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DSM V Revisions

HOARDING DISORDER
ABOUT REVISIONS FOR THE DSM V

DSM V Website (fifth edition of Diagnostic and Statistical Manual of Mental Disorders)

These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups. Viewers will be able to submit comments until April 20, 2010. After that time, this site will be available for viewing only.

Publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 will mark one the most anticipated events in the mental health field. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review and comment. We thank you for your interest in DSM-5 and hope that you use this opportunity not only to learn more about the proposed changes in DSM-5, but also about its history, its impact, and its developers. Please continue to check this site for updates to criteria and for more information about the development process.

To ensure the transparency of the DSM-5 development process, APA members, other psychiatrists, mental health professionals, medical professionals, and the public are invited to review and comment on the draft criteria. After the public-comment period closes on April 20, the DSM-5 work groups will review the comments. Field trials will then test the proposed criteria, with changes, in both specialty mental health and primary care settings starting in July. The field trials are expected to be concluded in July 2011. Data obtained from these field trials will be incorporated into later drafts.

PROPOSED REVISION:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=398

Hoarding Disorder

The work group is recommending that this be included in DSM-5 but is still examining the evidence as to whether inclusion is merited in the main manual or in an Appendix for Further Research.

A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.

B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

D. The hoarding symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease).

E. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, lack of motivation in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, food storing in Prader-Willi Syndrome).*

Specify if:

With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space.

Specify whether hoarding beliefs and behaviors are currently characterized by:

* Good or fair insight: Recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.

# Poor insight: Mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

# Delusional: Completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.

RATIONALE

1. Epidemiological studies suggest that hoarding occurs in 2-5% of the population and can lead to substantial distress and disability, as well as serious public health consequences that warrant consideration as a mental disorder. Most cases do not meet criteria for OCD or OCPD. Accumulating data challenge the current view of a specific relationship between hoarding and OCD/OCPD, and whether these diagnoses cover all the severe hoarding cases.

2. The creation of a new diagnosis in DSM-5 would likely increase public awareness, improve identification of cases, and stimulate both research and the development of specific treatments for Hoarding Disorder.

3. Criteria A-E: The proposed criteria are very similar to previously published criteria, which were based on research and clinical experience and that have been widely adopted by the field since 1996.

4. Specifiers:

a. The majority of people with hoarding disorder excessively acquire things either through buying or obtaining free things. However, not everyone with hoarding problems reports excessive acquisition, so including it as a diagnostic criterion would exclude people with true hoarding problems. Since recognition of and intervention for excessive acquisition is crucial for successful treatment of hoarding disorder, it is included as a specifier.

b. Available data suggest that a range of insight can characterize hoarding disorder. The proposed specifiers are similar to those proposed for other disorders, and they appear applicable to hoarding disorder.

WHAT THE DSM IV SAYS ABOUT HOARDING:

This disorder is not listed in DSM-IV; therefore, DSM-IV criteria for this disorder do not exist.

In DSM-IV, ‘the inability to discard worn-out or worthless objects even when they have no sentimental value’ is one of the 8 criteria for Obsessive-Compulsive Personality Disorder (OCPD)

In the text accompanying the OCPD criteria, DSM-IV states:

“Despite the similarity in names, OCD is usually easily distinguished from OCPD by the presence of true obsessions and compulsions. A diagnosis of OCD should be considered especially when hoarding is extreme (e.g. accumulated stacks of worthless objects present a fire hazard and make it difficult for others to walk through the house). When criteria for both disorders are met, both diagnoses should be recorded” (p. 728)

Report of the DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group
April 2009
Katharine A. Phillips, M.D.

Obsessive-Compulsive Spectrum Sub-Work Group

A number of researchers have suggested that while hoarding may be a symptom dimension of OCD, it may also merit classification as a separate disorder. The sub-work group is considering whether the empirical literature provides adequate support for adding hoarding to DSM, and hoarding is being considered for examination in a DSM-V field trial.

*

Reference: Mataix-Cols D et al: Hoarding Disorder: A New Diagnosis for DSM-V?; Depression & Anxiety (2010;in press)

Hoarding Scale Self-Report (HRS-SR) (Tolin et al., 2008)

Insight dimensions (proposed for OCD, BDD, ORS, Hoarding Disorder): Brown Assessment of Beliefs Scale (BABS) (Eisen et al., 1998)

This disorder is not listed in DSM-IV; therefore, DSM-IV criteria for this disorder do not exist.

In DSM-IV, ‘the inability to discard worn-out or worthless objects even when they have no sentimental value’ is one of the 8 criteria for Obsessive-Compulsive Personality Disorder (OCPD)

In the text accompanying the OCPD criteria, DSM-IV states:

“Despite the similarity in names, OCD is usually easily distinguished from OCPD by the presence of true obsessions and compulsions. A diagnosis of OCD should be considered especially when hoarding is extreme (e.g. accumulated stacks of worthless objects present a fire hazard and make it difficult for others to walk through the house). When criteria for both disorders are met, both diagnoses should be recorded” (p. 728)

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