"...proposed revisions for the American Psychiatric Association's (APA's) Diagnostic and Statistical Manual of Mental Disorders (DSM) include for the first time "behavioral addictions"—a change some say is long overdue and others say is still premature...
"Sex addiction" has received a lot of press lately, but O'Brien [University of Pennsylvania, chair of the addictions work group for DSM-V] says his work group found "no scientific evidence" that sex qualifies. APA psychiatrist Darrel Regier, co-chair of the DSM task force, says "it's not clear that reward circuitry is operative in the same way as in addictive areas." Nonetheless, a near equivalent may make it into the sexual disorders section of DSM: That work group is proposing a controversial new diagnosis of "hypersexual disorder."
The DSM teams have also tussled with the often-blurry line between addictions and compulsions. "I used to think [addictions] overlapped with OCD [obsessive-compulsive disorder]," says O'Brien. But new data from both brain-imaging and treatment studies suggest "more dissimilarities than similarities."
In another major change, O'Brien's group recommends dropping categories of "abuse" and "dependence" and labeling all problems major and minor as substance "use disorders" (or "disordered gambling"). Since the late 1980s, says O'Brien, "numerous large population studies" have shown there's no "breakpoint" where "abuse" becomes something more serious. He also says the term "dependence" only implies physiological dependence, which is not the same as the psychological obsession of addiction.
Some longtime addiction researchers, such as psychiatrist Victor Hesselbrock of the University of Connecticut, Farmington, have qualms about the direction DSM is moving. Hesselbrock believes behavioral addictions are dicey territory and prefers to limit the term "addiction" to substances, which are "pathogens we can identify." He also objects to fusing all drinking problems into "alcohol use disorder." Hesselbrock says he and others think there are proven subcategories of alcoholism that would aid both in treatment and discovering causes. "When you do a one-size-fits-all type of classification system," he says, "that will fit a lot of people but not so well."