Childhood Obesity News recently began discussing the fascinating evolution of the definition of pathological gambling according to the Diagnostic and Statistical Manual, commonly known as DSM-5. The definition has changed over the years as a result of much intellectual and political turmoil. The story of problem gambling is interesting to us because of the larger topic – the seeming arbitrariness of including some human malfunctions as official disorders while ignoring others. And of course there is the possibility that food addiction is a condition as disorderly as they come.
It is also significant because when we see how much discussion the gambling issue has inspired, and the changes the DSM-5 definition has gone through in this context, it opens up the likelihood that eating disorders are still being rethought and redefined in much the same way.
The National Center for Responsible Gaming (NCRG) reminds us that pathological gambling previously was classified under “Impulse Control Disorders Not Elsewhere Classified.” With the new edition, DSM-5, it graduated to the category of “Substance-Related and Addictive Disorders,” and the official description of its harmfulness is strangely reminiscent of the damage that can be done by untrammeled eating and the resulting obesity. Yet food addiction has not earned a spot in the lexicon of mental disorders.
Some researchers and clinicians disliked the old terminology, Pathological Gambling (PG), because pathological “is a pejorative term that only reinforces the social stigma of being a problem gambler.” Pathology just means a structural or functional deviation from the norm, which constitutes or characterizes a disease, and it seems appropriate, but apparently the colloquial usage of “pathological” has ruined it.
Another fascinating detail is that formerly, the clinical description of PG included a checkbox for illegal acts like embezzlement or forgery to acquire gambling stakes or pay gambling debts. Apparently, that kind of criminal behavior is so rare that its presence does not aid in making a diagnosis. The revised description in DSM-5, however, still mentions that illegal acts may be associated with this addictive disorder.
Other signs are frequent preoccupation with gambling and gambling as a response to feelings of distress. (Both of those things can be said of food addicts, but if the aberrant activity is just eating, it somehow doesn’t count.) There is also a time dimension. If four of the significant criteria are fulfilled, the diagnosis is made – but only if all four symptoms appeared during a 12-month period. The NCRG explains:
In other words, if the person had two symptoms years ago and two symptoms in the past year, he or she would not qualify for a diagnosis.
Dr. Pretlow is interested in all modalities that have been applied to any type of addiction, and expressed regret that the organizers of an international conference he once attended only seemed to focus on the “sexier” addictions like the Internet, gaming, gambling and, well, sex. One reason why this all matters is that methods that have been successful with other addictions have a good chance of being adaptable to treating food addiction.
Your responses and feedback are welcome!
Source: “The Evolving Definition of Pathological Gambling in the DSM-5
Image by Alan Cleaver