DSM-5: Hoarding, binge-eating and hypersexuality

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Adding Asperger’s syndrome to the autism spectrum, eliminating the terms “substance abuse” and “dependence” in favor of “addiction and related disorders,” introducing the condition “hypersexual disorder” and introducing an assessment of mental illness based on severity are among the proposed changes for the new edition of the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5). The newest version of the psychiatric bible isn’t scheduled for official release until May 2013, but today the American Psychiatric Association (APA) offered a sneak peek of the manual that will change the way we diagnose and treat mental disorders—and potentially what psychiatric care will be covered by insurance plans—in the years ahead. In a press release (PDF), Dr. Alan Schaltzberg, president of the APA, emphasized that the manual is still very much a work-in-progress, and that they are opening the draft for public commentary that will influence how the manual is refined and edited. Some of the proposed changes:

  • The term “mental retardation” would be dropped, in favor of “intellectual disability”—to reflect terminology already in use by many mental health organizations.
  • In addition to changing the terminology of addiction, from “substance abuse” and “dependence” to “addiction and related disorders,” the new DSM would also introduce a category of “behavioral addictions,” which currently is likely to include only gambling. Internet addiction was considered for inclusion in this new category too, but the DSM task force ultimately concluded that research doesn’t justify adding the condition. As Dr. Charles O’Brien, chair of the DSM-5 Substance-Related Disorders work group, told TIME last year, “At this point I think it’s appropriate that it’s not considered an official disease. We are probably going to mention it in the appendix.”
  • Asperger’s syndrome, which is categorized as a stand-alone condition in DSM-4, would be added to the broader category of conditions included as Autism Spectrum Disorders. Childhood disintegrative disorder and pervasive developmental disorder would also be included on the autism spectrum.
  • Hypersexual disorder would be added to the new version of the DSM, as a diagnosis for people who, for a period of six months or longer, meet at least four of five criteria, including engaging in sexual fantasies and behavior as a response to depression and anxiety, or repeatedly indulging sexual desires without regard for the emotional repercussions—for themselves or others.
  • Binge-eating disorder would be added to the category of eating disorders, which currently includes anorexia and bulimia, as well as “eating disorder not otherwise specified,” which could serve as an umbrella diagnosis for conditions such as “night eating syndrome,” or recurrent purging in the absence of binge eating, which are being considered for inclusion in the DSM-5 appendix.
  • Classified as “dimensional assessments,” the new DSM would include methods for physicians to incorporate the severity of symptoms into a diagnosis, as well as examine how certain symptoms—such as insomnia—may “cross-cut” several disorders. According to Dr. David Kupfer, chair of the DSM-5 task force, these new assessment techniques would better enable physicians to chart progress and tailor treatments to individual patients.
  • Hoarding disorder is currently being considered for inclusion in DSM-5, but task force members haven’t yet determined whether it will be in the main manual or in the appendix. According to the proposed inclusion, symptoms of hoarding disorder would include: struggling to part with personal possessions; accumulating objects to the point that they clutter living space, preventing normal use; and suffering social, work or other distress as a result of hoarding behaviors.

The draft-version of DSM-5 will be open for public comment until April 20 of this year. To learn more about the proposed changes, visit the DSM-5 development page.

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