The British Psychological Society have already come out against DSM. ICD is the future.

I'm not sure about the Royal College of Psychiatrists, but I think they plan to standardise on ICD-11 by its planned introduction in 2014. I can check with colleagues at work next week.

nick_psych wrote:Hi there,

I was wondering about peoples opinion on the DSM classification and generaly abnormal psychology and psychopathology.

Till now, the DSM is growing puting more and more behaviors under the label of abnormal and deviation.

Actually, the DSM has been not only reducing the number of disorders contained within it, but also tightening up the criteria so less people fall within some of the categories.

nick_psych wrote:Do we really have the tools to ''deside'' what is normal or not?

The DSM and mental health in general does not care about what is normal, as "normal" behaviors form the basis of some mental disorders, and "abnormal" behaviors can fall outside the realm of mental disorders. For example, having an attraction to prepubescent children is not, in itself, a mental disorder but I don't think many people would call such a behavior "normal".

Instead, mental health is only concerned with patterns of behavior or thoughts which affect someone's ability to function in society and their well-being. There's no implication that people need to be "normal" or "fit the mold", but simply that if they personally choose that they want to be happier and to have an easier time holding down a job or maintaining relationships with family and friends, then they can see someone who can teach them skills to help them do so.

In other words, the decision as to what is a disorder, is not made by professionals (initially at least). It is made by groups of people who come asking for help, and professionals simply look for commonalties in their complaints and give it a name, so that we can talk about it meaningfully. That is, instead of saying, "A successful treatment for issues A, B, C, E, G, J, and L is X, but it seemed to be useless for issue D, F, H, and I", we can say, "A successful treatment for depression is X, but it seemed to be useless for schizophrenia".

nick_psych wrote:For example do you agree with a term like ''internet addiction'', ''internet pathological use'' etc? For example a topic like ''behavioral addictions'' wouldn't be suitable for non chemical addictive behaviors? Why should there be a specific disorder category like the internet one?

Thank you

Well internet addiction is obviously a mental disorder in that it significantly affects the well-being and functioning of an individual, I don't think anyone can debate that, so the only debate is whether it deserves its own category that is distinct from the general class of addiction. To answer that we'd have to know more about the disorder, such as how many people are affected, whether there are unique features to it that separate it from other addictions, and so on. I wouldn't have thought that it would be unique enough to deserve its own category, which is why (I think) it's not going to be included in the DSM5.

If you're debating whether non-chemical addiction is a "real" disorder, then why wouldn't it be? Especially when we consider that a significant part of addiction to smoking, drinking, heroin, etc, is the behavioral addiction. Often, curing the physical addiction is the easy part.

nick_psych wrote:Ι wouldn't agree with you that the mental health professionals and the DSM only care about whether the person feels not good and has a disfunctional life. If it was for only that then I suppose that some of the personality disorders should immediatly get out of the psychiatric handbooks. The statistical deviation is also a criteria for psychopathology existance, something that assists to overdiagnosis of mental disorders like ADHD for example ( I think that ADHD is one of the biggest industries now in the USA).

Statistical deviation is a relevant, but minor, issue in considering whether something is a mental disorder. The general rule for determining whether something is a mental disorder is the three D's, which look at whether the issue is Distressing, Dysfunctional and Deviant. The first two are the most important, as something can still obviously be a problem for someone even if it falls within a "normal" range.

As for ADHD being overdiagnosed, can you present some evidence to support that? Specifically, I'd need to see evidence of its prevalence, and then evidence to show that more people are being treated than have it. The last time I looked up the topic, the evidence seemed to quite strongly suggest that there is no problem with overdiagnosis, and rates had not significantly increased in recent times.

nick_psych wrote:Regarding internet addiction, yes it is a disorder, yes there should be treatment. But we all came eyewitnesses of an effort, for internet addiction to have its own category in the mental health handbooks over the world. I do not support that beahvioral addictions are not real disorders. Indeed, i realy do. But I would not characterize a disorder by the divice used to reach the stimulus you are addicted to, but something more general that does not Implie that in the future new divice addictions will be invented.

But if characterising a disorder by the stimulus that a person is addicted to can be useful, then surely you'd agree that a special category should be created for it? This is keeping in mind that mental disorders are created primarily for ease of communication, so that researchers and other clinicians know what symptoms and issues you're discussing. In other words, saying something is a mental disorder does not mean that something like "depression" exists as a discrete thing. It's just a vague label given to a collection of symptoms which can have varying severity and causes.

So if by creating the label "internet addiction" it made diagnosing and treating these people easier, then we should include it - regardless of the fact that it's functionally no different from any other kind of behavioral addiction. As mentioned above, chemical addictions are no different from behavioral addictions and treating the physical dependency is pretty easy in most cases (and it's also a job for medical practitioners, not psychiatrists and psychologists). Once the physical dependency has been treated, there is no difference between addiction to heroin, alcohol or nicotine, and addiction to gambling, shopping or the internet. Since the DSM is only concerned with mental issues, would you suggest that having a particular category for substance addiction is redundant and should just be included under behavioral addictions?

Is internet addiction being proposed for DSM V? Not that I'm aware.

nick_psych wrote:Of course providing the same treatment for different chemical addictions would not be helpful.But we have neither poker addicts nor roullete addicts. We have gambling addicts. So I have the impression that behavioral addictions associated with interactive divices (even in cases of gambling) may follow common behavioral lows that lead to repeated use.

Not at all - poker addicts and roulette addicts and horse racing addicts, all require different treatments and have slightly different mechanisms of action. The reason they are grouped together is because each problem is not prevalent and distinct enough to require its own category.

The problem is that you seem to be thinking that mental disorders are categorised according to their cause and mechanism. They aren't. They're categorised according to whatever seems to be useful.

nick_psych wrote:For example, are we able to know if television created any addictions? What about the video games? Cell phones? Are you sure that all these have nothing to do with each other? Personaly I believe in phenomena. I think the society is going itself to control with the internet use, as it is becoming one of the main means of everyday communication, work and life. Maybe television created such exacerbations but we are maybe anaware of it. I am sure there are people out there addicted to tv but I doubt that a mental health professional would characterise this person as addicted.

Of course people can become addicted to TV, and a psychologist would classify them as having a mental disorder if they were to ask for help.

nick_psych wrote:So my opinion is to wait for the society and the individuals to moderate their use of internet in their everyday life as it becomes more and more part of our lives. It is posible in ten years from now such phenomena connected to internet use will not exist.

Internet addiction will still exist in the future. It has nothing to do with how people generally use it, or overusing it, but rather overusing it in such a way that is damaging to their life. In other words, people who are on the internet for 20 hours a day, but hold down a job, maintain relationships with family and friends, and are happy with their lives, will not have an internet addiction. Addiction does not mean "using a lot of something".

nick_psych wrote:I suppose that EVERY behavior could become addictive.

Definitely.

nick_psych wrote:Some have commone factors of their couses, and I think that interactive divices, where emotional, cognitive and behavioral parts of our mental function are stimulated by them, are offered for further research. My point is that if we hash more and more the categorising of mental disorders we give a message to the industry and the society that thousands of different therapies for thousands of different disorders are needed.

Thousands of different therapies might be needed. But having a particular category for a disorder doesn't imply that. The therapy for depression and anxiety are the same - should we lump them into a single category? Having a particular category for a mental disorder helps us communicate a list of symptoms. No more, no less.

nick_psych wrote:So with no doubt, it could turn into a disorder. The problem is that we do not know that if the guilty here is the network or the whole mental activity being stimulated by divices that interact perfectly with the human mind.

This is the problem with your thinking, I think. If we were to include "internet addiction", it does not mean that the cause of the problem is the internet. It's simply a name to help us discuss the symptoms and issues related to addiction to the internet.