This document discusses proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) regarding addictive and impulse control disorders. It proposes moving pathological gambling from a category of "not otherwise specified" to a new "substance use and related disorders" section. It also discusses considering Internet gaming addiction and other putative behavioral addictions for inclusion. However, it notes limitations in the current research on these disorders and considerations required for including new disorders in the DSM.

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, Schizotypal
disorders" 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, possibly
Disorders" behaviors: In OCD, compulsions to trichotillomania, possibly
manage the resulting tension" hypochondria"
Substance use, addiction and Pathological reward-seeking. Imbalance Substance addictions, compulsive
related 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"

6. Symptom Changes"

7. 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 "

8. 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

9. Comorbidity PG-SUD
Petry, 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 studies
Considerations 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"

10. Prevalence rates of “gaming” addiction
*modified
Proportion of adolescents reporting DSM-IV
symptoms for Internet “addiction” (Ko et al., 2005)

11. 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.