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2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
2010 Conference - Proposed Changes for DSM-V (O'Brien)
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2010 Conference - Proposed Changes for DSM-V (O'Brien)

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  • 1. Charles P. OʼBrien, MD, PhD" University of Pennsylvania"DIAGNOSTIC & STATISTICAL MANUAL Edition" Year" Pages" Categories" I" 1952" 132" 106" II" 1968" 119" 182" III" 1980" 494" 265" III-R" 1987" 567" 292" IV" 1994" 686" ~300" V" 2013" -" -"
  • 2. Criteria should be" •  For Clinicians •  Easy to Use •  Reliable & Valid •  Good Coverage PHILOSOPHY"•  Decide Using Data•  Change When Justified•  Base Decision On: Value Added Cohesive Structure Coverage
  • 3. Proposed DSM-5 " Clustering"Neurodevelopment disorders" Developmental impairments in cognition Autism, Learning Disabilities, or social cognition" Intellectual Disability"Neurocognitive disorders" Dementias, Delirium"Schizophrenia and related Schizotype with or without psychosis" Schizophrenia, Schizotypaldisorders" personality disorders, some nonaffective psychoses"Mood Disorders" Predominant disturbance of mood Depression, GAD, Bipolar disorder" regulation"Anxiety Disorders" Predominent dysregulation of fear" Panic disorder, social phobia, simple phobias, PTSD"Obsessive Compulsive Unwanted intrusive thoughts or motor OCD, Touretteʼs, BCC, possiblyDisorders" behaviors: In OCD, compulsions to trichotillomania, possibly manage the resulting tension" hypochondria"Substance use, addiction and Pathological reward-seeking. Imbalance Substance addictions, compulsiverelated disorders" between reward circuitry and cognitive gambling, possibly other compulsive control (PFC)" behaviors"Impulse Control Disorders" Pathological failure to control ADHD, CD, ODD, Intermittent inappropriate cognitive, emotional, or explosive disorder; perhaps behavioral responses" paraphilias; perhaps binge eating"Somatic Disorders" Eating, Sleep, Sexual, Somatic Disorders"Personality Disorders"
  • 4. Symptom Changes"
  • 5. Craving" Gambling"•  Move pathological gambling from ICD- not otherwise specified to a “substance use and related disorders” section."•  Change the name of the disorder (e.g., “disordered gambling”)."•  Reduce the threshold to 4 of 9 criteria and eliminate the legal criterion item "
  • 6. Other putative “addictions” ! •  Internet Addiction (insufficient data) " •  Sexual (sexual use disorders committee is evaluating; not sufficient evidence that it is similar to other non- substance related addictions)" •  Eating (some overlap with substance use disorders and putative associations with eating disorders)" •  Shopping (some empirical data available)" •  Work (minimal data available)" •  Exercise (minimal data available)" Addiction: A Brain Disease•  Genetic vulnerability, e.g. 40-80% heritability•  Biological risk factors, e.g. anhedonia•  Brain abnormalities, e.g. low DA density NcA•  Effective neurobiological interventions
  • 7. Comorbidity PG-SUDPetry, 2007•  >25% of treatment-seeking pathological gamblers also have a substance use disorder•  5-20% of treatment-seeking substance abusers also have pathological gambling (LTPcommunity 0.4-2%)•  General population studies also show high rates of PG-SUD comorbidity•  US and non-US studiesConsiderations for including new disorders in DSM-V "•  A clinical need"•  Sufficiently distinct from other disorders"•  Potential harm (to other patient or non- patient groups)"•  Potential for treatment"•  Meets criteria for a mental disorder"
  • 8. Prevalence rates of “gaming” addiction *modified Proportion of adolescents reporting DSM-IV symptoms for Internet “addiction” (Ko et al., 2005)
  • 9. Limitations! Usually non-random convenience samples (school surveys or on-line respondents, with limited representation of middle or older aged adults).! Response biases.! Different instruments with limited psychometric testing (Buyn et al., 2009).! Lack of a general agreement as to what constitutes Internet/gaming addiction.

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