DSM-5, Scientific Advances, and the A-Word

Don't tell your mother

For members of the Task Force concerned with the conceptual evolution of DSM-5 (Regier, Narrow, Kuhl, and Kupfer), the primary goal was “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” This is where we return, as promised, to the words of Prof. Graham Davey:

DSM-5 has continued the process of attempting to align its diagnostic criteria with developments and knowledge from neuroscience, when there is in fact very little new evidence from neuroscience that helps define specific mental health problems…

What? What was Dr. Davey thinking? Since the previous edition of the Diagnostic and Statistical Manual came out in 1994, the advances in neuroscience have been enormous. That was, after all, almost 20 years ago. Surely one of the more attention-getting obesity news events of 2011 was the publication of “Neural Correlates of Food Addiction,” in which brain scans showed:

Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake.

In other words, when you put certain people into MRI machines and tell them to think about milkshakes, their brains light up just like those of cocaine addicts contemplating their drug of choice. This was big news!

That study, and subsequent brain-scan explorations, have undeniably sparked discussion about the validity of the food addiction paradigm. In laboratories from coast to coast, lab rats have shown neuronal changes and addiction-like behaviors. Study authors Adrian Meule and Ashley N. Gearhardt wrote:

This increased scientific interest in this topic was in part driven by the rise of neuroimaging and subsequent findings that obesity and binge eating are associated with alterations in dopaminergic signaling and food-cue elicited hyperactivation of reward-related brain areas which are comparable to processes seen in drug users.

How did the DSM-5 Task Force, or Dr. Davey, or anyone, manage to hold onto a notion that the advances in neuroscience in the last 20 years have been negligible or nonexistent? Actually, the newest edition does acknowledge that the hallmark of addiction is the activation of the brain’s reward system, though it does this without using the word “addiction.” Medical writers interpret freely and just kind of work around it. This example is from addiction expert Elizabeth Hartney, PhD, specifically outlining “DSM 5 Criteria for Substance Use Disorders”:

While the pharmacological mechanism for each class of drug is different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

Another example is from TranscendRecoveryCommunity.com:

The DSM explains that the activation of the brain’s reward system is the key to drug abuse problems. Once the cycle of addiction activates the internal reward system, a rush in the brain, that behavior can become the sole focus of one’s life to the exclusion and detriment of other life-activities.

Your responses and feedback are welcome!

Source: “Changes in DSM-5,” Blogspot.com, 02/13/13
Source: “Neural Correlates of Food Addiction,” YaleRuddCenter.org, 04/04/11
Source: “Food addiction in the light of DSM-5,” NIH.gov, 09/06/14
Source: “DSM 5 Criteria for Substance Use Disorders,” About.com, 09/03/14
Source: “From Addiction to Recovery: Learning Leads the Way,” TranscendRecoveryCommunity.com, 05/14/14
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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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