Diagnostic And Statistical Manual Of Mental Disorders

Is the compulsion to hoard things a mental disorder? How about the practice of eating excessively at night? And what of Internet addiction: Should it be diagnosed and treated? As the clock ticks toward the release of the most influential of mental health textbooks, psychiatrists are asking themselves thousands of complex and sometimes controversial questions. The answers will determine how Americans' mental health is assessed, diagnosed and treated.

Is the compulsion to hoard things a mental disorder? How about the practice of eating excessively at night? And what of Internet addiction: Should it be diagnosed and treated? As the clock ticks toward the release of the most influential of mental health textbooks, psychiatrists are asking themselves thousands of complex and sometimes controversial questions. The answers will determine how Americans' mental health is assessed, diagnosed and treated.

Dave Taylor always knew his lust for playing "Fallout" and "Total Annihilation" bordered on the pathological. The video games would hold the West Hollywood software programmer in such a vise-like grip that he'd often play for 24-hour stretches, forestalling sleep, skipping meals and twisting himself in knots to delay bathroom breaks. "It's super unhealthy," he said. "But man, I'm just so swept away in another world and so focused on my goals that I don't care. It hurts to be away from the game."

Dave Taylor always knew his lust for playing "Fallout" and "Total Annihilation" bordered on the pathological. The video games would hold the West Hollywood software programmer in such a vise-like grip that he'd often play for 24-hour stretches, forestalling sleep, skipping meals and twisting himself in knots to delay bathroom breaks. "It's super unhealthy," he said. "But man, I'm just so swept away in another world and so focused on my goals that I don't care. It hurts to be away from the game."

Patients walk into Peter Breggin's office and lay their diagnoses on the couch: They're depressed. They're anxious. They're sure they have a measurable, palpable illness, with shape, substance, gravity, consistency. "A little boy came in with his parents and I asked him: 'Do you know why you're here?' " Breggin says. " 'Yes. I'm here because you're the doctor who doesn't believe I should take Ritalin for my ADHD (attention deficit-hyperactivity disorder).'

The final straw for Carolyn Alves came last fall when she tried to help her daughter Cecelia dress for kindergarten. The volatile 6-year-old had worked herself into a frenzy as she tried on outfit after outfit, rejecting each as unacceptable. The tantrum at full bore, she scooped up a pile of clothes and hurled them at the front door of the family's Spanish-style bungalow in Glendale. The clock ticked past the school's 8 a.m. bell. Alves pulled her wailing child into her arms and held her on the couch.

For New York City resident Esperanza Muñoz, the attack on the World Trade Centers is not over 10 years later — not by a long shot. At odd moments, the stench of death still rises to her nose, and the 55-year-old woman slides into a haze of nausea and tears. She suffers headaches and is awakened several times a week by nightmares of headless bodies and shoes with bits of feet left inside. She dreads the sound of sirens or a passing plane. Muñoz lives in the New York City borough of Queens, and can't — or won't — go into Manhattan, even to attend her support group for Latinas still scarred by the events of Sept.

They are some of the most troubled children that psychiatrists ever see. They have raging tempers and engage in reckless behaviors that frequently land them in the principal's office, even the hospital. But are they bipolar? In the last 15 years, diagnoses of bipolar disorder in children have skyrocketed as much as fortyfold, according to some estimates. The condition — defined by severe mood swings, between depression and mania, lasting for weeks or month at a time — has traditionally been considered a lifelong condition in adults and is treated through tranquilizers and antidepressants.

Several types of personality disorders will be dropped from the next edition of the Diagnostic and Statistical Manual of Mental Disorders. But one disorder previously proposed for elimination -- narcissistic personality disorder -- will likely remain in the text. The American Psychiatric Assn. announced Thursday that the framework for personality disorders in DSM-5 will be a "hybrid" model that is substantially different from how personality disorders are diagnosed currently. Under the new system, personality disorders will be aligned with particular personality traits and levels of impairment.

Jon Ronson is fascinated by people who are bonkers. And insane people who appear to be normal, and ostensibly sane people doing crazy things. The British journalist's book "The Men Who Stare at Goats" — about a secret U.S. military wing that hoped to use mind power to walk through walls, become invisible and perform psychic executions — was the basis for the 2009 film of the same title. Now, Ronson's paddling around the swampy parts of sanity again in "The Psychopath Test," a book that manages to be as cheerily kooky as it is well-researched.

Patients walk into Peter Breggin's office and lay their diagnoses on the couch: They're depressed. They're anxious. They're sure they have a measurable, palpable illness, with shape, substance, gravity, consistency. "A little boy came in with his parents and I asked him: 'Do you know why you're here?' " Breggin says. " 'Yes. I'm here because you're the doctor who doesn't believe I should take Ritalin for my ADHD (attention deficit-hyperactivity disorder).'

This is yet one more odd, albeit normal behavior that has been voted as a new mental illness by the psychiatric money machine ["A Tanning Addiction?" Aug. 23]. And, of course, the only "valid" treatment for mental illness is to drug the patient. How long are reasonable people, both in the medical profession and not, going to continue to allow the sham of DSM IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] to be shoved down our throats by the psychiatrists? Enough already!

About hypersexual disorder Psychiatrists have proposed adding hypersexual disorder to the next edition of the Diagnostic and Statistical Manual of Mental Disorders. A description of the disorder includes having four or more of the following criteria over at least six months. The symptoms must be severe and not caused by something else, such as drug abuse or medication. A great deal of time is consumed by sexual fantasies and urges and by planning for and engaging in sexual behavior.