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.