New recognition for obsessive-compulsive and related disorders

This week saw the release of the American Psychiatric Association's 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The DSM is used throughout the world and this is the first revision in nearly two decades. Not surprisingly, it has received a good deal of media coverage across the globe.

Professor Dan Stein (pictured) head of the Department of Psychiatry and Mental Health, and director of the Brain Behaviour Initiative at UCT, is one of the many international contributors to DSM-5.

An A-rated scientist, Stein headed the Sub-Work Group on Obsessive-Compulsive Spectrum disorders, and has published a number of papers on the DSM-5 revision process.

In one paper, co-authored with Professor Randy Nesse, a pioneer in evolutionary medicine from the University of Michigan, Stein and Nesse made the argument that some of the criticism of DSM-5 reflects overly high expectations.

"Behaviour is enormously complex and so it is not surprising that DSM-5 categories cannot be mapped onto specific biological abnormalities," said Stein. In a second paper, co-authored with Professor Katharine Phillips, from Brown University, who was on the DSM-5 Taskforce, Stein and Phillips noted that DSM-5 was the first edition of the manual where proposals were made available for public scrutiny during the revision process.

Stein and Phillips emphasise the value that consumer advocacy around certain Obsessive-Compulsive Spectrum Disorders played in this issue of the manual. It was very helpful to have stronger patient support for the changes proposed in this section.

Stein is pleased that Obsessive-Compulsive and Related Disorders will, for the first time, be a separate chapter in DSM.

Professor Christine Lochner, his University of Stellenbosch colleague in their MRC Unit on Anxiety and Stress Disorders, played a key role in leading field surveys in this area. These contributed to formulating the final diagnostic criteria.

Stein is hopeful that the improved diagnostic criteria will help encourage diagnosis and treatment of these prevalent, but often neglected, disorders which include body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder) and excoriation (skin-picking disorder).

Stein concludes: "In South Africa we focus a lot on medical conditions associated with mortality. But if one looks at morbidity, then psychiatric disorders such as obsessive compulsive disorder are among the greatest contributors to our national burden of disease. So it's important that we develop expertise in this area as well."