More on the DSM-V controversy

"The new mental disorders?"

Inspired by last week's op-ed in the L.A. Times, Atlanta Journal-Constitution staff writer Richard Halickshas has a new piece questioning some of the strange new diagnoses being proposed for the DSM-V:

Sex addiction. Internet addiction. Compulsive buying disorder. All of these and more could become officially recognized mental disorders in the next few years. The American Psychiatric Association is creating the fifth edition of its Diagnostic and Statistical Manual, or DSM-V, which defines mental disorders and adds new ones with each edition.

Christopher Lane, author of the book "Shyness: How Normal Behavior Became an Illness," complained last week that the new DSM, due out in 2011, is being put together in secret, a charge that DSM's editors denied.

In "Wrangling Over Psychiatry’s Bible," published in the Los Angeles Times, Lane also warned that the creation of new disorders where none currently exists may be "little more than a pretext for prescribing profitable drugs."

Here's a look at selected new ailments under consideration by the committees of experts writing DSM-V.

Sex addiction

Real, says Dr. Patrick Carnes, a leading researcher in the field. It's a "compulsive behavior that completely dominates the addict's life. Sex becomes the organizing principle of addicts' lives."

Not real, says Seattle therapist Roger Libby. Slate.com quotes Libby: "You cannot be addicted to yourself. You have to have a substance external to yourself like alcohol or drugs to be addicted."

Caffeine withdrawal disorder

Real, say Johns Hopkins University researchers. Withdrawing from the world's most-used drug causes headache, fatigue, irritability, depression, difficulty concentrating, even flulike symptoms.

Not real? Few seem to argue against this. It's in DSM-IV as a trial diagnosis and is up for official diagnosis designation in DSM-V.

Parental Alienation Syndrome

Real, says paskids.com: [PAS] "arises primarily in the context of child-custody disputes. Its primary manifestation is the child’s campaign of denigration against a parent, a campaign that has no justification."

Not real, says the National Organization for Women: "Parental alienation really is a dangerous and cleverly marketed legal strategy that has caused much harm to victims of abuse, especially women and children during and post-divorce."

Internet addiction

Real, says Dr. Jerald Block, writing in the American Journal of Psychiatry: "Internet addiction appears to be a common disorder that merits inclusion in DSM-V… . [It] consists of at least three subtypes: excessive gaming, sexual preoccupations and email/text messaging."

Not real, argues thelastpsychiatrist.com. "Internet addiction belongs in DSM-V… . And then let's rename the DSM The Book of Fantastikal Magickal Pixies and incorporate it into the Monster Manual."

As you see in the above coverage, the APA denies the charge by Lane and others, including none other than DSM-III Task Force Chairman Robert Spitzer, that the DSM-V revision process is occurring in secrecy.

But, as Spitzer points out in a letter to Psychiatric News, the secrecy is spelled out quite clearly in the contract that all DSM-V task force members must sign:

"I will not, during the term of this appointment or after, divulge, furnish, or make accessible to anyone or use in any way... any Confidential Information. I understand that 'Confidential Information' includes all Work Product, unpublished manuscripts and drafts and other pre-publication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from or relates to my work with the APA task force or work group."

The Atlanta Journal-Constitution article is online here. Spitzer's letter about the secrecy is here. My previous post on the DSM makeover controversy is here.