Charles O’Brien of the University of Pennsylvania and Nora Volkow, director of the National Institute on Drug Abuse (NIDA), have previously written that the APA committee responsible for revising the DSM-III in the 1980s favored the term "dependence" over "addiction" by a single vote. Since then, they and other psychiatrists have argued that the DSM conflates addiction and dependence. In general, clinicians (including the American Society of Addiction Medicine) define addiction not as chemical dependence but as repeatedly seeking and using a drug despite all its obvious repercussions. People who take antidepressants, pain mediations or drugs to keep their blood pressure in check all depend on drugs to function, for example, but they are not addicted. As a result of the DSM's conflation, wrote O'Brien and Volkow, "clinicians who see evidence of tolerance and withdrawal symptoms assume that this means addiction, and patients requiring additional pain medication are made to suffer. Similarly, pain patients in need of opiate medications may forgo proper treatment because of the fear of dependence, which is self-limiting by equating it with addiction."
Now, the APA has made a gesture toward fixing what many critics contend was a poor choice. The DSM-5 abolishes the confusing terms substance abuse and substance dependence. All addictions and related problems will fall under the single category of "substance use disorders" in a chapter titled “Substance Related and Addictive Disorders.” The DSM-5 also tightens criteria for these disorders and grades them as mild, moderate or severe. Whereas a diagnosis of substance abuse required only one symptom in the DSM-IV, a diagnosis of the newly defined mild substance use disorder requires at least two symptoms.
Although the APA originally proposed including a new chapter titled “Behavioral Addictions,” no such chapter will appear in the new edition according to Darrel Regier, vice chair of the DSM-5 Task Force. For the first time, however, the new manual will include gambling disorder in the same chapter as substance use disorders; previous editions of the DSM classified "pathological gambling" as an impulse control disorder. Whether one can be addicted to a behavior like gambling the same way one can be addicted to a drug remains highly controversial. The APA based its decision in part on recent evidence that the brains of people who are addicted to gambling change in similar ways to the brains of drug addicts and that both drug addicts and pathological gamblers benefit from group therapy and gradual weaning. Another behavioral addiction, Internet use gaming disorder, will appear in section 3, which is reserved for conditions that require further research before they are considered formal disorders. The proposed hypersexual disorder, which many people viewed as another name for sex addiction, was rejected from the new manual entirely.
Mistaking tantrums for a mental illness?
Unusually intense and frequent fluctuations in mood—swinging from an energetic, even agitated, state to serious depression—characterize bipolar disorder (previously known as manic-depressive disorder). For most of the DSM's existence, bipolar disorder was considered primarily an illness of adulthood, although it sometimes began in adolescence. In the last two decades, however, more and more children have been diagnosed as bipolar. Since about 2000 pediatric diagnoses have increased at least fourfold in the U.S.
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8 Comments
Add CommentI see nothing here addressing Complex Post Traumatic Stress as a disorder or syndrome or recognizing it at all. Did that not make the cut for this latest manual, or just not for this article?
Reply | Report Abuse | Link to thisI suspect that these manuals tend to disregard many disorders, as insurance companies prefer it that way.
Reply | Report Abuse | Link to thisA travesty of scientific evidence
Reply | Report Abuse | Link to thisAPA does not seem too worried about the serious risk of false positives, which may have dire negative consequences such as unsuitable drugs, professional exclusion, social labelling.
Reads like a conspiracy between insurance companies and mental health professionals, in which mess people with serious and curable syndromes may well be missed.
You didn't discuss the changes in the eating disorder criteria that are also rather controversial.
Reply | Report Abuse | Link to thisI suspect that this manual will continue to pathologize normal variants of the human personality, and stigmatize those bearing them. While in school, I tended to fidget and look out the window. Now I'm told that that's a symptom of "attention deficit disorder" for which powerful psychoactive drugs are indicated. Never mind that I maintained a 90+ average throughout. Never mind that our ancestors needed a periodic fix on their surroundings if they expected to be the diner and not the dinner. Never mind that our ancestors made their living running for hours on end and killing large animals with primitive weapons. Nothing in biology makes sense except in the light of evoluton, but that doesn't stop fat pigs behind desks from dispensing psychiatric diagnoses to robust healthy rambuntious kids.
Reply | Report Abuse | Link to thisI was never good at matching names with faces or interpreting body language. Now I'm told those are symptoms of Asperger's Syndrome; never mind that I compensate very well with written and spoken language and I do not consider myself sick.
Hardly a day passes when I do not think of President Kennedy. This does not affect my functioning in the least, except on November 22, the anniversary of his assassination, when I am not in the mood for entertainment or Thanksgiving dinner. Now I'm told I have "complicated grief," but all I experience is natural grief for a political idol the like of whom I do not expect to see again in my lifetime.
All this is giving me (complicated?) grief, and calls to mind the abuse of psychiatry by the Soviets to quell political dissent. If you have a biochemical, brain imaging or other definitive test for your diagnosis - fine. Otherwise, throw away the cookie cutter and celebrate humanity's pizzazz.
Geez! Another bestseller for APA. More money folks.
Reply | Report Abuse | Link to thisUnfortunately, commentors are not familiar with the body of work done on DSM, not to mention the study required to become conversant with psychology.
Reply | Report Abuse | Link to thisTo address only a couple misunderstandings:
DSM is a large manual, far beyond the 7 extremely short pages of this article.
Unedited internet comments on subjects which take decades of study to develop coherent understanding are particularly inappropriate.
Although I've studied psychology and related disciplines for sometime, I did not do so for therapeutic reasons. That said, almost no comment on the subject on this or other websites takes into account the real empathy which those involved in the therapeutic disciplines and the development of DSM, as well, have for others, ALL others.
SA is not a panacea site such as MSN Health or any site in which glib curealls are offered for illness or personal difficulties or desires. It is a digest of information which might be used as portal to specific peer-reviewed literature for those who seek knowledge of rigorous research encompassing the lifetimes of hundreds of thousands of dedicated individuals.
I am framing my criticism in terms of a social problem: failure of many in society to respect others, and promoting this disrespect of individuals, groups, and disciplines of professional dedication (ANY discipline, whether within their own culture or outside of it), through using internet comment as aggressive outlet for personal frustration elsewhere.
Commentors might look more insightuflly into their own motivations before attacking others.
How about G.A.S. ? Guitar Acquisition Syndrome? http://www.steelydan.com/gas.html
Reply | Report Abuse | Link to thisLuckily I've recovered. Sadly many haven't.