Add avoidance/anxiety to DSM-V stuttering criteria
With advances in the understanding of stuttering and development of pharmacologic therapies,1 modifications to the classification and treatment of this disorder are indicated. Research has shown that stuttering improves with pharmacologic therapy, and neurologic abnormalities have been identified.2
With DSM-V on the horizon, stuttering classification should be expanded to include an additional criterion of avoidance and/or anxiety around speaking situations related to stuttering.3 By adding this criterion, we recognize and can offer treatment to patients who do not have marked disturbances influency but experience avoidance and/or anxiety around certain feared words or situations.
We also recommend distinguishing childhood-onset, developmental stuttering—by far the predominant presentation—on Axis I separate from the adult-onset forms. Stuttering symptoms acquired as an adult—usually through neurologic injury4—are better coded under Axis III. Stuttering symptoms also rarely may be manifestations of conversion or malingering, and in cases such as this are better classified under these conditions.
As the understanding of stuttering leads toward a more physiologic etiology, clarification of DSM-V criteria will ensure that millions of individuals who stutter will have greater access to comprehensive care, including emerging pharmacologic therapies.
Gerald A. Maguire, MD, DFAPA
Victoria Huang, BA
C. Scott Huffman, MA
Department of psychiatry
School of medicine
University of California, Irvine
1. Maguire GA, Yu BP, Franklin DL, et al. Alleviating stuttering with pharmacological interventions. Expert Opin Pharmacother. 2004;5(7):1565-1571.
2. Alm PA. Stuttering and the basal ganglia circuits: a critical review of possible relations. J Commun Disord. 2004;37(4):325-369.
3. Diagnostic and statistical manual of mental disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.
4. Ludlow CL, Rosenberg J, Salazar A, et al. Site of penetrating brain lesions causing chronic acquired stuttering. Ann Neurol. 1987;22(1):60-66.