The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will include
a new chapter on Obsessive-Compulsive and Related Disorders to reflect the increasing evidence
of these disorders’ relatedness to one another and distinction from other anxiety disorders, as well as
to help clinicians better identify and treat individuals suffering from these disorders.
Disorders grouped in this new chapter have features in common such as an obsessive preoccupation
and repetitive behaviors. The disorders included in this new chapter have enough similarities to group
them together in the same diagnostic classification but enough important differences between them to
exist as distinct disorders.
Disorders in this chapter include obsessive-compulsive disorder, body dysmorphic disorder and trichotillomania
(hair-pulling disorder), as well as two new disorders: hoarding disorder and excoriation (skinpicking)
Hoarding disorder is characterized by the persistent difficulty discarding or parting with possessions,
regardless of the value others may attribute to these possessions. The behavior usually has harmful effects—emotional,
physical, social, financial, and even legal—for the person suffering from the disorder
and family members. For individuals who hoard, the quantity of their collected items sets them apart
from people with normal collecting behaviors. They accumulate a large number of possessions that
often fill up or clutter active living areas of the home or workplace to the extent that their intended use
is no longer possible.
Symptoms of the disorder cause clinically significant distress or impairment in social, occupational
or other important areas of functioning including maintaining an environment for self and/or others.
While some people who hoard may not be particularly distressed by their behavior, their behavior can
be distressing to other people, such as family members or landlords.
Hoarding disorder is included in DSM-5 because research shows that it is a distinct disorder with distinct
treatments. Using DSM-IV, individuals with pathological hoarding behaviors could receive a diagnosis
of obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder, anxiety
disorder not otherwise specified or no diagnosis at all, since many severe cases of hoarding are not
accompanied by obsessive or compulsive behavior. Creating a unique diagnosis in DSM-5 will increase
public awareness, improve identification of cases, and stimulate both research and the development of
specific treatments for hoarding disorder.
This is particularly important as studies show that the prevalence of hoarding disorder is estimated at
approximately two to five percent of the population. These behaviors can often be quite severe and
even threatening. Beyond the mental impact of the disorder, the accumulation of clutter can create a
public health issue by completely filling people’s homes and creating fall and fire hazards.
2 • Obsessive Compulsive and Related Disorders
Excoriation (Skin-Picking) Disorder
Excoriation (skin-picking) disorder is characterized by recurrent skin picking resulting in skin lesions.
Individuals with excoriation disorder must have made repeated attempts to decrease or stop the skin
picking, which must cause clinically significant distress or impairment in social, occupational or other
important areas of functioning. The symptoms must not be better explained by symptoms of another
This disorder is included in DSM-5 because of substantial scientific literature on excoriation’s prevalence,
diagnostic validators and treatment. Studies show that the prevalence of excoriation is estimated
at approximately two to four percent of the population. Resulting problems may include medical issues
such as infections, skin lesions, scarring and physical disfigurement.
Process for a New Diagnosis
New diagnoses were included in DSM-5 only after a comprehensive review of the scientific literature;
full discussion by Work Group members; review by the DSM-5 Task Force, Scientific Review Committee,
and Clinical and Public Health Committee; and, finally, evaluation by the American Psychiatric Association’s
Board of Trustees. Trustees approved the final diagnostic criteria for DSM-5 in December 2012.
DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric
Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process