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Should Sexual Addiction Become A Legitimate Mental Health Diagnosis?

By ROBERT WEISS LCSW, CSAT-S

Is Sex Addiction Real?

Should Sexual Addiction Become A Legitimate Mental Health Diagnosis?There will always be controversy – as there should be – when any form of inherently healthy human behavior such as eating, sleeping, or sex is clinically designated as pathological. And while the power to “label” must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as was homosexuality in the DSM-I and DSM-II), equal care must be taken to not avoid researching and creating diagnostic criteria for healthy behaviors when they go awry due to underlying psychological deficits and trauma.

Pre-Internet sexual addiction research in the 1980s suggested that approximately 3 to 5 percent of the adult population struggled with some form of addictive sexual behavior. Those studied were a self-selected treatment group, mostly male, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, old-fashioned phone sex, and similar behaviors.

More recent studies indicate that sexual addiction is both escalating and simultaneously becoming more evenly distributed among men and women. This escalation in problem sexual behavior appears to be directly related to the increasingly high-speed Internet access to both intensely stimulating graphic pornography and anonymous sexual partnering.

Today these connections are furnished not only through the use of home and laptop computers, but also via smart-phones and the related geo-locating mobile devices we now carry in our pockets and briefcases.

Lamentably, at the very same time that sexual addiction disorder began its technology generated escalation, the American Psychiatric Association (APA) backed away from the provision of either a diagnostic indicator or a workable diagnosis. Consequently, the past 25 years have wrought a somewhat anguished and inconsistent history in the attempts of the psychiatric, addiction, and mental health communities to accurately label and distinguish the problem of excessive adult consensual sexual behavior.

Today, American outpatient psychotherapists and addiction counselors are reporting a marked increase in the number of clients seeking help with self-reported crises related to problems like “I find myself disappearing for multiple hours daily into online porn” or “I feel lost on a never-ending treadmill of anonymous sexual hook-ups and affairs,” not to mention the tens of thousands who daily struggle with the dopamine-fueled nightmare combination of stimulant (meth/cocaine) abuse fused with intensely problematic sexual behavior patterns.

It would seem that these clinicians and clients would benefit greatly from the guidance the APA and DSM might offer them, but does not currently provide.

Read more: http://blogs.psychcentral.com/sex/2012/04/hypersexualitydisorder/

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Posted by on April 18, 2012 in General

 

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DSM-5 Critics Pump Up the Volume

By John Gever, Senior Editor, MedPage Today

Not Diseases, but Categories of SufferingWith crunch time looming for the ongoing revision of the psychiatry profession’s diagnostic manual, critics hoping to stop what they see as destructive changes are taking their campaign to the consumer media.

In early February, British psychologists and psychiatrists unhappy with proposed changes in the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders — the DSM-5, in its forthcoming incarnation — staged a successful press conference in London, which generated news coverage around the world.

Meanwhile, the most prominent U.S.-based critic of DSM-5, Allen Frances, MD — chairman of the task force that developed the fourth DSM edition in 1994 — has become a regular contributor to the popular Huffington Post website. Last week, he suggested there that the government should force the APA to abandon some of the proposed changes.

And the explosion in social media has allowed other, less well-connected mental health professionals and interested laypeople to create their own platforms for airing concerns about DSM-5 — starting websites and writing comments on others.

At least in part, the rising furor is driven by the DSM-5 revision schedule. The APA has committed to releasing the final version at its May 2013 meeting. Its internal process for ratifying it requires that it be in essentially final form this winter.

Thus, only a few months remain for critics to sway the DSM-5 leadership.

When Does Grief Become Depression?

DSM-5 Critics Pump Up the VolumeMost of the criticism has focused on a few of the many dozens of changes that the DSM-5 working groups have proposed. These include eliminating the so-called bereavement exclusion in diagnosing major depression and adding new diagnoses for people with mild psychotic-like symptoms and problem child behaviors such as severe, repetitive tantrums.

The complaints have a common theme: that the DSM-5 will medicalize — and therefore stigmatize — normal human behaviors.

At the London press conference, for example, psychiatrist Nick Craddock, director of the Welsh National Centre for Mental Health in the U.K., argued that removing the bereavement exclusion would have such an effect.

Under DSM-IV criteria, someone who has lost a loved one can be diagnosed with major depression only if depression symptoms last longer than two months or if they include features not typical of normal grief, such as suicidal ideation.

The proposals for DSM-5 would drop this caveat, allowing for diagnosis of major depression two weeks after a loved one’s death.

According to the DSM-5 working group on depressive disorders, there is no evidence to justify an exclusion for grief but not for other stressors such as divorce, sudden physical disability, or losing one’s home or job.

Defenders of the proposal have also argued that individuals with normal grief may benefit from counseling, which may not be covered by insurance without a DSM-sanctioned diagnosis.

Craddock agreed, but countered that such individuals “did not need a label saying they had a mental illness.”

Similar complaints have been leveled at the proposed new diagnosis of attenuated psychosis syndrome. Its proponents intended it to cover people with persistent but mild hallucinatory symptoms and disturbed thinking — mild enough that the individuals recognize that they aren’t real, but serious enough to find the symptoms bothersome.

In a commentary published in the Feb. 18 issue of The Lancet, two researchers said it would be “premature” to include the syndrome in the DSM.

Paolo Fusar-Poli, MD, of King’s College London, and Alison R. Yung, PhD, of the University of Melbourne in Australia, said that, from the evidence so far, the population likely to receive the diagnosis “is heterogeneous in presentation, clinical needs, and outcome” — and thus too ill-defined without more research and additional diagnostic criteria.

‘Shrinking the Pool of Normality’

Shrinking the Pool of NormalityOne British psychologist, referring to the DSM-5 as a whole, told the Guardian newspaper that its proposals “are likely to shrink the pool of normality to a puddle.”

They also allege that, by expanding the number of people potentially qualifying for a psychiatric diagnosis, DSM-5 will inevitably increase the number treated with drugs.

Another of the speakers at the London press conference, David Pilgrim, of the University of Central Lancashire in Preston, England, called it “hard to avoid the conclusion that DSM-5 will help the interests of the drug companies.”

Former New England Journal of Medicine editor Marcia Angell, MD, noted last year in the New York Review of Books that more than half of DSM-5 working group members had “significant industry interests.”

Frances, too, has written that the DSM-5 will be a “bonanza for the pharmaceutical industry.” But most of his criticisms, which he took public in 2009, have focused on the revision process.

He has been especially concerned with delays in the process — the APA had originally scheduled publication of DSM-5 for this May, but decided in 2009 to push it back one year — and what he believes has been a resulting rush to deliver a final product.

He has repeatedly called on the APA to abandon the revision in its current form. Recently he argued that the Obama administration’s decision to delay implementation of the ICD-10 classification system in the U.S. undercut the APA’s arguments for the May 2013 deadline for DSM-5.

DSM-5 Leaders Stand Their Ground

In a conversation with MedPage Today, APA President John Oldham, MD, and DSM-5 task force chairman David Kupfer, MD, defended their handling of the revision and argued that many of the criticisms were off-base.

For starters, Kupfer said, the proposed revisions were still open to change or abandonment. The DSM-5 will assume its near-final form in June or July, he said — meaning that the APA’s annual meeting in May would provide another forum to debate the changes.

“[The proposals] are still open to revision,” he said. “The door is still very much open.”

Oldham said he was satisfied with the process so far. “It’s an enormously long, and difficult, and challenging thing to do,” he said. “We’re not going to get it perfect. I don’t think anybody could. I don’t think any previous edition could.”

Oldham and Kupfer also argued in favor of removing the bereavement exclusion from the depression criteria.

Said Kupfer, “If patients are suffering not from normal sadness or grief, but are suffering from a severity of symptoms that constitute clinical depression, and need intervention, and they want help, that they should not be prevented from getting the appropriate care that they need because somebody tells them that, well, this is what everybody has when they have a loss.”

Oldham noted that extreme sadness can be triggered by any number of events — natural disasters, physical disability, job losses — yet the DSM-IV created an exclusion only for “bereavement.”

He also pointed out that there are “ranges of heritable risk for major depression” — suggesting that depression may in some sense be normal, yet deserving treatment nonetheless.

The DSM’s overarching purpose, Oldham said, is to enable “patients who need treatment [to] get it.”

Kupfer conceded that field trials of the revised criteria, by design, were not testing whether the changes would increase or decrease the number of people receiving a particular diagnosis. As a result, the critics’ worries won’t be refuted or confirmed until after the revisions go into effect.

“We won’t get 100% consensus on all the proposals,” Oldham said. “That would be totally unrealistic. But I personally think it’s been a thorough and careful process. We’re going to have disagreement. That’s going to happen.”

Source: http://www.medpagetoday.com/Psychiatry/DSM-5/31416

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Posted by on March 12, 2012 in General

 

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Possible DSM Changes Spark Controversy

By Rick Nauert, PhD – PHD Senior News Editor

Possible DSM Changes Spark ControversyProposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the fat text used to help identify and categorize mental illness, are not sitting well with many mental health professionals and the public.

Suggested changes to the definitions of autism spectrum disorders and depression, among others, are eliciting great concerns. And experts say there are larger concerns about the DSM as a whole.

“Almost no one likes the DSM, but no one knows what to do about it,” said University of Michigan psychiatrist Dr. Randolph Nesse.

The current round of revisions is the fifth since the DSM was originally published by the American Psychiatric Association in 1952.

Nesse and University of Cape Town psychiatrist Dr. Dan Stein combined for an article in the current issue of BMC Medicine titled “Towards a genuinely medical model for psychiatric nosology.”

The article provides a candid appraisal of the difficulty of categorizing mental disorders that the authors expect will not make a lot of their colleagues happy.

“The problem is not the DSM criteria,” Nesse said. “The problem is that the untidy nature of mental disorders is at odds with our wish for a neat, clean classification system.”

The proposed abolition of the grief exclusion, for example, in diagnosing major depression is just one example of a push to define psychiatric disorders according to their causes and brain pathology.

“A huge debate over when depression is abnormal seems likely to be resolved by removing the so-called ‘grief exclusion,’” Nesse said. “At the moment, depression is not diagnosed in the two months after loss of a loved one.

“The result of this proposed change would be that people experiencing normal grief will receive a diagnosis of major depression. Doing this would increase consistency in diagnosing depression, but at the cost of common sense. It’s clear that bereavement is not a mental disorder.”

Nesse and Stein point out that the rest of medicine recognizes many disorders that do not have specific causes.

“Conditions such as congestive heart failure can have many causes,” Nesse said. “This doesn’t bother physicians because they understand what the heart is for, and how it works to circulate blood.”

Furthermore, he said, physicians recognize symptoms such as fever and pain as useful responses, not diseases.

“These symptoms can be pathological when they’re expressed for no good reason, but before considering that possibility, physicians look carefully for some abnormality arousing such symptoms,” Nesse said. “Likewise, the utility of anxiety is recognized, but its disorders are defined by the number and intensity of symptoms, irrespective of the cause.

“It’s vital to recognize that emotions serve functions in the same way that pain, cough and fever do, and that strong negative emotions can be normal responses to challenging or anxiety-provoking situations.”

Instead of specific diseases with specific causes, many mental problems are “somewhat heterogeneous overlapping syndromes that can have multiple causes,” Nesse said.

“Most are not distinct species like birds or flowers. They are more like different plant communities, each with a typical collection of species. Distinguishing tundra from alpine meadow, arboreal forest and Sonoran desert is useful, even though the categories are not entirely homogenous and distinct.”

Source: http://psychcentral.com/news/2012/02/16/possible-dsm-changes-spark-controversy/34909.html

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Posted by on February 16, 2012 in General

 

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