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Friday Flashback for October 12, 2007

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  1. There is some controversy over how to classify delusions. Should delusions be classified according to theme (e.g., persecutory, somatic, grandiose etc) or should delusions be classified according to etiology (e.g., substance induced, cerebral trauma induced) or should delusions be classified according to content (e.g., replacement of person who is close with an impostor (Capgras), familiar people disguising as strangers and following me around (Fregoli), ‘I am dead’ (Cotard)?

    (There is clearly some overlap and some recurring problems. E.g., ‘My wife has been replaced by a robot’ Might be considered the same as ‘My step-son has been replaced by an alien’ because the theme of a close person being replaced – or it might be different because it is about a spouse compared to a child, or a robot compared to an alien).

    The issue is: How finegrained should classification go?

    Similarly with phobias. We might consider that there is this over-arching type or kind of disorder (specific phobia) with many different sub-types on the basis of theme (e.g., blood or injury etc). Or we might consider that the different types are more fine-grained than that (e.g., fear of flying, fear of spiders, fear of snakes etc).

    Should the DSM classify on the basis of over-arching type (phobia) or thematic types that are mid-level (e.g., blood / injury phobia) or particular types that are low level / fine grained (e.g., spiders, airplanes, heights)?

    Now lets have a think about whether internet addiction should be regarded as a disorder in its own right.

    Is internet addiction to addiction what a phobia of spiders is to addiction?

    If so… Then whats the problem again?????

    Some grounds we might have for distinguishing internet addiction from other kinds of addiction (e.g., TV addiction or gambelling addiction or crack addiction) might be if there are distinct etiological features, risk factors, demographic features, treatments, course etc than there are for other kinds of addiction. Surely the people who are likely to have a problem with using the internet to the extent that it is causing them impairment in functioning in the social / occupational / psychological sense are likely to be different from the people who are likely to have a problem with using crack to such an extent. If so.. Then it might be worthwhile considering it to be a distinct disorder in its own right.

    I guess… I just have difficulty with seeing how ‘internet addiction’ is different from ‘Capgras delusion’ is different from ‘phobia of flying’.


  2. I’m sorry – that wasn’t very clear:

    High-Level (General) type
    1) Addiction
    2) Phobia
    3) Delusion

    Mid-Level (Thematic?) type
    1) (Not sure what to put here) Substance?
    2) Blood-Injury etc (I think there are 4 in the DSM)
    3) Grandiose, Paranoid etc

    Low-Level type
    1) amphetamine, opiates, gambelling, TV, internet
    2) flying, spiders, heights, blood
    3) Capgras, Fregoli, Cotard, Mirrored-Self MisIdentification

    I guess I don’t see how this is analogous… So if you don’t mind the lists of phobias or delusions… I don’t see why you should mind the lists of addictions…



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