Should addictive disorders include non-substance-related conditions?

This article pertains to my exact question! Not exactly (but mentioned!) about trichotillomania in it’s entirety, this article asks the question, should non-substance-related disorders be considered addictive, or a SUD (substance use disorder)?

The main focus of this article pertains to PG (pathological gambling), which also happens to be an ICD (impulse control disorder) in the same classification as trich, as defined by the DSM (Diagnostic and Statistical Manual of Mental Disorders). Potenza states there would be both “pros” and “cons” to these definition changes in regard to ICD’s and other similar disorders. “There exist both pros (e.g. limiting confusion regarding the use of the term dependence—physical dependence versus DSM-defined, diagnostic dependence) and cons (e.g. the stigma generally associated with the term addiction) of making such a change”(Potenza 142). From my point of view the pros outweigh the cons. If a disorder shares the same characteristics as another it shouldn’t be categorized differently based on social stigma. These are medical issues that shouldn’t be viewed differently based on the views of society.

Potenza states, “One description of the core elements of addiction includes (modified from [3]): (1) craving state prior to behavioral engagement, or a compulsive engagement; (2) impaired control over behavioral engagement; and (3) continued behavioral engagement despite adverse consequences. If one adopts these components as core elements of addiction, other behavioral disorders, particularly those currently classified as impulse control disorders (ICDs), warrant consideration as addictions” (Potenza 143). Taking into consideration the substitution of “dependency” (as defined by the DSM) for “addiction,” the ICD category would most definitely be placed under the same grouping, as well as a list of other disorders. “Applying this definition, impulsivity has relevance to a broad array of psychiatric disorders including substance use, antisocial and borderline personality, bipolar, attention-deficit hyperactivity and impulse control disorders (ICDs) [7]”(Potenza 143).

“ICDs are currently grouped together in DSM-IV-TR in the category of ‘ICDs Not Else-where Classified’, and include pathological gambling (PG), kleptomania, pyromania, intermittent explosive disorder, trichotillomania and ICD not specified elsewhere”(Potenza 143). This alone should stand as proof that the means of classification could use a little adjusting.

What the entire situation seems to come down to is a “social stigma.” People are afraid, or ashamed, to be called an “addict,” or called out for facing addiction. The DSM even has a hard time using the word addiction, which leads to other, non-substance derived, disorders being placed in stupid categories like, “not else-where classified.”

“The current state of knowledge suggests that there exist substantial similarities between PG and SUDs. Further research is indicated prior to categorizing PG and other ICDs together with SUDs”(Potenza 142). After reviewing the article in its entirety, it’s clear that SUDs (substance use disorders), and ICDs (PG; most researched) are undeniably linked on a biochemistry, genetic, and environmental level. The only different feature seems to be a social understanding. Since this is a “new” approach to the categorization of these disorders it will probably take some time before any actual changes are made to the DSM. At the same time, for those that care to investigate it’s obvious that ALL of these disorders should be labeled as addictions.

Potenza, Marc N. "Should addictive disorders include non-substance-related conditions?" Addiction 101 (2006): 142-51.