Howard Hughes meets the DSM 5 criteria for OCD: the obsessions are repetitive and he tries in vain to repress his urges. His behaviors are compulsive and serve to reduce his anxiety. Obsessions and compulsions take time. Furthermore, they "are not attributable to the physiological effects of a substance or other medical condition" and "the disturbance is not better explained by symptoms of another mental disorder" (Butcher et al., 2014, p.195). It also has symptoms characteristic of other disorders, such as bipolar I disorder and schizophrenia. He has bursts of energy and feels like he can accomplish anything. He also claims he can actually see the germs on his hands or taps. Manic episodes and visual hallucinations are not DSM 5 criteria for OCD, but rather symptoms of bipolar I disorder and schizophrenia respectively (Butcher et al., 2014, p.241, p.448). It is therefore possible that Howard had OCD comorbid with bipolar I disorder with psychosis.