Der Nervenarzt

, Volume 85, Issue 5, pp 571–577 | Cite as

DSM-5: wichtige Änderungen im Bereich der Suchterkrankungen

Leitthema

Zusammenfassung

Im DSM (Diagnostic and Statistical Manual of Mental Disorders) -5 gibt es zwei wesentliche Änderungen, die den Suchtbereich betreffen. Zum einen die Aufhebung der Unterscheidung zwischen dem schädlichen Gebrauch und der Abhängigkeitserkrankung, bezogen auf die stoffbezogenen Suchterkrankungen. Zum anderen wird das pathologische Glücksspiel jetzt erstmals unter die Suchterkrankungen gerechnet und es findet eine leichtgradige Veränderung der diagnostischen Kriterien hierfür statt. Beide Änderungen betreffen wesentliche Aspekte der Konzeptualisierung psychischer Krankheiten, die auch in den Eingangsstatements des DSM-5 thematisiert werden. Bezüglich der Kategorie des schädlichen Gebrauchs, die jetzt in die Substanzgebrauchsstörung („substance use disorder“) einbezogen wird, stellt sich hier konkret die Frage nach der möglichen Aufweichung gut abgrenzbarer, schwerer Krankheitsbilder. Bezüglich der Verhaltenssüchte ergeben sich Bedenken aufgrund der möglichen Pathologisierung einer Vielzahl gesellschaftlich unliebsamer Verhaltensweisen als Verhaltenssüchte in weiteren Revisionen der Krankheitsklassifikation. Beide Problembereiche werden im vorliegenden Artikel angesprochen.

Schlüsselwörter

Substanzgebrauchsstörung Verhaltenssucht Pathologisches Spielen Klassifikation Suchtbegriff 

DSM-5: important changes in the field of addictive diseases

Summary

There are two major changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) concerning the field of addiction. Firstly, the previous distinction between abuse and dependence has been abolished and both disorders are now subsumed under the category addiction and related disorders. Secondly, pathological gambling has now been included in the section of addiction with slight changes in diagnostic criteria. Both changes have major implications for the definition and conceptualization of what we call a psychiatric “disease” or “disorder”, which have also been addressed in the introductory statement of DSM-5. Concerning the category of abuse that is now part of substance use disorders, there is a concern that a well-defined disorder (“dependence”) is now mixed with a less well-defined syndrome (“abuse”). The inclusion of non-substance, behavioral addictions poses the danger of pathologizing a wide range of human behavior in future revisions of the classification. Both concerns are further addressed in this article.

Keywords

Substance use disorder Behavioral addiction Pathological gambling Classification Addiction 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik für Psychiatrie und PsychotherapieCharité - Universitätsmedizin Berlin, Campus MitteBerlinDeutschland

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