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We have been following the process of writing the DSM, which will establish the new diagnostic criteria for psychiatric disorders, through the DSM-5 Shadow Team, which has created quite a broo-haha, as you can see here and here. One of the diagnoses that has been proposed is internet addiction disorder. This is apparently an addition to disorders for addictions to sex, food, gambling, whatever you name it, but we don’t have time to cover everything. Fact is it is pretty hard to know what they are doing as the head of DSM-5, David Kupfer MD, has required all members to sign a nondisclosure agreement and not take any notes. He runs a pretty tight ship.
The behavior of the committee members has gotten pretty mean and nasty, and the DSM Anxiety Disorders, OCD, PTSD and Dissociative Disorders committee retaliated against me for writing about the DSM here. I mean, those dudes are pretty thin skinned. And what would you think about a bunch of guys that signs a confidentiality agreement before they even know what they are getting into? Now David Kupfer is herding them toward a deadline of 2010 for completion of the DSM-5 and many are starting to balk. Are they headed toward a precipice?
Background David Kupfer. Forground DSM-5 AD Committee: back row, L to R, Robert Pynoos, Roberto Lewis Hernandez, Gavin Andrews, Katharine Phillips, Matthew Friedman, Scott Rauch, Dan Stein. Front row, L to R, Eric Hollander, Michelle Craske, Murray Stein, Susan Bogels, Hans Ulrich Wittchen, David Spiegel, Robert Ursano
Nice group shot guys! Baaaa!!!
Almost a third of the committee is from foreign countries, which my guess is that they had to go abroad to find people who actually wrote papers but weren’t up to their necks in consulting arrangements with pharmaceutical companies. Part of the attempt to add credibility which seems to characterize this process, like telling members not to consult during the process of working on the DSM.
This week things are fraying more around the cracks. Dr Jane Costello from Duke University resigned from the Workgroup on Children’s and Adolescent Disorders; the reasons outlined in the letter include an overly hasty rush to change things when there is little scientific evidence to support the changes. Hmmm I wonder where I have heard that before? Dan Carlat MD reports on Armegeddon and the developments and on a letter from Robert Spitzer MD and Allen Frances MD to the American Psychiatric Association (APA) Board of Trustees warning of “disastrous unintended consequences” and asking for an outside review panel.
The problem is that the APA is a million or two dollars in debt, and has become addicted to having these new DSM books come out, because then everyone has to throw out the old one and buy the new one, and since they are the publisher they get the profit. With the pipeline of psychiatric drugs drying up there is less advertising from the pharmaceutical industry for their journals and meetings, therefore things are getting tight, and hence the pressure to hurry up the process. However I don’t think that generating income for the APA is a good reason to change diagnostic criteria for mental disorders, and their behavior is going to call into question their rights to do that. Not all psychiatrists (including me) are members of the APA, and there are many other mental health professionals who must live with the DSM.
Anyhoo back to internet addiction disorder, which I guess we should call IAD, it is of course compulsive use of the internet, with hourse spent trolling on line, with disruption of work and social life.
You can read an editorial advocating for its inclusion here.
It is considered to be a big problem in many Asian countries. The other side of this is people who get into Real-life or other online games like that and develop relationships where they start having sex with other peoples avators and then they get caught and kicked out of the house.
I have a treatment for my 12 year olds computer game addiction. It is…
…GET OFF THE COMPUTER!!!
Seriously if anyone wants to know my opinion about IAD, it is that I agree with Allen Frances MD head of DSM-4 that we should shun any new and suspicious looking psychiatric diagnoses as we don’t want to add to the throngs of people who feel like they have been labelled with a psychiatric diagnosis. My opinion is that the DSM process should be put on hold, that the text can be revised but diagnostic criteria should not be revamped until there has been the time to collect more data.
Cheers!
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This psychologist is certainly already questioning the relevance, need for, and usefulness of a V (or this V, anyway)and thinking/planning/strategizing about what I can use instead. The ICD? Stick with DSM-IV? Stop diagnosing by the numbers at all?
I understand that, while past editions of the DSM have addressed addiction, the DSM IV does not, but rather instead refers to this concept as substance dependence.
Can you imagine what withdrawals would be like for internet addiction recovery? And the after-effects of one who eliminates cyberspace from their lives?
Eye contact with other humans may be re-acquired, as well as the re-acquisition of social skills, and improvement of social skills.
I’m not sure it’s worth it………
Dan, association is not causation.
Some people lack the ability to make eye contact or have social skills in the first place. That is why the Internet is such a draw for them. They don’t have to engage in “normal” human interaction. They can just be themselves. And I don’t mean just people with autism, though there are enough adults with that or Asperger’s (undiagnosed) to make the problem rather epidemic.
People with “dopamine issues,” including ADHD, are also more vulnerable to the lure of this constant source of stimulation (stimulation as self-medication). And they also can have trouble looking someone in the eye while they are thinking or processing information. Moreover, they often suffer social deficits from their inability to read social cues, have back-and-forth conversations, and show reciprocity.
An astute clinician would look to the underlying cause, not the symptom. And it sure seems that that DSM is including more symptoms than causes.
As technology expands, even more human vulnerabilities will be exposed. It’s not people who are changing. It’s their environment, along with their inability to cope with it or regulate their responses to it — or to even understand the reactions the environment is eliciting.
I apologize for being schoolmarmish, but it’s like nails on a chalkboard for me when I read “broo-haha.” Here’s what the Merriam-Webster online thesarus says: brou·ha·ha
Pronunciation: \brü-hä-hä, brü-hä-hä, brü-hä-hä\
Function: noun
Etymology: French
Date: 1890
: hubbub, uproar
Otherwise, I totally agree with this and almost all your other posts. Keep up the great work, and sorry about how Emory is treating you.
@Gina: Yes, an astute clinician would look beyond symptoms. But managed care (a whole ‘nother rant, I know) as well as the ever-expanding list of descriptive “disorders” in successive DSM’s are making that next to impossible in clinical practice.
I understand that too well, Virginia. Sadly so.
Here on the Peninsula, almost all the good clinicians are private pay — not part of any insurance network. It’s usually worth it, though, for people who can afford it, considering the alternative.
It’s easy to pooh-pooh “new” addictions and addictions that involve behaviors (e.g. gambling, sex) rather than chemicals. But behavioral addictions equally well involve (1) loss of control, (2) significant adverse consequences, and (3) preoccupation or obsession. Cybersex addiction has resulted in significant consequences such as job loss, marriage dissolution, and arrests for downloading/mailing underage pornography. Sex addiction is an old problem, but the internet, which has been termed “the crack cocaine of sex addiction,” has markedly increased the number of people hooked on this behavior. People can be compulsive users of the Internet in general, neglecting their family, job, and social relations, but the consequences tend to be more severe when the content they are viewing is sexual. My website, http://www.jenniferschneider.com, has several articles I’ve written, including an old one with Richard Irons MD called “Differential diagnosis of addictive sexual disorders using the DSM-IV” Sexual Addiction & Compulsivity 3:7-21, 1996. Sex addiction is alluded to in the DSM III, absent from DSM IV, and should be in DSMV. My book Untangling the Web: Sex, Porn, and Fantasy in the Internet Age discusses the Internet phenomenon at length.
Jennifer
I think the APA’s urgency about developing DSM-V is mostly financial.
Admittedly, I know very little about this process as a whole. But I do know that the criteria for ADHD is woefully inadequate and grossly outdated. The current criteria was tested on boys, mostly with hyperactivity. Not girls. Not adults.
The new proposed criteria for adult ADHD, developed by Russell Barkley et al, is the result of decades of research. As far as I’m concerned, it’s ludicrous that Barkley, the preemminent research scientist in this field, will not be among the committee members making the final decisions due to pharma-sponsored research during his long and highly respected career. (This rule alone shows how poorly regulated the APA must be, cognitively speaking, to swing from one ridiculous extreme to another — all to suit public opinion and grandstanding politicians who serve Big Insurance.)
For people with ADHD, these updated criteria are already about 15 years too late. But I shudder to think what hash might be made of Barkley’s elegant research.
Whatever the topic, you have such a good sense of humor it takes the edge off of this stuff, where did you find that avatar story, lol and that picture is hilarious!
Diclosures for skills not pills:
Mother of 3, no pharma industry connections, no money received from pharma, or my blog readers, I teach special education kids, have 1 cat, 1 dog and 2 birds. Never authored a book such as Pera or Bremner, though a children’s story has always been of interest to me, maybe even illustrating it.
Oh, I know it’s already written! that would be the DSM, complete with barnyard animals as authors!
It is easier to diagnose the hyperactive form in children than ADD without hyperactivity in adults using DSM-IV criteria. Which means that girls and women, who mostly have the inattentive type, are underdiagnosed and therefore undertreated.
However, and this is clear from her comment, Ms. Pera also agrees with the rest of us that any changes should be based on research, not on our wishes to make the diagnosis more inclusive.
If ADD/ADHD is the disorder she’s most familiar with, and therefore the perspective from which she addresses most of her comments, that should not present a problem. We all comment from the perspective of our areas of expertise–mine, for example, are from the perspective of outpatient clinical psychology. That does not make me or Ms. Pera anybody’s shill.
Interesting website, Dr. Schneider. Thank you.
I just deleted a bunch of comments that had degenerated into ad hominem attacks that were off topic. This website is a lot more interesting without me moderating comments and I don’t want to change that. Please don’t make me into a censor.
With all DUE respect, Dr. B why did you delete my comment about Gina and Skills needing couples therapy? My comment had no ” ad hominem” attack. I think your issues with Emory are making you paranoid. And you have lost your sense of humor to boot.
I don’t like diagnostic categories at all. They are flimsy and result in “provider bias”- several studies point to clinicians’ inability to see the person, and narrow-minded focus on the pathology. Rosenhan’s counselors described normal conversations with mentally healthy individuals as severely pathological when they were given a false label to work with. In another study, one group of psychiatrists was told that an actor was psychotic, the other was told that he was healthy. 60% of the first group diagnosed him with schizophrenia- NONE of the control group did so.
Because I’m “bipolar”, my psychiatrist allows me two emotions. I cannot simply be having a bad day. If I’m smiling, he views me suspiciously and asks me if I’m having racing thoughts. When my grandmother died, he said I was depressed (yeah, I loved her more than anyone in the world, I should hope I’d be depressed!) I am not allowed to go a sleepless night from stress or loud noises- uh-oh, I might be going manic.
The whole system is degrading and while some people feel they’ve been helped by it all, I’m in the group that feels that our biggest regret in life is ever getting involved with psychiatry. And it’s getting crowded over here.
I haven’t lost my sense of humour. I just don’t like it when people start talking about lawsuits that I might be a party to. I don’t get paid to write this website, I do it on my own nickel (ha, ha), I don’t ask for donations or even put up ads, and I don’t have any money for lawyers. I don’t want to be a policeman but if things get out of hand I reserve the right to delete all or portions of comments. Have a nice day.
I, for one, very much appreciate your efforts. You put a lot of passion, balanced by good humor, into this blog. You are a voice of pleasant reason and balance in an area of much malice, misunderstanding, and contention. Bravo for being willing to play referee as well. Keep it up.
And what we eill see is the Body Integrity Identity Disorder in the new DSM. A story written by Michael First. BIID is the lust cutting a healthy leg. If Prozac will not prevent you from cutting a healthy limb after two years you should find a surgeon. What a wonderful book.
[...] Doug Bremner, MD – DSM-5 Internet Addiction Disorder? Armageddon and Keeping the Troops in Line [...]
I understand your point, Dr. B. But those two still need couples therapy! I can’t imagine how my humble opinion would become party to a law suit. This is a blog after all.
Child Pornography isnt an addiction,..Its a CRIME!!!
Lisa wrote that “child pornography isn’t an addiction — it’s a crime.” Well, these two categories are not mutually exclusive! Just think of a drunk driver who kills someone: The driver may be addicted to alcohol, and he has committed a crime. So let’s try to keep our categories connected to the real world rather than reacting emotionally.
Dr. Schneider, I don’t think emotion can be taken out of it. Many of us would not have landed in a psychiatrist’s office to begin with if these pedophiles were locked away for good, rather than treated as addicts and allowed to abuse again.
Here are some ideas for disorders:
Anti-Conspiracy Theorist Disorder
Continually refuses to believe that one is taking place.
Dellusional Voter Schizoid Identity
The subject is under the illusion he belongs to a democracy or republic of a representative government. Every 4 years the subject thinks he chooses who represents him or her, that somehow his vote will somehow change things for the betterment of We the People of the USA. Over and over and over every election they cast their vote getting the same dim dismal results yet they cannot stop voting.
We are all neurotic as Carl Jung said. It covers the entire DSM4 and 5 in a nutshell. The DSM was a way of creating a very large economy called the Pharmaceutical, Insurance and Medical Industry. Not counting the sub corporations that run the 3 categories.
Ill leave you with this.
If you are mentally ill in the world we live in now…you are actually one of the few normal ones that are reacting to a very unatural world you try oh so hard to fit into.
The true mentally ill ones are the ones that think life is dandy, and its a wonderful life of aquiring things. The heiarchial mindframe of doing things…good, bad, rich, poor, republican, democrat, homosexual, heterosexual, pretty, ugly, smart, dumb, funny, boring, loveable, unloveable,…all illusions integrated within everyone of us at the DnA level. So basically your screwed. Even the corporations and the people that run them are in deep doo doo. LOL Enjoy
Doug,
If “get off the computer!” is an effective strategy for dealing with internet addiction, then how do you feel about treating alcoholism by telling an alcoholic, “Just stop drinking!” As a psychiatrist, you should know better! As Dear Abby used to say to readers who made ridiculous suggestions, “Ten lashes with a wet noodle to you!!!”
The reduction of mercury has, some are saying, anecdotally reduced the severity but not the frequency of autism. ,
The link for the editorial doesn’t work–could you fix it? Thanks
[...] insurance, the only part that mattered. You can read about how the thing went on from there here. DSM-5 Internet Addiction Disorder? Armaggedon and Manning the Barricades More on DSM and the process of speeding up the writing of the next Bible of [...]
hey, love your post!
[...] Addiction Disorder – I already wrote about this one and I am particularly against this one because I am afraid they will use it to lock me up in a [...]