Current Psychiatry Reviews - Volume 8, Issue 4, 2012

Since the introduction of DSM-III in 1980 the prevalence of mental disorder increased dramatically. Recent figures suggest that about one third of youth and almost half of the adult population meet the criteria for at least one mental disorder in their lifetime. At least three interacting pressures contribute to diagnostic inflation of mental disorders: 1) the aggressive marketing strategies of drug companies, 2) reification of categories and 3) pressure on doctors. The diagnostic bubble will likely inflate further with the introduction of DSM 5 in 2013. This starts, firstly, with the editorial intention of moving to dynamic DSM-versioning, which would alter the relative contribution of editorial and empirical labor to shaping the DSM contents. Second, new disorders at the fuzzy boundary with normality will be introduced. And third, the diagnostic thresholds of many disorders will be lowered. Further expansion of diagnostic boundaries will add mostly to the already significant number of mild and threshold cases receiving treatment, leaving less time, money and effort for the severely ill.

The imprecise wording of DSM-IV led to an abusive use of the Paraphilia NOS diagnosis to hospitalize sexual predators for indefinite periods of time through Sexually Violent Predator statues. DSM-5 has threatened to compound the error of DSM-IV through the addition of three diagnosis that invite forensic abuse: ‘coercive paraphilia’, ‘hypersexuality’, and ‘hebephilia’. This article reviews that status of those three diagnoses, as well as the arguments for excluding them from the new manual.

Dimensional measures have certain advantages over categorical diagnosis of personality disorders, but suffer from problems of their own. The limitations of the proposed DSM-5 system are based on three doubtful assumptions: that disorders are nothing but exaggerated traits, that clinicians can make reliable and valid trait ratings, and that a highly complex system will have clinical utility.

DSM-5 is considering adding a diagnostic category for young people who may be at higher risk of developing schizophrenia. Changing what otherwise would be risk factors for a future disease onset into a disease into its own right would open up floodgates for inappropriate and potentially harmful exposure to antipsychotic medication. The “at risk” population would not benefit from receiving a formal diagnosis because the proposed criteria stipulate that the individual already has to be help-seeking and desire psychiatric treatment, so already by definition these individuals are receiving psychiatric services. The implication that presence of risk factors implies future disease is not supported in epidemiologic studies in that there is insufficient specificity or sensitivity. Including the proposed risk category into DSM-5 therefore violates the basic medical principle of “first do no harm.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most frequently used book in the mental health professions. Psychiatric and non-psychiatric mental health professionals alike have depended on the American Psychiatric Association (APA) to develop credible and sound manuals; however, the DSM-5's proposals to include potentially dangerous, scientifically unfounded diagnoses may lead professionals to question its integrity. This article will to describe the problems and controversies associated with the DSM-5, as well as provide recommendations to help restore confidence in the manual.

The draft DSM-5 proposes multiple new disorders, and broadens the diagnostic criteria of existing disorders. This will lead to inappropriate diagnosis, resulting in misallocation of healthcare resources, with inevitable opportunity costs. In particular, it will result in inappropriate and potentially harmful prescribing of antipsychotics and other psychotropic drugs. Among the disorders that are likely to be inappropriately diagnosed and treated are attenuated psychosis syndrome, autism, bipolar disorder, and attention deficit hyperactivity disorder. If the diagnosis of attenuated psychosis syndrome is included in DSM-5, this will result in substantial iatrogenic harm in the form of stigmatizing labelling and adverse effects of antipsychotic drugs. There is already evidence of diagnostic up-coding with autism and bipolar disorder, and this is likely to increase with the new broader diagnostic criteria. Furthermore, the broadening of diagnostic criteria to include subthreshold disorders will facilitate the increasing corporatization and siloization of mental health services which promote treatment of prodromal conditions and simultaneously reduce treatment access for people with chronic conditions. Misallocation of resources to such services will also lead to neglect of non-medical needs, including housing, employment, social and educational support. The authors of DSM-5 have good intentions, but they need to accept that their current proposals will have damaging unintended consequences. They should address the weaknesses of DSM-IV, not exacerbate them, both to prevent iatrogenic harm and to protect the future of the DSM.

Because illness is a social construction, doctors are inescapably agents of social control, and diagnoses are inescapably a means to exercise power. Psychiatric diagnoses therefore shape identity according to whatever ideology provides the definition of mental health and illness, and they do so with the authority of science. This function of diagnosis is ambivalent. A disease label can be a ticket to social resources, but it can also be a means of oppression, leading people to attribute external ills to internal problems such as "chemical imbalances." A DSM that acknowledges its shaky scientific foundation can minimize the harm of the latter, but only at the expense of its power to provide the former.

Problematic computer use is a growing social issue which is being debated worldwide. Internet Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems. Surveys in the United States and Europe have indicated alarming prevalence rates between 1.5 and 8.2% [1]. There are several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD [2-5], and some reviews [6-8] addressing the treatment of IAD. The aim of this paper is to give a preferably brief overview of research on IAD and theoretical considerations from a practical perspective based on years of daily work with clients suffering from Internet addiction. Furthermore, with this paper we intend to bring in practical experience in the debate about the eventual inclusion of IAD in the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Despite its unambiguous advantages, cellular phone use has been associated with harmful or potentially disturbing behaviors. Problematic use of the mobile phone is considered as an inability to regulate one's use of the mobile phone, which eventually involves negative consequences in daily life (e.g., financial problems). The current article describes what can be considered dysfunctional use of the mobile phone and emphasizes its multifactorial nature. Validated assessment instruments to measure problematic use of the mobile phone are described. The available literature on risk factors for dysfunctional mobile phone use is then reviewed, and a pathways model that integrates the existing literature is proposed. Finally, the assumption is made that dysfunctional use of the mobile phone is part of a spectrum of cyber addictions that encompasses a variety of dysfunctional behaviors and implies involvement in specific online activities (e.g., video games, gambling, social networks, sex-related websites).

Gaming addiction has become a topic of increasing research interest. The last decade has witnessed a significant increase in the number of empirical studies examining various aspects of problematic video game play and video game addiction. This paper begins with a brief past history of how research into video game addiction has changed over the last three decades (i.e., the 1980s, 1990s and 2000s). It then examines more thoroughly the contemporary research literature by analyzing the (i) prevalence of problematic video game use and video game addiction, (ii) negative consequences of excessive video game use, (iii) factors associated with problematic video game use and video game addiction, and (iv) the treatment of problematic video game use and video game addiction. The paper concludes by looking at the trends in the field and a somewhat theoretical examination of what the future of video game addiction might be.

Eating disorders and infertility are both common among women in industrialized countries, and eating disorders (most notably anorexia nervosa) have long been considered to significantly reduce fertility. Especially since eating disorders are often undiagnosed, routine screening has been widely suggested when infertile women present for investigation or treatment. This paper reviews fertility of women with current, or a history of, eating disorders. There is evidence that anorexia nervosa directly impairs fertility, but the situation is less clear for milder eating disorders. Fertility and the treatment of infertility are impaired by excessive weight, so any eating disorder that is associated with obesity will contribute to infertility. While previous screening studies of infertile women have suggested that eating disorders are common, there have been very few such studies and a total of less than 250 women have been screened. The paper summarizes logical criteria for routine screening and concludes that insufficient numbers of women have been scrutinised at present to know if this would be appropriate. If prevalence were found to be high then it may be deemed necessary to demonstrate that such women could be engaged in treatment for their eating disorders and perhaps also that this had a tangible effect in improving fertility rates before a strong case for routine screening could be argued.

Objective: To examine the role of attachment and mentalization in eating disorders, as investigated using the Adult Attachment Interview. Method: A review of literature has been conducted in the Medline, Psychinfo, Embase and Cochrane databases. Results: Ten empirical research articles were found. Outcomes show a higher frequency of insecure attachment classifications in patients compared to a non-clinical population. No correlations were found between specific insecure attachment classifications and specific eating disorder diagnoses or symptoms. Mentalizing capacity was found to be lower in eating disorder patients than in controls. Discussion: Different outcomes on the frequency of specific attachment classifications in patient groups might be due to differences in sample size and in co-morbidity. All studies were cross-sectional. Insecure attachment and low mentalization might call for specific therapeutic interventions. Longitudinal cohort research on the relation between attachment, mentalization, symptoms and treatment outcome of eating disordered patients is required.

The stress-vulnerability model of schizophrenia is contemporary psychiatry's common explanation of how the symptoms of schizophrenia develop and evolve over time. Although the model has variants, its fundamental tenets are that the onset and course of schizophrenia result from a person's vulnerability, usually argued to be genetic, in conjunction with sufficient stress, as experienced by that person. In this paper, we conduct a conceptual analysis and selective review of problems of the stress-vulnerability model of schizophrenia as currently formulated, and we argue that the model is not sufficiently helpful – appearances to the contrary – so long as these problems are not addressed. These conceptual problems involve the subjectivity of stress, the non-specificity of vulnerability, and the unclear distinction between stress and vulnerability. We suggest solutions to these problems, and in conclusion we generalize our findings, arguing that such problems can be resolved by general methodological considerations.