DSM-5 must emphasize that physical symptoms deserve the respect of a thorough work-up before assuming their cause is psychiatric. And people with defined medical illnesses should not be casually mislabeled as also mentally ill just because they are upset about being sick.
This tale involves a “clever” inmate. He enjoyed the respectable rung of bank robber, but found he had suddenly descended to approximately the level of a sex offender. The reason for his slippage was the inmate code, which demands allegiance to other inmates under virtually all circumstances. “Ratting out” a fellow inmate may cost one his life, or at the very least, result in a decidedly anxious, paranoid existence.
Exposure-based therapies are highly effective for patients with anxiety disorders, to the extent that exposure should be considered a first-line, evidence-based treatment for such patients. In clinical practice, however, these treatments are underutilized, which highlights the need for additional dissemination and training.