Wednesday, February 17, 2010

DSM-5 Diagnostic Changes Gambling - Sex

I have been discussing some proposed changes in psychiatric disorder classifications for the fifth edition of The Diagnostic and Statistical Manual of Mental Disoders (DSM-5) which were recently released in draft version by the American Psychiatric Association. The final version won't be published until 2013 and there is opportunity for anyone to make comments on the draft at www.dsm5.org until April 20 of this year. I have discussed some proposed changes in substance use diagnoses, now refereed to as Addiction and Related Disorders as well as the changes regarding autism and Asperger's syndrome. There are also proposed changes in terms of pathological gambling and a new term Hypersexual Disorder.

Pathological gambling will now be referred to as Disordered Gambling and is under the classification of Addiction and Related Disorders as the only non-substance related behavioral addiction. Consideration was given to Internet addiction but it was left out due to lack of enough research in the area. The new categorization of disordered gambling as an addiction makes sense as the dopamine reward system is "hijacked" in gambling in the same way as substance related addictions and there has been a great deal of research in this area. Those in the recovery field have long treated disordered gambling as an addiction and it is good to see some "official" support for the concept.

There was hedging in the area of compulsive like sexual problems. These are not subsumed under the addiction category but are included as a new sexual disorder category, Hypersexual Disorder.The nearest diagnostic neighbors are the paraphilic disorders which are characterized by socially anomalous or deviant sexual arousal such as exhibitionism, fetishes, and pedophilia. The new category referred to as Hypersexual Disorder refers to "normal" sexual behaviors that are repetitive, excessive, or disinhibited. The classification of such issues as a psychiatric disorders will certainly be controversial as there are significant gaps in the current scientific knowledge base regarding antecedent, concurrent, and predictive validators as well as the lack of knowledge regarding developmental risk factors, family history,cognitive markers and neurobiological substrates.In addition there is almost no knowledge regarding these issues in women. There is also no knowledge in our understanding of how excessive sexual behaviors may part of overall impulsivity and inability to delay gratification.

On Medscape, which is an Internet medical site providing medical news, continuing medical education, and physician discussion boards I was amazed by the volume of responses and the vehemence of the responders to the question of whether or not sexual behaviors could be classified as addiction. I haven't seen any other question generate more comments and more heated discussion. I am very interested to see the public comments on Hypersexual Disorder in DSM-5. I will be off blog for several days but when I return I will talk a bit on the diagnostic criteria for this disorder.

Thought for the day

May I show the same compassion for myself that I show to others.

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