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For the first time, Binge Eating Disorder has a chance of being included as a diagnostic category in the main body of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The new category is proposed to be included in the proposed Eating and Feeding Disorders, rather than the new Addictions and Related Disorders category, which is planned to replace the Substance Related Disorders category.

It is good news that Binge Eating Disorder is being considered, as the Eating Disorders category has previously been dominated by the focus on conditions characterized by under-eating rather than over-eating.

Yet I wonder how well Binge Eating Disorder will fare in this category, and whether the new Behavioral Addictions section of the Addiction and Related Disorders category would be a better place for Binge Eating Disorder, under a different label, such as “Food Addiction.” Although a disorder of eating, a key characteristic it shares with other behavioral and substance addictions is perceived lack of control.

In contrast, Eating Disorders such as Anorexia Nervosa and Bulimia Nervosa are characterized by attempts to exert excessive control.

What do you think? You can post comments here, but more effectively, you can give your comments directly to the DSM working group, who will be taking comments from the public for the next few months.

Binge Eating Disorder Proposed For DSM-V originally appeared on About.com Addictions on Sunday, February 14th, 2010 at 15:52:54.

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The long-awaited proposed criteria for the next edition of the Diagnostic and Statistical Manual (DSM), due to be published in 2013, have been revealed, and are available for public viewing and commentary online.

Fundamental changes to the way that addictions are categorized are proposed, including:

• A shift in focus from “dependence,” which is proposed to refer exclusively to physiological dependence as a normal process, to “addiction,” which is proposed to refer to “compulsive, out-of-control” behaviors.
• A move towards including behavioral addictions, such as gambling and internet addictions.
• Re-naming the “Substance-Related Disorders” category “Addiction and Related Disorders,” a move which reflects both of the above changes.

These are very positive changes. In addition, I applaud the DSM working group for recognizing the difficulty that the past focus on substance dependence has caused for both physicians and their patients, particularly when the prescription of dependence-causing drugs is involved. They even give examples of scenarios where patients in severe pain are denied adequate doses of drugs such as opioids, beta-blockers, antidepressants, anti-anxiety agents and other drugs which may cause tolerance and withdrawal without addiction, because of fear on the part of the physician of producing “addiction” in these patients .

Great news for people who need prescriptions for potentially dependence-forming drugs!

Sex addiction is not included in this category, although Hypersexual Disorder, which refers to “out-of-control” sexual behavior, including cybersex, is proposed to be added to the Sexual and Gender Identity Disorders category.

Nor is food addiction included in the Addictions and Related Disorders category, although given the problem of widespread obesity and related problems, I am pleased to see Binge Eating Disorder is proposed to be promoted from the appendix of the manual to a specific diagnostic disorder.

The DSM working group also invites feedback, so if you are affected by addictions, or care about those who are, now is the time to have your say.

Diagnostic and Statistical Manual Changes Proposed For Addictions originally appeared on About.com Addictions on Wednesday, February 10th, 2010 at 19:00:40.

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Smoking, as everyone knows by now, takes a serious toll on health. So when you decide to quit smoking, it can be a great time to think about making changes to your diet. One of the payoffs of smoking is enhancement to your senses of taste and smell, which can make food more pleasurable than it was when you were smoking, but to avoid weight gain and substitute addictions to food or drink, a healthy diet is essential.

A diet containing the full requirements of vitamins and minerals is essential for health, but may be more important during the period of recovery after smoking, as the body repairs the damage done. Research indicates smokers have lower vitamin C levels than non-smokers and ex-smokers, yet this vitamin is also needed to repair the damage caused by cigarettes. There is also speculative and anecodotal evidence that vitamin B3 or niacin is particularly helpful in reducing the cravings and irritability associated with quitting smoking, so you may want to increase foods containing this vitamin while quitting.

Check with your doctor that you can do this safely, and remember, too much can also be harmful, so don’t overdo any particular nutrient though diet, supplements or both. Excessive amounts of niacin can cause liver damage, and excessive amounts of vitamin C can cause diarrhea or loose stools.

Foods Rich in Vitamin B3 (Niacin)

Adults need about 14-16mg of niacin per day in a regular diet, and you should not take more than 35 mg per day, including dietary and supplemental intake. Examples of foods commonly cited as being a rich source of niacin are given below, showing the amount of niacin per 100grams. This allows you to compare the amount of niacin across foods, but bear in mind, a typical serving of one food, such as chicken, may be a different size from a typical serving of another food, such as sesame seeds.

Niacin is found in poultry, fish, and lean meats. Some authors also cite dairy products and eggs as sources of niacin, but if you look up the actual amounts contained in different foods, for example, on NutritionData.com, the amounts are negligible compared to meats sources.

• Chicken: 14.8mg/100grams
• Canned tuna: 13.3mg/100grams
• Turkey: 9.1mg/100grams
• Steak: 4.2mg/100grams
• Cheese: 0.1mg/100grams
• Egg: 0.1mg/100grams

Vegans and Vegetarians

Vegans and vegetarians can get their supply of niacin through nuts and legumes. As with non-vegetarian foods, there is wide variation among the foods that are cited as containing niacin. Enriched breads and cereals are also a potential source of niacin.

• Bran flakes: 70mg/100grams
• Cheerios: 69mg/100grams
• Corn flakes: 66.7mg/100 grams
• Peanuts: 13.5mg/100grams
• Sesame seeds: 4.5mg/100grams
• Almonds: 3.7mg/100grams
• Soymilk: 3mg/100grams
• Split peas: 3mg/100grams
• Lentils: 2.6mg/100grams

A variety of processed meat substitutes contain high amounts of niacin – check the nutritional information label on the packaging for specific amounts.

Although beer also contains niacin, among other nutrients, it only contains about 1.8 mg per 12 oz serving, so you would be risking alcohol-related problems if you attempted to obtain sufficient niacin through beer-drinking. Alcohol-reduced beer is an option, but again, you would have to drink a lot of it to get your daily niacin requirements.

Foods Rich in Vitamin C

Adults need about 75-90mg of vitamin C per day in a regular diet, and you should not take more than 1800 to 2000mg per day, including dietary and supplemental intake.

The main sources of vitamin C are non-problematic for most people, as fruit and vegetable are rich in this important nutrient. But as with other nutrients, the actual amount you get can vary greatly. Here are some examples:

A Vitamin-Rich Diet While Quitting Smoking originally appeared on About.com Addictions on Monday, February 8th, 2010 at 01:26:58.

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Many readers of the addictions guidesite will have had personal experience of discrimination within the healthcare system. People with addictions are among the most stigmatized of all patient groups, and drug users in particular, suffer from the judgements of health professionals.

Sometimes, this is a result of prejudice or ignorance. Sometimes, it is the result of self-interest. And sometimes, it is the result of financial pressures from within the healthcare system that provides care.

In the past, I have blogged about this phenomenon, asking the question: “Do only nice people deserve drugs?” Ironically, it is typically the physician that starts the patient on this process of addiction, offering pain medications rather than multidisciplinary treatment in a pain clinic to manage pain. When a patient moves from being a “deserving pain patient” to a “drug-seeking addict,” they may be cut off from access to drugs, such as painkillers, that they have become emotionally and physically dependent on. This observation isn’t anecdotal, it’s based on research with physicians.

OK. That’s the reality. We are all human, and even doctors make mistakes. But now the College of Physicians is attempting to legitimize discrimination by doctors by changing the fundamental principles on which medical practice is based.

Shrouded in the apparently well-meaning term of “social justice,” Dr Rich, a staunch advocate for patients’ rights argues that this amounts to rationing of healthcare resources. This rationing will be at the discretion of the healthcare provider. So now, instead of being a human failing on the part of the individual physician, discriminating against patients will be an accepted part of medical practice.

This issue, and it’s implications for patients, is very clearly explained by Trisha Torrey, About.com’s Patient Empowerment Guide.

Have you suffered from discrimination by a healthcare professional? Share your comments here.

American College of Physicians Legitimizes Discrimination originally appeared on About.com Addictions on Tuesday, February 2nd, 2010 at 17:39:14.

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According to an article in the UK’s Guardian newspaper, Broadway Lodge in Weston-super-Mare is the first clinic in the UK to offer treatment to people with video game addiction. Read more…

UK Clinic First to Welcome Gaming Addicts originally appeared on About.com Addictions on Thursday, January 28th, 2010 at 20:42:55.

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I was recently talking to someone who quit smoking for her New Year’s Resolution. She was constantly craving cigarettes and was “beyond irritable.” Read more…

Nicotine Cravings and Vitamin B Complex originally appeared on About.com Addictions on Friday, January 22nd, 2010 at 13:27:52.

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According to CBC news, North America’s first safe injection site, known as Insite, has officially won the right to keep operating in Vancouver BC.

The safe injection site has been controversial since it first opened it’s doors Read more…

Insite Drug Injection Site Wins originally appeared on About.com Addictions on Monday, January 18th, 2010 at 00:48:45.

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According to the New York Times, medical marijuana will be permitted for the treatment of chronic illnesses in New Jersey next week. This is timely, given the change in White House policy on medical marijuana last Read more…

New Medical Marijuana Bill — New Jersey originally appeared on About.com Addictions on Thursday, January 14th, 2010 at 19:38:03.

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And behavioral addictions, such as food, exercise and video game addiction, can often be hidden behind a veneer of social acceptability which conceals the pain and difficulty these addictions can cause.

Social Acceptability and Addiction originally appeared on About.com Addictions on Thursday, January 7th, 2010 at 15:41:38.

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