Dear Editors and Colleagues,

Just a few quick thoughts regarding the anticipated changes to GAD in the upcoming DSM V. I have made these well know to the current Task Force on several occasions. Given, my expertise on the disorder as a clinician and researcher, I do not feel the name change to Generalized Anxiety and Worry Disorder is warranted. GAD is an "anxiety disorder"marked by worry, not a "worry disorder". In other words, pathological worry does not equal GAD. In addition, GAWD is cumbersome and awkward, which is an added reason for excluding this diagnostic name change.

Even though contemporary conceptual models and treatment approaches favor worry as the key target of GAD, this precludes the marked somatic piece that is characteristic of many with the condition who present first to PCPs and then later on to other mental health professionals. GAD is a heterogeneous disorder and I have advocated retaining the current name and suggesting two subtypes be added to the DSM V. These would include the following: a "worry" subtype and a "somatic tension" subtype.  In this way, the overpsychologizing of worry is tempered and the somatic piece, as mentioned, is no longer obscured and ignored. The DSM V needs to more fully take into consideration not solely the empirical research that comes out of highly select  samples from generally healthier subjects, but the actual patients that are also seen in clinical practice.

Best,
Dr. Michael E. Portman

What's the worry! Anxiety disorder is caused by a fatty maternal diet, and is typically seen in the offspring of diabetic pregnancies (B Metzger, 1997), in which the maternal diet is demonstrably fatty ( L Tapsell, 1997). Maternal diet that is richer in mouth-watering sat fats (cheese, butter, chocolate, cakes and pastries) than in counter-balancing polyunsaturated fatty acids (in soft margarines, fish, nuts olive oil, avocado) will lead to faulty, polyunsaturate-depleted cell and mitochondrial membranes. That causes, in turn, insulin resistance and systemic oxidation, plus low-grade inflammation--which is known to affect the placenta also, allowing maternal cortisol to leak across and PROGRAMME PERMANENT FEAR AND STRESS AXIS ACTIVATION in the foetal brain (M Holmes, Edinburgh). Anxiety affects about 20-30% of children and adults in the fat-eating nations (eg. 30% in dairy-loving New Zealand). Easily detected in clinical practice (ask about childhood shyness or sensitivity, plus lifelong worry), this simple nutritional brain disorder responds rapidly to Inositol supplement, or an Inositol-rich diet (grains, nuts, legumes, citrus, cantaloupe). Anxiety and its dietary fat-induced partner, depression, are not seen in traditional low-fat societies like the Kaluli in Papua, or among Japanese fishing people.

I believe that anxiety and panic attacks can be cured with out medication