DSM-V: Tic disorders and Tourette’s

A number of minor changes and one big change have been proposed for tic disorders. One of the changes made for all tic disorders has been to redefine a tic as “a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.” The work group also removed the term “stereotyped” from the definition of  a tic and proposes removing the phrase ” usually in bouts”  from the diagnostic criteria for Tourette’s, where they also propose deleting the criterion of a tic-free period of no more than 3 months.

To see how existing tic disorders are changing in their diagnostic criteria, follow the links below. You will see the proposed diagnostic criteria. By clicking on the “rationale” tab, you will find the work group’s explanation for the proposed criteria. Clicking on the “DSM-IV” tab will show you the existing diagnostic criteria:

• 307.23 Tourette’s Disorder
• 307.22 Chronic Motor or Vocal Tic Disorder
• 307.21 Transient Tic Disorder
• 307.20 Tic Disorder Not Otherwise Specified

Two new tic-related diagnoses have also been proposed:

• Substance-Induced (indicate substance) Tic Disorder
• Tic Disorder Due to a General Medical Condition

The biggest proposed change, however, has nothing to do with specific diagnostic criteria for tic disorders, but has to do with how and where tic disorders are grouped in the DSM-V classification of disorders.  If the existing Childhood Disorders category remains in the DSM-V, tic disorders will remain under that grouping, but if that grouping is eliminated, the work group recommends listing tic disorders under a new grouping to be called “Anxiety and Obsessive-Compulsive Disorders.”

I think that this is a terrible idea, and I’ve outlined my concerns in feedback I submitted to the workgroup and in a letter to the editor I wrote that was published in Psychiatric Times, “DSM5 Proposal Triggers Anxiety, Not Tics.”