motivated by the usefulness of the object or its monetary worth," whereas with kleptomania, there "is the recurrent failure to resist impulses to steal items even though the items are not needed for personal use or for their monetary value."

Kleptomania or klopemania is the inability to refrain from the urge for stealing items and is usually done for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in psychiatry as an impulse control disorder. Some of the main characteristics of the disorder suggest that kleptomania could be an obsessive-compulsive spectrum disorder.

The disorder is frequently under-diagnosed and is regularly associated with other psychiatric disorders, particularly anxiety and eating disorders, and alcohol and substance abuse. Patients with kleptomania are typically treated with therapies in other areas due to the comorbid grievances rather than issues directly related to kleptomania.

Over the last 100 years, a shift from psychotherapeutic to psychopharmacological interventions for kleptomania has occurred. Pharmacological treatments using selective serotonin reuptake inhibitors (SSRIs), mood stabilizers and opioid receptor antagonists, and other antidepressants along with cognitive behavioral therapy, have yielded positive results.

The inability to control the urge to pick is similar to the urge to compulsively pull one's own hair, i.e., trichotillomania. Researchers have noted the following similarities between trichotillomania and excoriation disorder: the symptoms are ritualistic but there are no preceding obsessions; there are similar triggers for the compulsive actions; both conditions appear to play a role in modifying the arousal level of the subject; and the age of onset for both conditions is similar. There is also a high level of comorbidity between those that have trichotillomania and those that have excoriation disorder. A notable difference between these conditions is that skin picking seems to be dominated by females whereas trichotillomania is more evenly distributed across genders.

Research has also suggested that excoriation disorder may be thought of as a type of obsessive compulsive disorder (OCD). Excoriation disorder and OCD are similar in that they both involve "repetitive engagement in behaviors with diminished control" and also both generally decrease anxiety.

Nevertheless, Odlaug and Grant have suggested that excoriation disorder is more akin to substance abuse disorder than OCD. They argue that excoriation disorder differs from OCD in the following fundamental ways: (1) there is a much greater share of females with excoriation disorder; (2) excoriation disorder may be inherently pleasurable whereas OCD is not; (3) the treatments that are generally effective for patients with OCD (i. e., SSRIs and exposure therapy) are not as successful in patients with excoriation disorder; and (4) unlike OCD, picking the skin is rarely driven by obsessive thoughts. Odlaug and Grant have recognized the following similarities between individuals with dermatillomania and patients with addictions: (1) a compulsion to engage in the negative behavior despite knowledge of the harm; (2) a lack of control over the problematic behavior; (3) a strong urge to engage in the behavior prior to engagement; and (4) a feeling of pleasure while engaging in the behavior or a feeling of relief or reduced anxiety after engaging in the behavior. One study that supported the addiction theory of picking found that 79% of patients with excoriation disorder reported a pleasurable feeling when picking.

Odlaug and Grant also argue that dermatillomania could have several different psychological causes, which would explain why some patients seem more likely to have symptoms of OCD, and others, of an addiction. They suggest that treating certain cases of excoriation as an addiction may yield more success than treating them as a form of OCD.

An addictive behavior is a behavior, or a stimulus related to a behavior (e.g., sex or food), that is both rewarding and reinforcing, and is associated with the development of an addiction. Addictions involving addictive behaviors are normally referred to as behavioral addictions.

Episodes of skin picking are often preceded or accompanied by tension, anxiety, or stress. In some cases, following picking, the affected person may feel depressed. During these moments, there is commonly a compulsive urge to pick, squeeze, or scratch at a surface or region of the body, often at the location of a perceived skin defect. When picking one may feel a sense of relief or satisfaction.

The region most commonly picked is the face, but other frequent locations include the arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, and extremities such as the fingernails, cuticles, and toenails. Most patients with excoriation disorder report having a primary area of the body that they focus their picking on, but they will often move to other areas of the body to allow their primary picking area to heal. Individuals with excoriation disorder vary in their picking behaviour; some do it briefly multiple times a day while others can do one picking session that can last for hours. The most common way to pick is to use the fingers although a significant minority of people use tools such as tweezers or needles.

Skin picking often occurs as a result of some other triggering cause. Some common triggers are feeling or examining irregularities on the skin and feeling anxious or other negative feelings.

Complications arising from excoriation disorder include: infection at the site of picking, tissue damage, and septicemia. Damage from picking can be so severe as to require skin grafting. Severe picking can cause epidermal abscesses. Severe cases of excoriation disorder can cause life-threatening injuries. For example, in one reported case a female picked a hole through the bridge of her nose, which required surgery to fix, and a 48-year-old female picked through the skin on her neck exposing the carotid artery. Pain in the neck or back can arise due to prolonged bent-over positions while engaging in the behavior. Besides physical injuries, excoriation disorder can cause severe physical scarring and disfigurement.

Excoriation disorder can cause feelings of intense helplessness, guilt, shame, and embarrassment in individuals, and this greatly increases the risk of self-harm. Studies have shown that excoriation disorder presented suicidal ideation in 12% of individuals with this condition, suicide attempts in 11.5% of individuals with this condition, and psychiatric hospitalizations in 15% of individuals with this condition.

In the American Psychiatric Association's DSM-5, schizotypal personality disorder is defined as a "pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts."

At least five of the following symptoms must be present: ideas of reference, strange beliefs or magical thinking, abnormal perceptual experiences, strange thinking and speech, paranoia, inappropriate or constricted affect, strange behavior or appearance, lack of close friends, and excessive social anxiety that does not abate and stems from paranoia rather than negative judgments about self. These symptoms must not occur only during the course of a disorder with similar symptoms (such as schizophrenia or autism spectrum disorder).