Is 'gambling' an addiction? How about 'internet shopping'?

DSM-V panel proposes expanded definition for 'addiction'

Specialists reworking the American Psychiatric Association's (APA) diagnostic manual have proposed an expanded definition of addiction, a move that could classify as many as 20 million more U.S. residents as addicts. 

The new Diagnostic and Statistical Manual of Mental Disorders (DSM) is scheduled to be released in May 2013. It will be the fifth edition of a manual that has long been used by the U.S. government and health care industry, dictating everything from insurance and public funding criteria to pharmaceutical research to the legal definition of metal impairment.

So far, APA has received about 25,000 comments on the proposed DSM changes, which have been posted online, but has declined to make the comments public.

A broader definition of addiction
Among many changes, some controversial, the panel developing the DSM-V has proposed:

  • Expanding the list of recognized symptoms for drug and alcohol addiction;
  • Reducing the number of symptoms required for an addiction diagnosis;
  • Including gambling as an addiction; and
  • Introducing a "behavioral addiction—not otherwise specified" category.

According to APA, which debated the addiction definition this week at its annual conference, the broader diagnosis is intended to help physicians more accurately diagnosis the condition, promote earlier intervention, and improve outcomes.

University of Pennsylvania's Charles O'Brien, who heads the DSM-V addiction panel, says the new criteria will allow providers to "stop [addicts] from getting to the point where they're going to need really expensive stuff like liver transplants."

Critics express concern
The proposed changes already have stirred controversy, according to the New York Times. As with proposed changes to depression and autism, critics say the new criteria would significantly change the number of individuals diagnosed with addiction.

For example, individuals who often consume more alcohol than intended and crave drinks may be considered mild addicts under the new criteria. In comparison, the DSM-IV required more serious symptoms—such as skipping work or driving under the influence—for the diagnosis.

Economists say as many as 20 million additional U.S. residents may be categorized as "addicts" under the new rules. Although APA says the shift would bring down health costs in the long run, critics say it could cost hundreds of millions of dollars in the short term. Moreover, some say the scarce resources may be redirect to individuals with only mild problems.

Expert questions APA's 'monopoly' on mental diagnoses
Allen Frances—a Duke University School of Medicine professor and the leader of the DSM-IV panel—in a New York Times opinion piece wrote that he has "reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness," noting that psychiatrists are "no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy" (Urbina, New York Times, 5/11; Frances, New York Times, 5/11).

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