More DSM-5 Oddities

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In a couple of Childhood Obesity News posts last week, we asked the following question about the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): while other, similar disorders are included in the manual, how did food addiction get left out? Binge Eating Disorder has the Feeding and Eating Disorder category all to itself – while food addiction receives nary a mention! Really, is this fair?

We recalled how most people who are unable to control their eating, are pretty much captivated by one problem food, or a handful of them. So when we say “food” we are not talking about all foods (where are the broccoli fiends?) or even one particular kind. For the purpose of this discussion, “food” is whatever a patient (or worse yet, not even a patient, but just a troubled person running around at large) finds heinously irresistible.

The Disorder of Gambling

Even gambling shows up in DSM-5 with a fancy title – it’s a “Non-Substance-Related Disorder,” and it’s the only one of those, but subsumed into a larger category called “Substance-Related and Addictive Disorders.” We will call this category SRAD for short. All the other disorders in the SRAD category are based on substances – alcohol, caffeine, cannabis, hallucinogens, inhalants, opiods, sedatives, stimulants, and tobacco. Since gambling is not substance-related, it must then logically be the titular Addictive Disorder.

So, gambling is just off-handedly granted addictive status, while food addiction, which has been struggling for years to be recognized, is ignored. But that’s not all. The SRAD category adopted every stray dog on Addiction Street by including “Other or Unknown Substance-Related Disorders,” a real slap in the face to food addiction, which was not mentioned at all.

Then the SRAD category went ahead and shoe-horned in a disorder that isn’t even about any substance: gambling. Elsewhere in the book, even Binge Eating Disorder was allowed through the gate, as a Feeding and Eating Disorder. Of course, there was no mention of food addiction in that neighborhood, either. The compilers of the book wrote,

Many scientists and clinicians have long believed that problem gamblers closely resemble alcoholics and drug addicts….

They had the nerve to say such a thing, and yet totally ignore the overwhelming resemblance between overeaters and people addicted to alcohol and drugs. They say gambling is a behavior that has common elements with substance use disorders. What about the fact that food addiction also has common elements with substance use disorders? First of all, food is a substance, which gambling is not. And yet food, a perfectly tangible substance if ever there was one, was not invited to the ball.

Your responses and feedback are welcome!

Source: “DSM-5 Table of Contents
Psychiatry.org, 2013
Image by David Stanley

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