Expanding the definition of addiction: DSM-5 vs. ICD-11

Abstract

While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially 'addictive' qualities of repetitive behaviors, and whether such behaviors constitute 'behavioral addictions', is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, and compulsive sexual behavior, and problem internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of 'behavioral addictions' has been handled by latest revisions of the Diagnostic and Statistical Manual (DSM) and International Classification of Disease (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.

Naltrexone in the Treatment of Broadly Defined Behavioral Addictions: A Review and Meta-Analysis of Randomized Controlled Trials

“…Standardized mean difference estimates were calculated using Hedge's adjusted g . Heterogeneity was evaluated using the I 2 statistic and values >50% were considered as indicative of a large heterogeneity [6]. Funnel plots were used to calculate risk of bias and forest plots were generated to show standardized mean difference with 95% CI for each study.…”

“…They share many clinical characteristics and neurobiological underpinnings with substance use disorders (i.e., tolerance, withdrawal, and relapse) [5]. While pathological gambling was included in the addiction realm for Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), other behaviors such as kleptomania, hypersexual disorder, trichotillomania, skin picking disorder, compulsive buying, and impulse control disorder in Parkinson disease were not, as research on these disorders was deemed insufficient [6]. …”

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

“…The rationale for these recommendations is derived from in-depth scientific analysis coupled with multiprofessional clinical and public health experience, involving experts from over 25 countries; changes from the ICD-10 were debated in a series of workgroup meetings [97]. Indeed, discussion in the scientific literature has continued as emerging data suggests that, alongside the phenomenological and psychobiological overlaps between gambling and gaming disorders and disorders of substance addiction [98,99], including high levels of clinical comorbidity, overlaps are also to be found with certain impulse control disorders, such as kleptomania and compulsive sexual behaviour disorder, and obsessive-compulsive or related disorders such as trichotillomania and excoriation disorder [100,101]. Thus, as research grows and our understanding of these and other putative addictive disorders crystallizes, further revisions to some of these ICD sections may arise.…”

Sport und Leistung: Gibt es eine Sportsucht?

“…Solche Einzelfälle und Kohortenstudien gelten dabei als erste Hinweise auf eine "Sportsucht" [3,4] [5], welche zu den substanzungebundenen Suchtformen, die mit dem Überbegriff "Verhaltenssüchte" umfasst werden, gezählt werden kann und neben substanzgebundenen Süchten, wie Alkoholoder Heroinsucht, auftritt [6]. Offiziell wird nur Spielsucht in den internationalen Kompendien für Krankheiten (das ICD 11) und psychische Störungen (DSM 5) aufgeführt [7]. Andere Verhaltenssüchte wie Kaufsucht, Sexsucht oder Internetsucht werden noch nicht als Störungen anerkannt [8].…”