DSM-5 and OCD

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), produced by the American Psychiatric Association, was published in July of 2000. It is now in the process of being updated, and the next edition, The DSM-5,  is scheduled to be released in May, 2013. This manual is the main resource used by mental health professionals in identifying, diagnosing, and treating all mental health disorders.

One of the areas under consideration for revision is the categorization of obsessive-compulsive disorder. Currently classified under Anxiety Disorders, there are those who feel it should be included in a proposed OC-Spectrum Disorders category, and still others who think this OC-Spectrum Category should then become a subset of the Anxiety Disorders section. I’ve also read about the possibility of an Obsessive-Compulsive and Movement Related Disorders grouping.

It’s enough to make my head spin. As I read and research and struggle to understand the pros and cons of the various classification options, and how it will affect those with OCD, I have to admit I’m kind of lost. I know that where and how OCD is ultimately classified might change statistics (prevalence rates of the disorder, for example), and can even affect how the disorder is assessed and treated in some cases. But it doesn’t change OCD. It is what it is and my hope is that, no matter what the new manual says, psychiatrists and psychologists will pay more attention to the person they are treating than the manual they are referencing.

For specific information regarding possible changes to the classification of OCD, you can start with this American Psychiatric Association site, and if you are interested in commenting on the proposed changes, you can do that here. There’s also a great interview on mentalhelp.net with Gregory Murray, PhD., which touches on the history of the DSM and what it’s really all about.

From my viewpoint what it’s really all about is helping those with obsessive-compulsive disorder. How it ends up being classified in this new manual shouldn’t be nearly as important to health care providers as making sure they know and understand what OCD involves and the proper therapies for it.

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13 Responses to DSM-5 and OCD

  1. 71 & Sunny says:

    Hi Janet. You nailed it. OCD is what it is regardless of how it’s characterized. You’re also correct though when you state that how it’s classified can affect prevalence numbers and the like. Which I guess could affect funding and research. Personally, I think it fits quite well as an anxiety disorder. When I look at the symptoms of all the other anxiety disorders, I have some in common from all of them, with the exception of PTSD.

    I do hope more attention is given to compulsive skin picking. I’m not even sure it’s in the DSM at this point.

    In any case, the DSM is a tool, and only that. The fact that so many changes have taken place in the DSM over the years is testament that it’s definitely not infallible!

    • ocdtalk says:

      You’re so right, Sunny, about the manual only being a tool. It would be interesting to read what the very first DSM had to say about OCD! And as OCDKids says below, there is discussion about including CSP in the DSM.

      • Brief DSM History Regarding OCD

        The term Anxiety Disorder didn’t appear until DSM III (1980).
        DSM I included 3 conditions which were precursors to anxiety disorders as they are currently classified. All three were examples of the broader classification known in DSM -1 as psychoneurotic disorders. *DSM -1 also contained a condition called gross stress reaction, which overlapped most closely with what we now refer to as PTSD.

        1st Anxiety reaction- a state of anxiety that is “diffuse and not restricted to definite situations or objects (APA, 1952, p.32).” It stipulated that anxiety reaction could not be “controlled by any specific psychological defense mechanisms as in other psychoneurotic reactions (APA, 1952, p.32).”
        2nd Phobic reaction- in which anxiety “becomes detached from a specific idea, object, or situation in the daily life and is displaced to some symbolic idea or situation in the form of a specific neurotic fear…the patient attempts to control his anxiety by avoiding the phobic objects or situation (APA, 1952, p.33).”
        3rd Obsessive-compulsive reaction- Anxiety that is “associated with the persistence of unwanted ideas and of repetitive impulses to perform acts which may be considered morbid by the patient. The patient himself may regard his ideas and behaviors as unreasonable, but nevertheless is compelled to carry out his rituals (APA, 1952, p.33).” Examples listed in DSM-I include touching, counting, ceremonials, hand washing, and thoughts (often accompanied by a compulsion to repeat the same action).
        • DSM-II changed Obsessive-compulsive reaction to Obsessive-compulsive neurosis and was included in the broader category of neuroses. The disorder was described as the “persistent intrusion of unwanted thoughts, urges, or actions that the patient is unable to stop. The thoughts may consist of single words or ideas, ruminations, or trains of thought often perceived by the patient as nonsensical (APA, 1968, p.40).”
        • DSM-I & DSM-II were similar relating to Obsessive-compulsive in that the amount of detail in the description was comparable and both descriptions were exactly 8 lines.
        • DSM-III was first to clearly define obsessions and compulsions and remain quite similar to today’s DSM-IV. Additionally, clinically significant stress or impairment was necessary for diagnosis. Also stipulated was the symptoms could not be caused by another mental disorder.
        • DSM-IV includes important changes. These changes are, the mention of mental/covert compulsions, specification of the boundary between obsessions and worry, and addition of the “with poor insight” specifier to identify individuals who do not recognize their obsessions or compulsions as unreasonable or excessive.

  2. After thorough review, I believe the Rational portion of proposed changes to the current DSM are all good, positive, well thought out changes. However, regarding the Severity portion of proposed changes I am in disagreement. This is the part which addresses how to determine the severity of an OCD suffer. What they seem to have done is eliminate half of the questions currently used by the Yale BOCS. These proposed changes will not provide: the depth and complexity of information attained currently using the Y_BOCS, thereby, leaving the sufferer and care provider with a score which misrepresents the actual severity. Certainly, because of the complexity of OCD we must have the most reliable and accurate measurement scale possible. The test used and relied on is exceptionally important and limiting the entire test to 5 questions seems almost insulting.

  3. Thank you for this post. I was not aware of the current work being done, and I am definitely interested in the the outcome.

  4. ocdtalk says:

    Thanks for the comment, Tina. It does seem as if anyone who wants to can comment on the proposed changes……not sure how much the comments are considered, but it’s good to be able to express our opinions at the very least.

  5. Janet, you’re exactly right … OCD remains itself however it is classified!!! However they change/don’t change the classification, I just want more awareness!!! 🙂

  6. ocdtalk says:

    Thanks for the comment, Jackie. I couldn’t agree more!

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