Sex addiction sells – for the drug industry

Latest psychiatrist's bible is criticised for pathologising people's everyday habits

Health Editor,Jeremy Laurance
Friday 12 February 2010 01:00
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This may come as unwelcome news to the millions of men who, surveys suggest, think about sex at least once every 20 minutes: you may be suffering from "hypersexual disorder".

It is also likely to irritate the millions of women who feel grumpy at a certain time of the month: you may be labelled with "pre-menstrual dysphoric disorder".

The latest edition of the psychiatrists' bible – the fifth Diagnostic and Statistical Manual of Mental Disorders, or "DSM 5" – is already drawing flak for pathologising behaviour which many doctors regard as part of ordinary life.

The first complete revision of the manual since 1994, DSM 5 was unveiled by the American Psychiatric Association this week. It is used principally in the US, but its influence is felt in Europe and beyond, where the equivalent tome, the International Classification of Diseases, or ICD, is being updated. Critics fear it could increase the numbers diagnosed with mental illness and treated with powerful psychotropic drugs, as well as subtly shifting perceptions of what it is to be normal.

Other new diagnostic labels include "binge-eating disorder", "gambling addiction", and "internet addiction". Some of the most controversial involve the extension of adult diagnoses to children, such as "psychosis-risk syndrome", for people who have mild symptoms of suspicion or delusions. Early diagnosis can improve outcomes, but there will always be adolescents whose ideas are a little odd.

Peter Tyrer, professor of psychiatry at Imperial College London and chair of the working group leading revision of the ICD on personality disorder, said: "The joke about the DSM is that it doubles in size each time it is revised so everyone is pathologised in time. I call hypersexual disorder the Bill Clinton Syndrome. If you are really going to pathologise men who can't stop thinking about sex, that is going to be an awful lot of people. Similarly with pre-menstrual dysphoric disorder – it is likely to affect 50 per cent of women of child-bearing age."

The revised DSM 5, which is in draft form and subject to review, has involved more than a decade of work by hundreds of experts. Professor Tyrer said: "They promised to include only disorders with a proper basis in biology. They have abandoned that entirely now. The scope has widened further than ever despite the concern that we are medicalising far too many conditions."

Critics say the manual's expansionist tendencies are driven in part by the pharmaceutical industry, always on the lookout for new indications for its costly drugs. A swath of US academics in receipt of undeclared funds from the drug industry have recently been revealed, and several high-profile names have been suspended.

Tim Kendall, the deputy director of research at the Royal College of Psychiatrists, said: "If DSM 5 comes up with a new category like hypersexual disorder, quite often it has an influence here. We know that shortly after a new category of disorder is developed, companies come in with a drug to treat it.

"You can characterise almost any behaviour as a psychiatric problem. But it should only receive a diagnosis if it impairs your ability to lead the life you want to live."

The psychiatrists' bible: Diagnosed 'disorders'

Hypersexual disorder

Over a period of at least six months, recurrent and intense sexual fantasies and sexual urges, unsuccessfully controlled while disregarding the risk of physical or emotional harm.

Binge-eating disorder

Recurrent episodes of binge eating more than most people would consume, rapidly, with lack of control until uncomfortably full followed by feelings of distress or guilt.

Temper dysregulation disorder with dysphoria (in children)

Verbal rages or physical aggression, grossly out of proportion to the provocation, three or more times a week with persistent angry or sad mood.

Psychosis risk syndrome

Delusions, hallucinations, disorganised speech in mild form but beyond normal variation, at least once a week, which are getting worse and causing sufficient distress to seek help.

Pathological gambling (Re-classified from Impulse Control Disorders to Substance-Related Disorders)

Preoccupied with gambling, needing increasing amounts of money for the same level of excitement, unsuccessful efforts to control or cut back, lies to family members.

Minor neurocognitive disorder

Evidence of minor cognitive decline from a previous level of performance or in comparison with people of similar age, gender and education which are not sufficient to interfere with independence, but greater effort and compensatory strategies may be required.

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