Medical Science: Updates and Prospects Vol. 8

Obsessive-compulsive disorder (OCD) is a severe and common mental illness associated with high rates of treatment resistance. Quality of life is significantly impaired by OCD. This study is a thematic conceptual comparison of Obsessive-Compulsive disorder(OCD) as its understood in Diagnostic and Statistical Manual of mental disorders 5th edition (DSM-5-TR) and Psychodynamic Diagnostic Manual 2nd edition (PDM-2) situated in historical development of Psychiatric nosology and conceptual sensitivity of both the diagnostic systems where a nomothetic-homogenous categorical approach and ideographic-heterogeneous dimensional approach to diagnosis of OCD was analyzed on their divergence and convergence to present incremental validity of psychodynamic clinical formulation. Thematic analysis as a qualitative research method using Nvivo software was done. An iterative review to identify seminal papers which were further expanded through backward snowballing search. The foundational and clinical differences of both the systems in regard to OCD could be seen in themes like descriptive symptomatology vs. psychological dynamics, categorical vs. dimensional personality organisation, behavioural manifestation vs. intrapsychic conflict, descriptive phenomenology vs. neuropsychoanalysis and universal classification vs. singular subjectivity. The key findings indicate that DSM-5-TR conceptualizes OCD primarily through descriptive symptomatology and observable behavioural manifestations, whereas PDM-2 emphasizes underlying psychological dynamics, unconscious conflict, and subjective experience. The DSM-5-TR includes insight specifiers- good or fair insight, poor insight, and absent insight/delusional beliefs to acknowledge variability in reality testing and the degree to which individuals recognize their obsessive–compulsive beliefs as unreasonable. In contrast, the PDM-2 situates insight within broader mental capacities, including identity integration, affect tolerance, mentalization, and defensive flexibility, thereby conceptualizing insight not merely as cognitive awareness but as a reflection of overall structural integration and personality organization. Furthermore, DSM focuses on phenomenological classification and reliability, whereas PDM-2 incorporates neuropsychoanalytic and psychodynamic perspectives that link symptoms to emotional systems, developmental processes, and mental functioning. DSM represents a universal classification system aimed at standardization, while PDM-2 prioritizes singular subjectivity and individualized case formulation. The study highlights ongoing epistemological tensions between psychiatric nosology, clinical psychology, and neuroscientific approaches regarding the adequacy of DSM-5-TR, particularly its emphasis on reliability over depth of understanding. This study identifies with such a person- centered movement in the mental health field with future implications for process- oriented research in psychodiagonostics and psychotherapy.