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.

Treating Internet Addiction at Cottonwood de Tucson

Rose Hoban's article titled Internet Addiction: Latest Obsession brings up an interesting topic that is indeed emerging as a challenge for behavioral health professionals. In that article Hoban references Psychologist Louise Nadeau's statement that "addiction is marked by two phenomena...the first is that a person has a behavior he or she can't control", and the other being "that the behavior causes a series of problems in many spheres of your life." She continues that "You're having problems with your work, you're having problems with your social network, you're having problems also with your mental health."


I think a big contributor to Internet addiction is the advancement of technology. As technology advances computers are becoming more affordable for persons who 5 years ago would not have dreamed of having a computer in their home. If you remember the evolution of the television, 25 to 30 years ago families were fortunate to have just one in their home. However, as the prices of televisions have dropped tremendously from 25 year ago, today most homes have 2, 3, or more. The same is happening today with computers. As the prices have dropped, computers are gaining more of a presence in homes. Today, it is uncommon to not have a computer in your home and homes with kids often will have a computer in the child's room as well. So with the accessibility of computers increasing, Internet addiction is becoming more prevalent in society. The other draw to the Internet is that it offers immediate gratification. Rather it's gambling, shopping, pornography, or gaming just a click of the mouse and an addict can be engaged in their addiction.

While Hoban's article states Psychologist Louise Nadeau is doing more study to develop a standard of treatment for Internet addiction, I can add that flooding is not a treatment intervention I would recommend. Flooding is a therapeutic technique sometimes used by professionals where they "prescribe" the behavior with which the client is struggling. The idea is that the client will become overexposed to the behavior such that it no longer brings them pleasure and they stop. This technique would only feed the addiction and work to strengthen it, as noted in the article where the man spent 2 weeks in the airport's Internet cafe and never went on his vacation. With Internet addiction, I feel it is up to the professional to look at the need the behavior is meeting for the client, evaluate with the client the legitimacy of the need, and then seek an alternative behavior to meet the legitimate needs of the client. This is putting it in simple terms, but a lot of work would need to be done to extinguish the behavior associated with Internet addiction.


Eric Parrish
Clinical Director of Extended Care
Cottonwood de Tucson
4110 W. Sweetwater Drive
Tucson, AZ 85745
(800) 877-4520


http://www.cottonwooddetucson.com//