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See Inside Scientific American Mind Volume 23, Issue 2

Psychiatry's "Bible" Gets an Overhaul [Preview]

Psychiatry's diagnostic guidebook gets its first major update in 30 years. The changes may surprise you

Some psychiatrists say the new rules are too strict: they worry some high-functioning autistic people, such those now diagnosed with Asperger’s, may not meet the criteria and may miss out on educational and medical services as a result. On the other hand, if people with milder autismlike symptoms do make it onto the spectrum, the lack of an Asperger’s label could benefit them. States such as California and Texas now provide educational and social services to people with autism that they deny to those with Asperger’s. Some parents argue, though, that limited resources should go to kids with more severe symptoms before anyone else. —F.J.

Craving Cash, Food and Sex
Several new types of addiction may appear in the upcoming version of psychiatry’s bible, the DSM-5. Gambling disorder is one. In the past decade studies have shown that people get hooked on gambling the same way they become addicted to drugs and alcohol and that they benefit from the same kind of treatment—group therapy and gradual withdrawal. Neuroimaging research has revealed that the brains of drug addicts and those of problematic gamblers respond to reminders of drugs and monetary rewards in similar ways: their reward circuits light up, much more than casual gamblers or one-time drug users. The DSM-5 may also include obsessions with food and sex:

Binge Eating Disorder
Consuming “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances” and lacking control over what, how much or how fast one eats.

Hypersexual Disorder
Having unusually intense sexual urges for at least six months or spending excessive amounts of time having sex in response to stress or boredom, without regard for physical or emotional harm to oneself or others, de­spite the fact that it interferes with social life and work.

Absexual Disorder
Feeling aroused by moving away from sexuality or behaving as though moralistically opposed to sex. As sex educator Betty Dod­son told Canadian news­paper Xtra! West, these are “folks who get off complaining about sex and trying to censor porn.” —F.J.

This article was published in print as "Redefining Mental Illness."

This article was originally published with the title "Redefining Mental Illness."

(Further Reading)

  • On Being Sane in Insane Places. D. L. Rosenhan in Science, Vol. 179, pages 250–258; January 19, 1973.
  • Sexual Disorders: New and Expanded Proposals for the DSM-5—Do We Need Them? Howard Zonana in Journal of the American Academy of Psychiatry and the Law, Vol. 39, No. 2, pages 245–249; April 2011.
  • The First Flight of DSM-5. Niall Boyce in Lancet, Vol. 377, pages 1816–1817; May 28, 2011.
  • Autism Spectrum Disorders according to DSM-IV-TR and Comparison with DSM-5 Draft Criteria: An Epidemiological Study. M. L. Mattila et al. in Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 50, No. 6, pages 583–592.e11; June 2011.
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