New Manual to Offer One-of-Kind Layperson’s Guide to DSM-5
Abstract
Research in the last 20 years indicates that obsessive-compulsive disorders are genetically and neurobiologically similar. This is the second article in a series on the new guide to DSM-5 for the lay public.
The new DSM-5 guide for laypersons, Understanding Mental Disorders: Your Guide to DSM-5, which will be published by American Psychiatric Publishing in May, appears to be a unique publication.
“There’s really nothing like it on the market, certainly nothing quite as comprehensive,” said psychiatrist Donald Black, M.D., vice chair for education in the Department of Psychiatry at the University of Iowa Roy J. and Lucille A. Carver College of Medicine and one of the six editorial advisers for the new book. “There are other books for the public about various disorders, but none that covers DSM-5 in its entirety. And many of the books on the market are not authoritative or are written in a style that is not really accessible to the average reader.”
Understanding Mental Disorders: Your Guide to DSM-5 is intended for patients and their families, but also for other members of the public with an interest in psychiatric illness and how it might be affecting the people around them or for whom they are responsible—teachers, administrators, coaches, employers, and clergy, among others will find it useful. A first draft was written by a professional medical writer, with each chapter being rigorously reviewed, edited, and revised by the advisory panel (for a list of the panel members, see Psychiatric News, February 6).
“The new book introduces the public to DSM-5 and its organization in a language that is accessible to the layperson,” Black told Psychiatric News. (To listen to an audio interview with Donald Black, M.D., click here).
Mirroring the clinician’s version released in 2013, the new guide is arranged roughly along developmental lines, reflecting a “lifespan” approach to mental illness. Hence, the first chapter is “Disorders That Start in Childhood,” followed by “Schizophrenia and Other Psychotic Disorders” and “Bipolar Disorders” (Psychiatric News, February 6).
Allen’s Story
Allen, a 22-year-old gay man, came to a mental health clinic for treatment of anxiety. He worked full time as a janitor and engaged in very few activities outside of work. When asked about anxiety, Allen said he was worried about contracting diseases such as HIV. Aware of a strong disinfectant smell, the mental health care provider asked Allen if he had any special cleaning behaviors linked to his concern about getting HIV. Allen said that he avoided touching almost anything outside of his home. He said that if he even came close to things that he thought might have been in contact with the virus, he had to wash his hands many times with bleach. He often washed his hands up to 30 times a day, spending hours on this routine.
Physical contact was quite difficult. Shopping for groceries and taking the subway were big problems, and he had almost given up trying to go to social events or engage in romantic relationships. When asked if he had other worries, Allen said that he was bothered by sudden images of hitting someone, fears that he would say things that might be offensive or wrong, and concerns about upsetting his neighbors. To ease the anxiety caused by these thoughts, he often replayed prior conversations in his mind, kept diaries to record what he said, and often apologized for fear he might have sounded offensive. When he showered, he made sure the water in the tub only reached a certain level. He was afraid that if he was not careful, he would flood his neighbors.
Allen used gloves at work and performed well. He spent most of his free time at home. Although he enjoyed the company of others, the fear of having to touch something if he was invited to a meal or to another person’s home was too much for him to handle. He knew that his fears and urges were “kinda crazy,” but he felt they were out of his control. Allen was diagnosed with OCD. He had many obsessions, including ones related to contamination (fear of HIV), aggression (intrusive images of hitting someone), and symmetry (exactness in the level of water). These caused Allen to spend hours on his OCD routines and to avoid leaving his apartment, engage in social relationships, and perform basic errands.
He also had many compulsions: excessive hand washing, checking (keeping diaries), repeating (often clarifying what he said), and mental compulsions (replaying prior conversations in his mind). The symptoms got in the way of Allen’s normal daily tasks. Even though he was able to work, his job choice may have been swayed by his symptoms (few other jobs would allow him to always wear gloves and use bleach). Not only did his symptoms consume much of his time, but he appeared to be a lonely, isolated man whose quality of life was greatly affected by his OCD.
The fourth, fifth, and sixth chapters of the new book are on depressive disorders, anxiety disorders, and obsessive-compulsive disorders. The opening paragraph of the chapter on depressive disorders offers a glimpse of the straightforward way in which the book distinguishes ordinary sadness from the disorder known as depression:
“In everyday life, the word ‘depression’ or ‘depressed’ is often used to express when someone is unhappy or sad for a moment. For example, people might say ‘I’m depressed’ when they feel let down that their sports team lost a game. In contrast, real depression is a major medical problem that can have a deep and profound impact on a person’s safety and well-being. Depressive disorders share the common feature of causing a person to feel sad, empty, or irritable (easily annoyed or in a bad mood).
“Someone with depression may have trouble sleeping, thinking, or doing once-normal daily functions. The disorders in this group differ in how long symptoms last, when they arise, and their causes.”
The chapter covers major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, and disruptive mood dysregulation disorder. Each disease section includes not only a description of the disorder but a variety of user-friendly features—tips for medication use, ways to cope with the disorder, and what to expect when seeking psychiatric treatment. And each chapter includes an illustrative patient story drawn from actual patient experiences but with names and other identifying information changed.
For instance, in the section on premenstrual dysphoric disorder (PMDD), under a feature titled “A Healthy Body and Mind,” the manual notes that “during treatment, changes in lifestyle may help relieve symptoms.” And it offers the following common-sense ways a patient can improve her chances of recovery:
Eat healthy. Making diet changes to reduce the intake of caffeine, salt, and sugar may help relieve symptoms.
Try over-the-counter relief. Pain relievers such as aspirin and ibuprofen may help ease breast tenderness, backache, and cramping. Diuretics, or water pills, can help with bloating.
Exercise. Although it’s unclear whether exercise can relieve more severe symptoms of PMDD (and it may be hard to exercise when symptoms are at their worst), regular aerobic exercise—such as walking or bicycling—can help ease fatigue, boost mood, and improve sleep.
Keep a diary. Writing down the type of symptoms and their severity and duration can help health care providers diagnose the disorder and choose the best treatment.
Similarly, the chapter on anxiety disorders notes that these illnesses differ from normal feelings of being worried, ill at ease, or afraid. “People with these disorders have extreme fear or worry that impairs their life function and goes beyond what is normal for their age or the setting,” the guide states.
The chapter covers panic disorder, agoraphobia, generalized anxiety disorder, specific phobia, social anxiety disorder, and separation anxiety disorder.
Obsessive-compulsive disorders (OCD), according to the manual, “involve frequent fears, worries, urges, or thoughts (obsessions) that distract and distress the people who have them. These obsessions often are combined with ritualistic behaviors (compulsions) that are repeated in an intense attempt to deal with the unwanted obsessions.”
The chapter covers OCD, body dysmorphic disorder, hoarding disorder, hair-pulling disorder, and skin-picking disorder. Also, it notes that DSM-5 marks a departure from previous editions of DSM by separating the OCDs from the anxiety disorders.
Black, who has had a career-long research and clinical interest in OCD, explained why. “Research over the last 20 years has shown that the disorders now grouped within this chapter appear to be related genetically and neurobiologically,” he said. “This is research from family and follow-up studies that has demonstrated how these disorders group within families, produce similar kinds of changes in the brain, and respond in similar ways to similar treatments.” ■
More information on Understanding Mental Disorders, including pre-ordering information and links to previous articles in Psychiatric News about the content, can be accessed here.
