Does ‘climate anxiety’ belong in the DSM?

It has been seven years since Nguyen Hoang Nam, 25, had a good night’s sleep. In college, Nam started to notice people dumping heaps of garbage on roads. That observation combined with what he was learning in his studies of energy and environment worried him. Since then, every time he lies down, the impact of climate change on his — and humankind’s — future looms large. “It just kicks in when I close my eyes,” says Nam, who lives in Vietnam. 

Natural disasters such as hurricanes, wildfires and floods, which climate change has made worse and more frequent, have a direct impact not just on physical health, but also on mental health. More than half of Americans felt that climate change has had an impact on their mental health, according to a poll conducted by the American Psychiatric Association (APA). Specifically, there is an association between climate change and disorders such as depression and schizophrenia, according to a systematic descriptive review published in 2020. 

The impact of climate change on mental health hit home for Seattle-based psychotherapist Andrew Bryant when wildfire smoke blanketed the Pacific Northwest for three consecutive summers and numerous people came to him for help. “People had the stress of being forced out of their homes,” says Bryant. “They realized really experientially, what climate change is going to be like, and that it is going to impact their lives and the lives of their loved ones.”

Experts recognize this link as a problem, but call it by different names. Psychotherapists call it climate anxiety, while the American Psychological Association names it ”ecoanxiety” and describes it as a “chronic fear of environmental doom” in its 2017 guide on climate and mental health.

It’s possible that climate anxiety could manifest the same way that other forms of anxiety do, according to Bryant. “There’s definitely an indication that climate anxiety is common, but how it shows up symptomatically is not yet known,” he says. Still, Bryant adds it would be good for the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the APA, to mention it. 

Dr. Lise Van Susteren agrees, saying she has been pushing the APA to insert climate-related stressors somewhere in the DSM, perhaps by assigning what is known as a “V code” to climate anxiety. Such codes, which include problems related to education, jobs, and finances, “may” require clinical attention but are not necessarily mental disorders.  

Van Susteren, a general and forensic psychiatrist in Washington, D.C., says that she supports legitimizing climate anxiety as a separate condition that affects people as a way to validate what they are going through. She says, however, that the APA has not responded to her efforts.

But the APA says that neither she nor anyone else has submitted a proposal to include climate anxiety in the DSM through their website. “Anyone can initiate this process,” which includes sending supporting documentation, according to an APA spokesperson.

Van Susteren acknowledges that she had not done so, but says that “submitting a proposal in this situation is equivalent to emailing the fire station when your house is under fire.” So, this March, she, along with some early career psychiatrists, plans to petition the APA’s general assembly to change the DSM in a way that incorporates the reality of climate disruption on the mental health of the public. 

“The APA should be leading on this, not following,” Van Susteren says. Adding climate anxiety to a standard manual like the DSM, she notes, will enable more people suffering from the condition to get their treatment costs covered by insurance because insurers recognize it as a legitimate problem.

Dr. Robin Cooper, a psychiatrist in San Francisco, also supports including climate anxiety as a V-code, saying it is a trigger for worry and distress, but not itself a separate condition.  “Climate change just drives these worries about the future,” says Cooper. “Like any anxiety or depression, or post-traumatic stress disorder, people vent their emotions. But, within my profession, there is no uniformity about including climate anxiety in the DSM.”

Likewise, Dr. Francis Lu, a professor of psychiatry at the University of California, Davis, also advocates adding climate anxiety to the V-code in the DSM. But he noted the lengthy process involved in making changes to the manual: “In order to create a new category of ‘climate-induced anxiety,’ there is a strict and long process within the APA” says Lu.  “APA is usually very conservative in changing this document.”

 But Lu adds that there is a section within the DSM titled “Other problems related to psychosocial circumstances”, which includes problems associated with personal and environmental circumstances. Lu urges therapists to consider recording symptoms of climate anxiety in this broad category. “There’s nobody stopping us from doing that, and in telling others to do so.”

Not everyone agrees that climate anxiety belongs in the DSM, no matter the format. Dr. Bernadka Dubicka, a child and adolescent psychiatrist based in Manchester, U.K., says climate anxiety is a normal and rational response to a real climate emergency, and it should not be categorized as a disorder. 

“We all become distressed and upset when we lose somebody through bereavement. And that is a normal response,” she says. “And it’s the same with climate anxiety. We are not all sick. We’ve made the planet sick.”

Governments across the world should enact policies to achieve carbon neutrality in the next few decades, says Dubicka. “When we talk about the DSM, we tend to lose the focus on pushing the governments to achieve the targets.”