Transcript “He`s a born worrier” CBT for GAD

Hoarding and the DSM5
Dr Christopher Mogan
The Anxiety Clinic , Melbourne
PATHWAYS THROUGH THE MAZE
Hoarding and Squalor Conference
Sydney 2012
DSM5
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New and revised 5th edition of the
Diagnostic and Statistical Manual of the
American Psychiatric Association.
DSM is the ‘Good Book’ of mental disorders
that started with 106 disorders in 1952, with
last revised edition DSM-IV-TR in 2004.
DSM5 proposes 283 disorders.
Hoarding Disorder proposed for inclusion
for the first time as a diagnostically distinct
entity.
Hoarding - new & separate disorder
Despite a long association with OCD, recent
research has shown that 80% of hoarders:
1) Do not meet diagnostic criteria for OCD
2) Do not endorse other clinically significant
OCD symptoms (Mataix-Cols, Frost, Pertusa et al, Depress Anxiety,2010)
Clinically significant hoarding is prevalent and
severe; standardized assessment specifies
hoarding as a distinct disorder.
Comorbidities are high.
Need research prevalence, course, causes,
training of workers, outcomes and therapy.
Proposed Criteria for Hoarding Disorder in
DSM5:
A. Persistent difficulty discarding or parting with
possessions, regardless of the value others may
attribute to these possessions.
B. This difficulty is due to strong urges to save items
and/or distress associated with discarding.
C. The symptoms result in the accumulation of a large
number of possessions that fill up and clutter active
living areas of the home or workplace to the extent
that their intended use is no longer possible.
C (cont)
If all living areas are uncluttered, it is only because of
the intervention of third parties (e.g. family
members, cleaners, authorities).
D. 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).
E. Hoarding symptoms not due to a general medical
condition (e.g. brain injury, cerebrovascular disease).
F.
The hoarding symptoms are not restricted to the
symptoms of another mental disorder (e.g. hoarding
due to obsessions in Obsessive Compulsive Disorder,
decreased energy in Major Depressive Disorder,
delusions in Schizophrenia or another psychotic
disorder, cognitive deficit in Dementia, restricted
interests in Autistic Disorder, food storing in PraderWilli 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 behaviours are
currently characterized by:
Good or fair insight: Recognizes that hoardingrelated beliefs and behaviours (pertaining to difficulty
discarding items, clutter, or excessive acquisition) are
problematic.
Poor insight: Mostly convinced hoarding beliefs and
behaviours (pertaining to difficulty discarding items, clutter,
or excessive acquisition) are not problematic despite
evidence to the contrary.
Absent insight: Completely convinced that
hoarding beliefs and behaviours are not problematic
(pertaining to difficulty discarding items, clutter, or excessive
acquisition) despite evidence to the contrary
7
Field Trials
Review of criteria based on clinical
vignette methodology supported the
proposed criteria – acceptability,
sensitivity and specificity.
 Criteria endorsed also by sufferers.
 Second field trial is under way to review
these finding in clinical settings.
 There is a portal on the web for further
input. DSM5 scheduled for publication in
2013.
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Hoarding Disorder in DSM5 means
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Guidelines for assessment and diagnosis of HD
are specified, accessible and helpful for timely
interventions – provide a conceptual model.
Formal status of Hoarding Disorder will enhance
research, policy development, collaborative
practice, legislation and training of workers.
Government, community, housing and mental
health teams will have a clearer framework.
Opportunities to build on shared experiences.
Funding packages for the amelioration of the
disability of hoarding disorder will be accessible,
as funding bodies require DSM status.
The future
New chapter open with the inclusion in DSM5, if
it actually happens.
 This is a condition much misunderstood, largely
undiagnosed or treated, well known to frontline
workers, and emerging as a significant problem.
 Raising awareness of sub-types - animal hoarding,
hoarding in the elderly, children in hoarding
households, isolated and depressed hoarders - is
the ‘bottom-up’ process that needs energy and
leadership at health, legal and government levels.
 Prevalence estimates at 2%-5% are twice that of
OCD, five times Panic Disorder and
Schizophrenia.
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Dr Christopher Mogan
The Anxiety Clinic
140 Church Street
Richmond 3121 Vic
Tel 03-9420 1424
[email protected]
www.theanxietyclinic.com