Report of the DSM-V Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group

November 2008
Katharine A. Phillips, M.D.

Work Group Structure

The Anxiety, Obsessive Compulsive (OC) Spectrum, Post-Traumatic, and Dissociative Disorders Workgroup has three subworkgroups: 1) Anxiety, 2) Trauma/Dissociation, and 3) the Obsessive Compulsive Spectrum.  

Liaisons to Other Work Groups and Study Groups 

This work group has liaisons to many other work groups, including: Childhood Disorders, Mood Disorders, Psychosis, Personality and Personality Disorders, Neurocognitive Disorders, Sleep/Wake Disorders, Somatic Distress Disorders, and Substance-Related Disorders. The work group also has liaisons to the Lifespan/Developmental, Diagnostic Spectra, Gender/Cross-Cultural, and Functioning Study Groups.  

Advisors

Advisors have been nominated for all sub-work groups. Additional advisors will likely be nominated. Some advisors have participated on conference calls, and many are co-authoring literature reviews. 

Conference Calls 

Work group conference calls have focused on “overarching” themes that are relevant to all of the sub-work groups, such as clinical utility, criteria for adding and deleting disorders, considerations for changing diagnostic criteria, and how to incorporate gender, developmental considerations, a cross-cultural perspective, and etiology/pathophysiology into DSM-V. The sub-work group calls have focused on issues relevant to the disorders and other topics covered by each sub-work group.  Literature review proposals and literature reviews, advisors, secondary data analyses, available databases, and other issues are being addressed by the work group as a whole, as well as by the subworkgroups.  

Workgroup Meetings  

Since the last task force meeting, the work group met in October, 2008. At that meeting, progress was made on the above issues. There were several content-focused presentations/discussions, including developmental considerations, dimensional issues, and how some of the disorders covered by our work group might be grouped in DSM-V. 

Literature Reviews 

Evidence-based literature reviews are being done, some in collaboration with other work groups and study groups. The reviews will provide a balanced review of the literature on key issues that are relevant to DSM-V. They will include a statement of the issues, significance of the issues, search methodology, results, and discussion and recommendations. Reviews are in progress on key issues for DSM-V in each of the following topic areas: 

  • Operationally defining the term: “mental disorder“
  • The nature and conceptualization of anxiety/anxiety disorders
  • Panic disorder
  • Agoraphobia
  • Social phobia
  • Generalized anxiety disorder, including overanxious disorder of childhood
  • Specific phobia
  • Adult separation anxiety disorder
  • Subthreshold anxiety
  • Obsessive compulsive spectrum
  • Relationship of OCD to anxiety disorders
  • OCD subtypes and dimensions
  • Hoarding
  • Tourette’s disorder/tics
  • Stereotypic movement disorder
  • Body dysmorphic disorder
  • Trichotillomania
  • PTSD
  • Developmental aspects of traumatic events and response
  • Acute reactions to stress
  • Dissociative disorders
  • Categorization of trauma/dissociation/adjustment disorders
  • Psychosis/insight across disorders
  • Developmental issues: in addition to a broader overview review, developmental issues will be covered in other reviews
  • Cross-cultural review focusing on broader issues for DSM-V using dissociative disorders as an example
  • Gender review of disorders covered by the work group  

Funded Secondary Data Analyses 

Two funded projects (see below) are in progress. Additional, unfunded secondary data analyses are being conducted to address other key issues being considered by the work group. 

        1) The structure of mental disorders based on epidemiological data on lifetime, cross-sectional, and sequential comorbidity: Several authors have recently suggested structural models of selected mental disorders for DSM-V, based on epidemiologic data and higher-order factor analytic methods. This study is re-examining the assumptions, models, and findings of this line of research, examining the effects of using a considerably broader scope of diagnoses than originally covered in these modeling exercises, the stability/instability of these models in different age groups, and the value and limitations for specific diagnostic areas and anxiety disorders in particular.

        2) Obsessive-compulsive disorder comorbidity and familiality: This study is using comorbidity and familiality data to determine the extent to which anxiety disorders/traits and putative OC-spectrum conditions occur in OCD-affected probands and their first-degree relatives, compared with control probands and their first-degree relatives. This review will shed important light on the concept of the OC spectrum. 

Meetings with the Field 

Work group members have participated in a number of scientific and advocacy group meetings to discuss the DSM-V development process and issues being considered by the work group, including: annual meetings of the American College of Neuropsychopharmacology, the American Psychiatric Association, the Anxiety Disorders Association of American, the Obsessive Compulsive Foundation, and the upcoming meeting of the International Society for Traumatic Stress Studies.  These meetings involve discussion with attendees and have produced valuable input from the field.

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