Several new diagnoses will appear in the soon to-be-released Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V).  In fact, quite a bit of controversy surrounds the inclusion of several of these new “disorders” in what is considered to be the mental health world’s diagnostic “bible,” as many question their validity and appropriateness for inclusion.

Among the new DSM-V disorders is Excoriation (Skin Picking) Disorder, classified within the Obsessive Compulsive and Related Disorders.  It is understandable that the initial public reaction to this release of information has been skeptical (at best). News outlets have begun to question the validity of the diagnosis. Readers have begun to leave comments such as, “Great, now we’re all mentally ill.”

Yes, everyone picks at his or her skin at some point; however, Excoriation Disorder far exceeds “normal” grooming behavior. Think of grooming behavior as occurring on a continuum, with normal, washing and exfoliating on one end of the continuum, extending to picking, scraping, or gouging that results in scarring or disfigurement on the other end.

We know that when we get anxious, the fight-or-flight response is triggered and our bodies experience many physiological changes and symptoms that we find stressful and unpleasant. But, do you know what causes us to get anxious? It may not be what you think.

No, it’s not that upcoming presentation at work or that plane flight next week.  It’s not something external.

I’m a psychologist, so I’m going to try to help you discover the answer. Here’s an example.  You and a friend are out on a morning walk and a neighborhood dog barks loudly.  You love dogs and this makes you smile as you comment, “He’s up bright and early.” Your friend, on the other hand, is startled. Her heart begins to race and she finds herself a bit breathless, as she comments, “Oh my! Where is it? I don’t like dogs.”  Same situation.  Very different reactions.  Okay, now do you have an idea of what causes anxiety?

Compulsive hoarding has attracted a great deal of media attention. These media portrayals, whether they are television, newspaper, or other illustrations of the problem, tend to be somewhat unidimensional.  Yes, these individuals’ homes are frequently difficult to navigate, and, yes, these individuals appear to be excessively attached to items that many of us view as of very little or no value. However, these snapshots into the lives of these individuals sometimes lack the depth of difficulty these individuals have in their lives.

Let’s look at a few of the challenges that are often under-conveyed, but that are very real, very significant challenges to individuals, their family members, and to us, as psychologists who treat them.

One of the most difficult parenting moments we may experience is seeing our child in distress and feeling powerless in our ability to help him or her feel better. There will be a time in the life of every parent in which his or her child is struggling and the path to understanding and overcoming this struggle is unclear.

In order to help a child overcome distress, it is first important to identify the problem. Anxiety disorders are among the most common psychological difficulties in children and adolescents, affecting approximately 13% of youth in the United States.

Anxiety disorders in childhood are the greatest predictors of anxiety, mood, and substance abuse difficulties in adulthood; thus, it is important to identify and treat anxiety difficulties as early as is feasible.

Early identification and intervention is associated with positive long-term outcome.

A Parent’s Guide to Anxiety Disorders

Anxiety is a healthy, normal, and adaptive response to stress. It is our body’s way of alerting us to danger. It can be motivating and helpful to us in meeting our goals. However, in excess, it can cause us to feel overwhelmed and leave us unable to carry out our daily activities.

There are a number of anxiety disorders common to children of which parents should be aware:

The compulsion to hoard belongings has been likened to addiction; yet there are some important differences between the two. In a previous post,  some of those differences were discussed.  Most importantly, however, are the differences in treatment approach. I am frequently asked by loved ones, “Can’t I just go in and clean the house?” It can be difficult to understand why this is not in the best interest of the individual struggling with hoarding difficulties.  Herein lies the reason:

The topic of compulsive hoarding has garnered much attention in recent years in the mainstream media.  Compulsive hoarding has been likened to addiction in some discussions of the problem, yet they are very different constructs.  Let’s take a look at the what we know about the similarities and differences in order to answer the burning question of why can’t someone clean a hoarder’s home for him/her. For brevity’s sake, let’s look at the two behaviors in simplistic terms (although they are both quite complex):

WHAT IS COMPULSIVE HOARDING?

Compulsive hoarding is a disorder that involves the accumulation of belongings to such an extent that the resulting clutter renders parts of the living space unusable.

WHAT ARE THE SIGNS/SYMPTOMS OF COMPULSIVE HOARDING?

• The acquisition and failure to discard a large number of items/possession that are considered by most to be of little or no value
• These possessions clutter the living space, rendering the space unable to be used in the manner in which it was intended
• The hoarding behavior causes marked distress or interferes with one’s daily functioning

NOT JUST MESSY

Clutter is a symptom, not the problem. People who hoard form powerful attachments to objects.

I had never seen anyone quite like “Max.”  The plunge from what appeared to be a normal 8 year-old boy to a scared, paranoid, fragile child who was grasping to hold on to reality was striking.  Max knew what many of his doctors had yet to discover, he had a raging strep infection. And, this infection, like many times in the past, would run rampant  in his body, largely undetected, causing him to experience a host of symptoms of serious mental illness.

In 1998, Dr. Susan Swedo, a researcher at the National Institute of Mental Health (NIMH), first described in the scientific literature a subtype of OCD in which children demonstrated an abrupt onset of neuropsychiatric  symptoms (OCD, tics, ADHD-like symptoms, anxiety) preceded by streptococcal infection. This syndrome was termed PANDAS, Pediatric  Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  In PANDAS, the body’s immune system is over-reactive to  strep bacteria, leading to psychiatric and neurological symptoms.

The greatest challenge for Max was the professional community’s debate over the very existence of PANDAS/PANS.

In 1998, Dr. Susan Swedo, a researcher at NIMH, first described in the scientific literature a subtype of OCD in which children demonstrated an abrupt onset of neuropsychiatric symptoms (OCD, tics, ADHD-like symptoms, anxiety) with a “saw-toothed” course, preceded by streptococcal infection.  This syndrome was termed PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  In PANDAS, the body’s immune system is over-reactive to strep bacteria, leading to psychiatric and neurological symptoms.  Dr. Swedo continued to study this subgroup and investigated potential therapies, including intravenous immunoglobulin (IVIG), plasmapheresis, and antibiotic prophylaxis to prevent symptom exacerbations. PANDAS remained a little known and debated diagnosis.

Dr. Swedo, and more recently, other researchers as well, have dedicated themselves to understanding this phenomenon.