Behavioral Addictions

Tomorrow will mark the release of the first public draft of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — also known as the DSM-V. (As you can see, we have an exclusive first-copy of it to the right!)

Because we were not on the American Psychiatric Association’s media list, we didn’t receive a copy of the news releases that the mainstream media will be basing a lot of their stories around that will be published tomorrow. We also weren’t invited to the conference call today, despite our repeated attempts to contact the APA’s media office.

This turns out to be good news for our readers. I’m free to talk about what I suspect will be in the draft that appears on the dsmv.org website tomorrow. I gathered this information from numerous anonymous sources, both online and off. Here’s what you’re likely to find in tomorrow’s draft release of the DSM V:

Autism Spectrum Disorders

As we first noted back in November, Asperger’s Syndrome is slated for the chopping block in the DSM-V. Instead, all the autism-related disorders — including Asperger’s — will be placed into a general category known as Autism Spectrum Disorders. Asperger’s will probably be known as something similar to “mild autism” in this new category in the DSM-V.

Behavioral Addictions

Yes, you heard me right — behavioral addictions as a category has made it into the draft revision (according to our sources). The only behavioral addiction that will be recognized, however, will be pathological gambling. Sex addiction and Internet addiction (which, remember, started off as a joke in 1995) will instead appear in the Appendix under the Criteria Sets and Axes Provided for Further Study. In other words, the concept of a “behavioral addiction” will be recognized, but most specific behavioral addictions simply do not have the robust research base to be included at this time. So while technically in the DSM V, Internet addiction and sex addiction are not disorders that can be diagnosed at this time (by providing an agreed-upon set of criteria, the DSM V publishers hope researchers can use the criteria to further research in those areas).

Substance & Alcohol Dependence Gone

For a long time now, the DSM-IV has made the distinction between someone who was “abusing” alcohol or illegal substances like cocaine, and those who were “dependent” upon them. It was a difference with very little distinction or use amongst clinicians, since substance abuse and alcohol abuse treatment were largely the same no matter which of the two diagnoses you received. DSM-V will rectify this confusing two sets of diagnoses and combine them into one that will have a set of specifiers to note severity and length.

Binge Eating Disorder

Languishing in the categories needing further research for 16 years, binge eating disorder will now be a recognized eating disorder in the regular section of the DSM V. This will come as a relief to tens of thousands of people every year who have this concern, but have not had it officially recognized by the American Psychiatric Association until now.

Dimensional Assessments

As we noted way back in May of last year, one of the most significant changes in the DSM-V draft will be the inclusion of dimensional assessments for depression, anxiety, cognitive impairment and reality distortion that span across most mental disorders. So a clinician might diagnose schizophrenia, but then also rate these four dimensions for the patient to characterize the schizophrenia in a more detailed and descriptive manner. We’re not certain how well these catch on with clinicians unless they become required by insurance companies, as past efforts to supplement diagnoses with additional patient functional information have been failures.

Assessing Risk

Prodromal signs is a fancy psychobabble term for assessing risk and looking for the signs of a disorder before it turns into a full-blown disorder. Imagine if we could more reliably and consistently assess risk for depression, actually preventing some people from becoming full-blown depressed? I’m not certain exactly how this is showing up in the draft, but there will be more of an emphasis in the DSM V draft in assessing risk.

Temper Dysregulation in Children

High emotional reactivity, high temper, emotional over-reactivity and affective lability. Now there’s a mouthful! What did I just say? The interpretation of this new proposed disorder for the DSM-V is basically for children who can’t control their temper (you probably know someone like this in your life), and because of the way their anger spills out into their lives, they suffer from depression. It will be characterized by persistent negative mood with bursts of rage. So this new disorder will be known as “Temper Dysregulation with dysphoria,” or something like that, in the DSM V.

So there you have it — a quick rundown of the highlights that you’ll see in the draft public release of the DSM-V tomorrow. We’ll have a more in-depth run-down tomorrow about the biggest changes.