- The Washington Times - Tuesday, March 2, 2010

When does a vice become an addiction?

Too easily and too soon for some.

The nation’s psychiatrists are considering defining addictive acts such as overeating, gambling and compulsive sex as medical disorders in their professional manual.

The proposed changes to the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) would open the door to better diagnoses and treatments.

However, the new diagnoses also are creating criticism and mirth among some observers, including lawyers and eminent doctors who see the nation’s psychiatrists as addicted to overdefining and predict headaches in terms of insurance coverage, businesses’ ability to hire and fire, and overtreating the nation’s populace.

Workplace disability law is a major concern for employers because “how are you going to be able to determine if someone is a binge eater or not?” Chicago lawyer Steve Miller told the National Law Journal.

Dr. Allen Frances, chairman of the DSM-IV Task Force in the 1990s, predicted a “slippery slope” if gambling is defined as a “behavioral addiction,” a process he said would end with video-game use and shopping turned into medical conditions.

This and other changes appear to promote “what we have most feared — the inclusion of many normal variants under the rubric of mental illness,” Dr. Frances said. The result can be millions of misidentified “patients” and “massive overtreatment.”

Questions like these are being heard until April 20, when the comment period ends for this fifth edition of the DSM.

First published in 1952 by the American Psychiatric Association (APA), the DSM contains a detailed listing of every psychiatric disorder recognized by the U.S. health care system and defines how they are diagnosed. However, DSMs do not list recommended treatments.

Given the authoritative status of the DMS, revisions are made rarely and carefully. The DSM-V is the first revision since 1994, and it is not expected to be complete until May 2013.

However, DSM diagnoses can be cited in child-custody cases, employment background checks and court cases. Drug companies also use it as a guide for what psychiatric ailments exist and for which they can develop remedies.

Among the proposed changes is the creation of a “behavioral addiction” category with a single disorder — pathological gambling, the APA said. Internet addiction was considered for this category but instead will be listed in the DSM-V’s appendix to encourage more research, the group said.

A spokeswoman for the American Gaming Association, a trade group for the casino entertainment industry, said her organization did not have an immediate response to the proposed change in the gambling diagnosis.

But in an odd twist, the “gambling addiction” diagnosis is being applauded by conservative family-values groups that are often harshly critical of the psychiatric establishment both for its role in debates over homosexuality and for its perceived willingness to medicalize actions seen as vices or sins by traditional religion.

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