Saturday, 5 April 2014

Behavioural Addictions - A Medicalisation of Normality?

A topic I've recently been studying in my tutorials at uni is the neural basis of addiction. The part of this topic I found most interesting was behavioural addiction – as opposed to a chemical or substance based addiction.

A behavioural addiction is one where the sufferer is not addicted directly to a substance, but more to the feelings or behaviour that are brought about by carrying out a relevant action. They feel a compulsion to carry out addictive behaviours that usually come with a fast reward feedback loop (such as gambling or video gaming). I also thought it was interesting that the sufferer of a behavioural addiction feels that by carrying out this action they are satisfying a want (as opposed to someone suffering from Obsessive Compulsive Disorder, who feels they are satisfying a need).

A thought-provoking part of this topic is the controversy that surrounds it. Some experts say that behavioural addictions should not be considered “real” addictions. They have only recently been included in the DSM (Diagnostic and Statistical Manual of Mental Disorders), which was met with debate. Some say this may lead to the medicalisation of normality. In other words, eventually clinicians would be able to diagnose anyone with a “passionate interest” as someone with a psychiatric illness. Following the criteria to diagnose a behavioural addiction, it would be plausible to say you or I had an addiction to breathing or eating, even though these are fundamental human traits.

Professor Allen Frances was Chair of the DSM-IV task force, but strongly rejects the idea of including behavioural addictions in the DSM-V. He speculates that a problem with diagnosis of behavioural addictions is the fact that as humans we have an endogenous need to seek pleasure and reward. He states that this will lead to a diagnosis of “anything that people do for fun but causes them trouble”.

However, there is some evidence to suggest that the inclusion of behavioural addictions in the DSM-V will not lead to a descent into a society where everyone is labelled with an addiction. An article by Dr Hilarie Cash states that the results of research into behavioural addictions show that it is completely different to a passionate interest in something. The neurobiology suggests that there are similar chemical mechanisms at fault in those with behavioural addictions, as with those suffering from substance-related addictions.

Despite this, the DSM-V (published in 2013) did not include behavioural addictions. The DSM-V stated this was because “.there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviours as mental disorders”. The controversy continues.

What do you think? Feel free to comment below and let me know!

Professor Frances’s article,”Do We All Have Behavioural Addictions?”:

Dr Hilarie Cash’s article, “Why Is It So Hard to Believe in a Behavioural Addiction”:


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