Addiction Diagnoses May Rise Under Guideline Changes

[alp227]

Source: NYT

In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.

The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book.

In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, Internet use or playing video games.

Part medical guidebook, part legal reference, the manual has long been embraced by government and industry. It dictates whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will expand financing for certain special-education services. Courts use it to assess whether a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research.

Read more: http://www.nytimes.com/2012/05/12/us/dsm-revisions-may-sharply-increase-addiction-diagnoses.html?pagewanted=all

[JDPriestly]

1. I think that new methods will be found (are being found)

to treat some of these addictions and that within ten years, this will not be the problem it is today.

We are learning so much about how the brain and mind function and how we can reprogram ourselves that broadening the definition of addiction will be helpful to many people.

And with that, I sign off DU and go do something else. DU can be addictive. We wouldn't want that, would we?

[MichiganVote]

2. One error in the article: Schools do not depend solely on medical/mental health Dx

for the provision of Special Education services. Per the eligibility regulations, multiple sources of information are required for the identification / eligibility of kids.

AND for any Doctors reading this: Quit writing "special education" on your prescription pads. You look like idiots.

[loudsue]

3. They REALLY need to include teapartiers and neonazis as mentally impaired

and hopefully we could find a way to treat them and so they will no longer be a threat to society.

[hifiguy]

4. NOT a good idea.

Turning fairly normal behaviors into pathologies is a bad thing, and I say that as someone dx'd on the autism spectrum. Sometimes people are just stupid and self-destructive. This is ultimately just another way to line the pockets of Big Pharma.

[boppers]

7. "Normal" behaviors that are socially dangerous is a bad thing.

Since we're both on the ASD scale, I would posit the following:

1. Obsession with cultivating information about a topic is not an addiction (though quite common in ASD).
2. Said Obsession leading to impairment in general social functioning is a bad thing.
3. Dx of said obsession as "addiction" rather than another Dx is problematic.

So, let us "play with fire", so to speak (I hope you can follow that). Assume somebody with ASD is tuned into beer varieties. Is the fact that they think about beer constantly a problem? Not really. Thinking isn't an impairment. If they think about, and use beer, to the detriment of existing relationships, a problem? Possibly. If they are considered "addicted" to beer, just because they think about it so much, a problem? Definitely.

I would say the problem is not that "Turning fairly normal behaviors into pathologies" is not the problem, but mis-diagnosis is the problem. Obsession is not addiction.

[TygrBright]

5. "Joe, we're here to Intervene on your Behavioral Addiction Not Otherwise Specified..."

"Wait, what??!? What addiction?"

"How do we know? It hasn't been specified."

ironically,
Bright

[boppers]

8. Just in case you are being clever...

...that's really a "catch-all" category.

Say, for example, you or I were addicted to stealing panties from public laundromats, or something similar, that isn't easily "coded" for (and thus, could not be treated, and billed, for). Maybe it's you, or I, who have an addiction for putting Barbies in GI Joe boxes. Whatever.

The vague category allows for unusual behaviors that are not prevalent enough to warrant their own categories.

[chill_wind]

6. DSM-5- "An inexplicably closed and secretive process"

Beginning with the fact that the task force overseeing the development of DSM-5 consists of only 27 members.

http://en.wikipedia.org/wiki/DSM-5


From what I can tell, the new DSM-5 has been an incredibly controversial process. Many papers, letters, critiques can be seen at http://www.psychiatrictimes.com

(resource site for physicians and other MH professionals)

Just a few of many criticisms:

(1) Why introduce Disruptive Mood Dysregulation Disorder when it has been studied by only one research team for only six years and risks further encouraging the inappropriate use of antipsychotic drugs for kids with temper tantrums?

(2) Why have a diagnosis for Minor Neurocognitive Disorder that will unnecessarily frighten many people who have no more than the memory problems of old age?

(3) Why insist on removing the Bereavement exclusion—thus allowing the inappropriate diagnosis of Major Depressive Disorder in people who are experiencing normal grief?

(4) Why open the floodgates to even more over-diagnosis and over-medication of Attention Deficit Disorder (by raising the allowed age of onset to 12)?

(5) Why dramatically lower the threshold for Generalized Anxiety Disorder when this will confound mental disorder with the anxiety and sadness of everyday life?

(6) Why combine substance abuse with substance dependence under the rubric of Addictive Disorders—when this confuses their different treatment needs and creates unnecessary stigma for many young people who will never go on to “addiction”?

(7) Why include a category for Behavioral Addictions that will open the door to the mislabeling as mental disorder all sorts of normal interests and passions? The DSM-5 suggestion to include “Internet addiction” in the Appendix is an ominous first step.

much more at
Wonderful News: DSM-5 Finally Begins Its Belated And Necessary Retreat
By Allen Frances, MD | May 4, 2012
http://www.psychiatrictimes.com/blog/frances/content/article/10168/2068571

[sendero]

9. Well well..

.. if you classify behaviors exhibited by a large proportion of the population as "illness" it sure creates a lot of new "patients".

What a pantload psychiatry has become.

[chill_wind]

10. An APA Cash Cow

Is DSM 5 A Public Trust Or An APA Cash Cow?
Commercialism And Censorship Trump Concern For Quality
Published on January 3, 2012 by Allen J. Frances, M.D. in DSM5 in Distress

http://www.psychologytoday.com/blog/dsm5-in-distress/201201/is-dsm-5-public-trust-or-apa-cash-cow

("Allen Frances, M.D., was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.&quot

[hedgehog]

11. I would think that sometimes those behaviors are indicators of depression.