Obsessive-compulsive disorder (OCD) is characterized by the presence of either obsessions (worries is a more user-friendly term for children) or compulsions (rituals is a more user-friendly term for children). Although OCD is categorized among the anxiety disorders in DSM-IV (American Psychiatric Association 1994, 2000), especially in younger children, a variety of hidden or poorly articulated affects may drive the symptoms. There is active consideration of removing OCD from the DSM category of anxiety disorders and creating a new limited category for OCD "spectrum" disorders in DSM-V. Table 23–1 shows the current DSM-IV-TR criteria for OCD. The specifier "with poor insight" may be especially relevant to the diagnosis in youth since children's ability to explain their obsessions and the fears driving their compulsions may be quite limited.