By all accounts, the current revision process for developing the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due in May 2013, is an extremely complex and controversial endeavor. Judging by discussions at the recent meeting of the Anxiety Disorders Association of America, that is certainly true for issues related to the anxiety disorders section of psychiatry’s bible.
Among the revisions proposed to the DSM-IV anxiety disorder criteria, the one that appears most controversial involves broadening obsessive compulsive disorder (OCD) to include a grouping of other related diagnoses under the heading “Anxiety and OCD Spectrum Disorders.”
The notion that disorders such as trichotillomania, hypochondriasis, and body dysmorphic disorder should all be considered aspects of a common underlying pathology doesn’t sit well with everyone, Bradley Reimann, Ph.D., told me. “There’s a dividing line. Some people are for it and some are against it. There’s not much gray area,” he said.
And even among those who agree with “lumping,” there is debate about which disorders belong under the heading. Family study data presented at the meeting by Dr. O. Joseph Bienvenu suggest that generalized anxiety disorder (GAD), agoraphobia, tic disorders, and “grooming disorders” such as trich or skin picking run strongly in families of patients with OCD, whereas eating disorders and substance abuse disorders do not.
Dr. Reimann spoke about a possible new category called “health anxiety” that might include hypochondriasis and “disease phobia.” It would be placed under the OCDS/Anxiety heading, separate from OCD. However, disease phobia might actually be the same phenomenon as OCD contamination fear, he pointed out.
One proposed change that I could actually wrap my head around would replace the term GAD with “Generalized Anxiety and Worry Disorder.” Maybe that’s because I would certainly have those symptoms if I were among those tasked with writing the DSM-5.
The APA is taking online comments on the proposed criteria through April 20. And while you’re at it, please consider leaving a comment here, too!