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Mental health nurses need to follow the guidelines for diagnosis and treatment outlined in national and international manuals. However, in some cases, the information in these sources does not cover the condition that the patient may have (Petry, Zajac, & Ginley, 2018). For example, the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes only one non-substance-related addictive disorder – gambling disorder (Mann, Fauth‐Bühler, Higuchi, Potenza, & Saunders, 2016).
According to the authors, other “groups of repetitive behaviors … are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria” (American Psychiatric Association, 2013, p. 481). At the same time, there exists a multitude of cases of other behavioral addictions that mental health nurses have to diagnose to help their patients (Potenza, 2014; Saunders, 2017). Thus, it becomes clear that mental health nurses have to use the DSM-5 as a framework for addressing behaviors that may not be included in the current edition.
DSM-5 and Behavioral Addiction
The addition of gambling as the only type of addictive disorder has been widely discussed in recent scholarship. Along with analyzing how the patterns, signs, and symptoms presented for this condition can be used for other behavioral addictions, scholars also debate the limits between simple repeating behaviors and a mental health problem. Such examples as internet use, gaming, exercising, eating, tanning, and sex are among the most researched topics in this field (Chen, 2016; Kuss, Griffiths, & Pontes, 2017; Lemeshow et al., 2018; Poli, 2017; Stapleton et al., 2016; Van Gordon, Shonin, & Griffiths, 2016).
In their works, most researchers rely on the information outlined in the DSM-5 to describe their type of behavioral addiction. Grant and Chamberlain (2016) argue that the limitations of using one diagnostic system do not allow one to consider all aspects of a patient’s environment, leading to the homogenization of the diagnostic process. Thus, another question arises of how nurses should approach a situation where a person presents with indicators of a behavioral addiction that does not fall into the strict definitions of the DSM-5.
Diagnosis: Nursing Role
The role of the nurse in the diagnostic process is crucial, thus requiring these clinicians to be prepared for cases that do not fully resemble the guidelines in the DSM-5. Van Gordon et al. (2016) present the case study of a patient with sex addiction, which is not currently recognized by the DSM-5. The authors acknowledge this fact but argue that other disorder classification organizations present findings supporting this diagnosis.
Thus, the healthcare provider had to use a different screening test to help the diagnosis of sexual addiction and base the patient’s treatment on the results of it. Here, the DSM-5’s lack of data about behavioral addiction is supplemented with other screening tests’ and the clinician’s knowledge of other classification recommendations (Wery et al., 2016). Furthermore, such studies serve as arguments for adding new disorders to the future version of the manual.
A different case looks at the highly-debated problem of internet gaming disorder that is currently under further investigation in the DSM-5. The manual does not have enough information to add this condition to the list of behavioral addictions. However, researchers focus on another issue of nurses having to distinguish between gamers with a healthy habit and an addiction (Starcevic & Aboujaoude, 2017). Kuss et al. (2017) and Deleuze et al. (2017) find that the outdated definition is detrimental to mental health nurses’ ability to diagnose and treat addiction properly. In this case, the lack of specificity is one of the major concerns. Health care providers cannot fully use their experience to explain which of the aspects of gaming constitute a foundation for the diagnosis.
Another type of behavioral addiction is related to food. Although eating disorders are a part of the DSM-5, addictive food consumption is distinguished by some researchers as a separate mental health problem. Schulte, Potenza, and Gearhardt (2017) use the framework proposed for diagnosing gambling disorder on food addictive-like behaviors. They discover that this particular condition lies on the border between substance and non-substance use disorders as food often has addictive qualities, and eating is a process with the risk of unhealthy repetition.
The combination of substance abuse and behavioral addiction is another point that is widely debated to be recognized in the DSM-5 (Konkolÿ Thege, Hodgins, & Wild, 2016; Starcevic, & Khazaal, 2017). Wieland (2019) argues that nurses have to consider this diagnosis using the Yale Food Addiction Scale (YFAS) and focus on the behavioral patterns of their patients.
Relevance to Contemporary Mental Health Nursing
The research described above shows that the lack of information about behavioral addiction in the DSM-5 does not represent the amount of research and case studies that analyze the various types of this problem. Mental health nurses have to acknowledge that the manual may not have guidelines for every patient’s unique situation. A modified treatment approach and a broader scope of resources for the diagnosis are essential for nurses to provide patients with high-quality care (Constantino, 2016; Starcevic & Khazaal, 2017). Moreover, this discussion shows that nurses have to engage in continuous education to understand the complexity of patients’ environments, behaviors, and thoughts.
DSM-5 is a manual that presents mental health nurses with a plethora of guidelines for diagnosing and treating mental disorders. However, it cannot fully represent the scope of problems due to the lack of consistent research findings. It is crucial for nurses to continuously broaden their knowledge about behavioral addictions – a topic underrepresented in the DSM-5. This may help them to deal with unique cases of non-substance addiction and advocate for patients whose conditions are difficult to categorize.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C.: American Psychiatric Publishing.
Chen, W. J. (2016). Frequent exercise: A healthy habit or a behavioral addiction? Chronic Diseases and Translational Medicine, 2(4), 235-240.
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Deleuze, J., Nuyens, F., Rochat, L., Rothen, S., Maurage, P., & Billieux, J. (2017). Established risk factors for addiction fail to discriminate between healthy gamers and gamers endorsing DSM-5 Internet gaming disorder. Journal of Behavioral Addictions, 6(4), 516-524.
Grant, J. E., & Chamberlain, S. R. (2016). Expanding the definition of addiction: DSM-5 vs. ICD-11. CNS Spectrums, 21(4), 300-303.
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Schulte, E. M., Potenza, M. N., & Gearhardt, A. N. (2017). A commentary on the “eating addiction” versus “food addiction” perspectives on addictive-like food consumption. Appetite, 115, 9-15.
Stapleton, J. L., Hillhouse, J. J., Turrisi, R., Baker, K., Manne, S. L., & Coups, E. J. (2016). The Behavioral Addiction Indoor Tanning Screener (BAITS): An evaluation of a brief measure of behavioral addictive symptoms. Acta Dermato-venereologica, 96(4), 552-553.
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Van Gordon, W., Shonin, E., & Griffiths, M. D. (2016). Meditation awareness training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5(2), 363-372.
Wery, A., Vogelaere, K., Challet-Bouju, G., Poudat, F. X., Caillon, J., Lever, D.,… Grall-Bronnec, M. (2016). Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic. Journal of Behavioral Addictions, 5(4), 623-630.
Wieland, D. M. (2019). Food addiction: A new mental health disorder? Journal of Psychosocial Nursing and Mental Health Services, 57(12), 3-5.