Pop that a condition qualifies as a pop psychology diagnosis does not mean that it is invalidated, Diagnoses only that it is unvalidated. As a hoary scientific D. Anne Winiarski, Sarah Francis dictum reminds us, absence of evidence is not Smith, and Scott O. Lilienfeld evidence of absence. In the case of most pop , U.S.A. psychology diagnoses, the problem is more the former than the latter. Evaluating the validity of pop psychology Inmanyrespects,thelandscapeofpsychi- diagnoses is not a straightforward task, in part atric classification and diagnosis is a tale of because the boundaries between valid and two worlds. One world comprises academic invalid diagnoses are fuzzy. In evaluating the psychiatry and psychology, in which classifica- validity of pop psychology diagnoses, we adopt tion systems and the diagnoses they subsume the criteria laid out by Eli Robins (1921–94) are informed largely (although by no means and Samuel Guze (1923–2000) in a classic arti- entirely; see Greenberg, 2013, for withering cle. There, Robins and Guze (1970) delineated critiques of the evidentiary basis of DSM-5)by several benchmarks for ascertaining whether systematic research. The other world comprises a psychiatric diagnosis is valid. According to popular (“pop”) psychology, in which formal them, a valid diagnosis should (a) distinguish classification systems are typically absent, as the disorder from similar disorders (or what diagnoses are not organized within concep- psychologists call “discriminant validity”), tually or empirically informed subgroupings. (b) display a clear-cut pattern of familial Moreover, in this second world, diagnoses are aggregation, (c) predict diagnosed individuals’ based largely on anecdotal reports, self-help performance on laboratory and psychometric books, and the entertainment media rather measures, and (d) forecast the natural history than on controlled research. This entry exam- (course and outcome) of diagnosed individ- ines the scientific status of influential pop uals. Although not mentioned explicitly by psychology diagnoses. Robins and Guze, a valid diagnosis should There is no formal or widely accepted opera- also ideally (e) predict diagnosed individuals’ tionalization of pop psychology diagnoses, nor response to treatment. Nevertheless, because any clear-cut distinction between academic a condition’s treatment response does not and pop psychology diagnoses. Nevertheless, necessarily inform us about its etiology, this for the purposes of this entry, we propose the fifth criterion should be regarded as a desider- following working definition. Pop psychology atum rather than a formal requirement. Some diagnoses are conditions that have (a) received authors have offered friendly amendments to considerably more attention in popular psy- the Robins and Guze criteria by incorporating chology (e.g., self-help books, newsstand additional external validating indicators, such magazines, television talk shows, radio call-in as measures of presumed endophenotypes shows) than in academic psychology, (b) (e.g., biological markers). Still, the Robins received scant validation in controlled studies, and Guze rubric is a helpful starting point for and (c) not been incorporated into formal clas- evaluating the validity of psychiatric diagnoses, sification schemes, such as DSM-5 or ICD-10. including pop psychology diagnoses. As a consequence of (b) and (c), the scientific The Robins and Guze framework reminds status of pop psychology diagnoses is contro- us that a valid diagnosis must provide us with versialatbest,dubiousatworst.Still,thefact surplus information: knowledge that was not

The Encyclopedia of , First Edition. Edited by Robin L. Cautin and Scott O. Lilienfeld. © 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc. DOI: 10.1002/9781118625392.wbecp568 2 POP PSYCHOLOGY DIAGNOSES available to us before the diagnosis was made. are black rage (acts of violence perpetrated by In this context, Millon (1975) distinguished African Americans that are apparently trig- diagnoses from labels, with the former offering gered by repeated discrimination), road rage surplus information and the latter, being essen- (acts of intense reactive aggression directed tially descriptive, offering little or no surplus toward offending drivers), urban survival information. For example, the DSM diag- syndrome (a predisposition toward violence nosis of schizophrenia affords us additional resulting from prolonged exposure to ghetto information that we did not have previously; “war zones”), syndrome the knowledge that a person meets diagnostic (the longstanding estrangement of a child from criteria for schizophrenia tells us something a parent, stemming from the other parent’s new about his or her likely family history, indoctrination of the child into a negative risk for other conditions (e.g., alcohol-use view of his or her partner), child sexual abuse disorder), and probable course and outcome. accommodation syndrome (a constellation Incontrast,apsychiatriclabeltellsuslittle of behaviors, such as secrecy and delays in or nothing about the person that we did not reporting of sexual abuse, that supposedly already know. If we were to identify a distinct stem from a child feeling responsible for the class of people who feel compelled to watch abuse), rape trauma syndrome (a presumed baseball games at every opportunity, com- distinct reaction to rape marked by puzzling pulsivelymemorizebaseballstatistics,track behaviors, such as the victim’s continuing to the results of every major and minor league maintain contact with the rapist and neglecting baseball game, and experience anguish when- to report the rape), and battered woman’s syn- ever they cannot immediately access baseball drome (a pattern of behavior characterized by news, we could christen their ostensible afflic- learned helplessness stemming from an abu- tion with the moniker of “baseball addiction sive relationship). The last condition featured syndrome.” Yet it is unclear what, if any, new prominently in the widely publicized 2013 trial information this new label would provide. The of Jodi Arias, an Arizona woman convicted label would be merely descriptive, succinctly of murdering her boyfriend. Precious few of summarizing the features of the “condition” these contested legal labels have been the sub- without offering surplus knowledge. jects of extensive scientific research (McCann, Most of the putative conditions reviewed Shindler, & Hammond, 2003). in this entry are probably closer to labels Because of space constraints, in this entry we than to diagnoses. In this respect, the phrase focus on pop psychology diagnoses that have “pop psychology diagnoses” is arguably a mis- received the lion’s share of public and media nomer, although it is used here for the sake of attention over the past few decades. In each continuity with previous literature. case, we briefly survey the historical origins of There are dozens, perhaps even hundreds, the label and the modest research base bearing of pop psychology diagnoses. Among those on its validity. that have received intermittent media attention over the past several decades are Peter Pan syndrome (a label affixed to adults who do not seem to want to grow up), Cinderella complex The concept of codependency traces its roots (a pathological and unconscious desire to be to the field of chemical dependency, and first cared for by others), and television intoxica- gained recognition in the early to mid 1980s. tion (an all-consuming devotion to the small This concept grew out of treatment programs screen). In addition to these pop-psychology for family members of people with alcoholism, diagnoses are a plethora of informal labels such as Al-Anon (Morgan, 1991). At that time, that have been introduced periodically into codependency referred to a pattern of behav- courtrooms as legal defenses. Among them iors displayed by partners of alcoholics that POP PSYCHOLOGY DIAGNOSES 3 was believed to result from living with them. literatures for nearly 30 years, it has received This pattern comprises “enabling” behaviors, minimal research attention. Some evidence in which partners of alcoholic individuals suggests that individuals with backgrounds become pathologically dependent on their ostensibly linked to codependency (e.g., off- partner and unintentionally reinforce their spring of an alcoholic parent) are more willing dependency. Eventually, the codependency to help exploitative than nurturing individ- concept expanded to encompass dysfunctional uals, whereas healthy individuals display the relationships of many kinds, including those opposite pattern. Bradshaw (1988) described in which a partner engages in irresponsible codependency as a shame-based condition behaviors other than drinking, such as domes- marked by low self-esteem. Some evidence tic abuse or excessive gambling. Codependent supports this assertion, as codependency is individuals purportedly believe that they negatively associated with self-esteem (Wells, should be able to alter their partner’s unhealthy Glickauf-Hughes, & Jones, 1999). Never- behavior, even when this belief is unrealistic theless, numerous psychological conditions, (Morgan, 1991). such as mood disorders, are also tied to low Cermak (1986) was among the first to pro- self-esteem, so this attribute is unlikely to be pose standardized criteria for “co-dependent diagnostically discriminating. Codependency .” First, codependent indi- has been linked empirically to decreased levels viduals invest their self-esteem in their ability of narcissism and emotional expressivity, as to control themselves and others. Second, they well as to increased depression, anxiety, and assume excessive responsibility for others, family dysfunction (Marks, Blore, Hine, & often to the detriment of their own needs. Dear, 2012). Third, they possess distorted views regard- Nevertheless, numerous scholars have ing intimacy, and experience marked anxiety criticized the construct of codependency, about separation from others. Fourth, they especially on the grounds of marked hetero- are involved in relationships with people who geneity and lack of discriminant validity. Some suffer from substance abuse problems, per- have deemed codependency as a “catch-all” sonality disorders, or problems with impulse diagnosis for almost anyone trapped in a control. Fifth, they exhibit at least three ofa dysfunctional relationship (Anderson, 1994). constellation of symptoms and signs, includ- Although this criticism may contain a kernel ing denial, constricted emotion, depression, of truth, it is probably too extreme given that hypervigilance, anxiety, and substance abuse. some individuals in troubled relationships are Dear, Roberts, & Lange (2004) attempted to psychologically healthy. Another concern is demarcate the core features of codependency. that codependency may be difficult to dis- They identified four traits associated with the tinguish from certain personality disorders. condition: external focusing, self-sacrifice, In particular, codependency correlates highly interpersonal control, and emotional suppres- with borderline and dependent personality dis- sion. External focusing involves the direction orders (Morgan, 1991) and displays a similar of attention towards others. Self-sacrifice pattern of correlates to the aforementioned dis- entails focusing on the needs of others to the orders (e.g., rigid and perfectionistic cognitive pointofneglectingone’sown.Interpersonal schemas, proneness to depression). control refers to the belief that one can fix oth- ers’ maladaptive behaviors. Finally, emotional Behavioral Addictions suppression involves inadequate attentive- ness to one’s emotions until they become In the last few decades, a myriad of proposed overwhelming. behavioral addictions have gained attention Although codependency has been widely from researchers and the media. The concept of discussed in the popular and theoretical behavioral addiction is controversial because 4 POP PSYCHOLOGY DIAGNOSES critics contend that it represents an inappro- of the greater availability of the internet. Specif- priate extension of the concept of substance ically, skeptics of the internet-addiction label addictiontoeverydaybehaviors.Thesenew contend that the diagnosed addiction should proposed addictions range from compulsive instead reflect the specific internet-related exercising and tanning (sometimes colloqui- activity (e.g., gaming, pornography, online ally termed “tanorexia”) to compulsive sex dating)inwhichtheindividualengages. and gambling. In this entry, we focus on three Numerous approaches have been pro- widely discussed behavioral addictions: Inter- posed for the treatment of internet addiction, net addiction, sexual addiction, and shopping although few have been investigated systemat- addiction. ically. Most treatment approaches include cognitive and behavioral strategies. For Internet Addiction example, clients may be instructed to keep Internet addiction has been conceptualized a behavior log, in which they record how by some as a compulsive-impulsive spectrum much time they spend online. Once a baseline disorder (Block, 2008) that manifests in (a) usage time is established, therapists teach excessive computer use, resulting in a loss of clients strategies for decreasing the amount sense of time, a neglect of basic needs, or both; of time spent online. These strategies include (b) withdrawal symptoms, such as depression creating “external stoppers” (e.g., a timer), as or anxiety when a computer is not present; well as reminder cards outlining the benefits (c) tolerance symptoms, such as a desire to of abstaining, and the negative consequences possess the latest technology to maximize arising, from excessive internet use. When the hours of usage; and (d) negative professional, internet is used to escape reality or as some personal, and interpersonal repercussions other coping strategy, it may be necessary to arising from excessive computer use. Internet employ cognitive strategies to target negative addiction often overlaps with other behavioral core beliefs and cognitive distortions associated addictions, raising questions concerning its with compulsive computer use. Although a few discriminant validity. For example, the advent studies on the treatment of internet addiction of the Internet has made it easier for compul- have included control groups, the research lit- sive shoppers to spend countless hours making erature is too preliminary to draw conclusions purchases, and has simplified the process of regarding the most effective treatment for this obtaining pornography for those with extreme condition. sexual urges. Given its clinical importance and prelim- In some parts of the world, most notably inary work on its prevalence (especially in parts of Asia, Internet addiction has become Asian countries), internet use gaming disorder, apublichealthconcern,withprevalence marked by an excessive preoccupation with estimates as high as 13.7% in China. In the online games, was approved for inclusion in , credible prevalence rates are Section 3 of DSM-5. Nevertheless, this con- lacking. Internet addiction co-occurs fre- dition requires further research before it can quently with many other disorders, such as be incorporated into the main body of the obsessive-compulsive disorder, making it diffi- manual. cult to diagnose in isolation. Furthermore, no standardized, mutually agreed criteria exist for Sexual Addiction diagnosing the condition. Sexual addiction is a term that encompasses Some researchers argue that internet addic- a wide variety of problematic behaviors, tion is a misnomer, as the condition should including compulsive masturbation, excessive be conceptualized not as a problem with the pornography use, cybersex, exhibitionism, and internet per se but rather with specific activities voyeurism.Individualswiththiscondition that are now more accessible as a consequence report an insatiable sex drive that interferes POP PSYCHOLOGY DIAGNOSES 5 with daily functioning, including occupational been used for paraphilic and nonparaphilic and social performance. They may spend behaviors, but there is no evidence demon- excessive time planning for or engaging in sex- strating superior efficacy of one medication ual behavior, which is often performed without over another, and no extensive randomized, adequate regard for physical risks (e.g., sexually double-blind placebo-controlled studies have transmitted diseases) or emotional harm to been published (Fong, 2006). oneself or others. Although the original intent generally focuses on individual therapy, such for engaging in sexual behavior is typically as cognitive-behavioral therapy, designed to to relieve distress, this maladaptive coping target compulsive sexual thoughts and behav- strategy eventually results in individuals losing iors or in some cases, marital therapy, which control of their actions. may help restore trust and reduce shame in Although originally slated for inclusion in the relationships of presumed sexual addicts. DSM-5, hypersexual disorder, which is similar Nevertheless, these interventions have yet to to most clinical conceptualizations of sexual beevaluatedinrandomizedcontrolledtrials. addiction, was not included in the manual. Support group recovery program options, This decision probably reflects the paucity of such as Sex Anonymous (SA) or Sex Addicts research demonstrating that sexual addiction Anonymous also exist, as do support groups is a distinct condition rather than a nonspecific for partners of sexual addicts (e.g., Co-Sex symptom of many extant conditions, such as Addict Anonymous). antisocial personality disorder, bipolar disor- der, and impulse control disorders. Similarly, Shopping Addiction criticshaveraisedconcernsthatthiscondi- Shopping addiction has been discussed in the tion is highly heterogeneous (Gold & Heffner, literature under many different names, includ- 1998). ing oniomania, shopaholism, compulsive Sexual addictions can be grouped into two buying, and compulsive spending. The hall- categories: paraphilias and nonparaphilias mark characteristics of shopping addiction are (Coleman, 1992). Paraphilias involve sexual preoccupations, urges, or behaviors surround- arousal to objects, people, or situations, and ing shopping and spending money, resulting in are generally considered to lie outside the distress, impairment in functioning, or both. range of conventional behavior. Conversely, Research suggests that the urge to spend nonparaphilias reflect a range of more con- money compulsively afflicts about 5.8% of ventional sexual behaviors that are taken to an the population (Koran, Faber, Aboujaoude, extreme, such as excessive pornography use. Large, & Serpe, 2006). The age of onset for The increase in the availability of pornogra- shopping addiction is generally in the late phy and cybersex online may fuel compulsive teens or early 20s, and it is more common in sexual behavior by creating a perception of developed countries. This condition co-occurs anonymity and disinhibition (Griffiths, 2001). with many mood and anxiety disorders, as Sexual addiction has been treated using well as with several personality disorders, multiple approaches, including pharmacother- such as obsessive-compulsive, avoidant, and apy, individual therapy, and group therapy. borderline personality disorders, rendering its Although sexual addiction is not traditionally differentiation from other conditions unclear. included in the obsessive-compulsive spec- The compulsive act of shopping may, for trum, there is substantial overlap between example, serve as an outlet or stress reliever for sexual disorders and obsessive-compulsive individuals who are anxious or depressed. disorder, leading some to posit similar Proposed treatments for shopping addiction mechanisms of pharmacological interven- include pharmacological and psychological tion (Bradford, 2001). Selective serotonin interventions. One case study reported on reuptake inhibitors (e.g., Paxil, Zoloft) have the use of Quetiapine, a potent antipsychotic, 6 POP PSYCHOLOGY DIAGNOSES to treat bipolar I disorder associated with committing criminal activities perpetrated by comorbid compulsive shopping (Di Nicola the group that kidnapped her, the Symbionese et al., 2010). Another case study reported Liberation Army. a possible successful treatment of shopping Nevertheless, there is little scientific consen- addiction with high doses of naltrexone, an sus regarding whether this syndrome qualifies endogenous opiate blocker, aimed at reducing as a distinct disorder. Moreover, scholars do urges to shop (Grant, 2003). Pharmacotherapy not yet agree on formal diagnostic criteria, trials for compulsive shopping are limited and andlittlesystematicresearchonthecondition inconsistent, and substantially more research has been conducted. In addition to explaining is required before firm conclusions can be victims’ puzzling behavior in hostage situa- drawn. Nonpsychopharmacological treatment tions, Stockholm syndrome has been invoked options have also been explored. In one study, to account for why some women remain in individuals with compulsive buying exhibited abusive relationships, how soldiers respond less problematic buying behavior, healthier to traumatic stress in war zones, and why purchasing patterns, and fewer maladaptive some victims of childhood abuse do not report thoughts surrounding buying behaviors fol- victimization. lowing cognitive-behavioral therapy than those Limited research has attempted to identify assigned to a wait-list control group (Mueller Stockholm syndrome in individuals exposed et al., 2008). to traumatic situations, particularly those Shopping addiction is a relatively new pro- involving abusive relationship partners. In posed disorder with very little associated one study (Graham et al., 1995), researchers research, a lack of clear diagnostic criteria, and evaluated a 49-item scale developed to measure limited information on effective treatment. In Stockholm syndrome in a sample of 764 under- addition, its differentiation from other condi- graduate women. Factor analyses identified tions is poorly understood. It is therefore too three well-defined dimensions: core Stockholm early to include this disorder in the current syndrome, love-dependence, and psycholog- classification system. ical damage. The first factor, core Stockholm syndrome, was characterized primarily by Stockholm Syndrome cognitive distortions aimed at reducing the stress associated with abuse. Love-dependence Stockholm syndrome (sometimes called “trau- was characterized by an inability to imagine matic bonding” and “terror binding”) describes being without the partner, and psychological the paradoxical emotional attachment that damage reflected victims’ feelings of dimin- some kidnapping victims purportedly develop ished self-worth. The authors concluded that toward their captors. This condition owes victims of abuse sometimes use love to explain its name to a hostage situation in the Kred- theirhigharousalstateandhopesofescape itbanken in Stockholm in 1973, in which from their abuser. the victims became bonded emotionally to Most research on Stockholm syndrome has their captors, even defending them against relied on retrospective questionnaires and case accusations after being rescued by the police. interviews. One notable exception is an investi- Since Nils Bejerot coined the term in 1973, gation conducted by Auerbach, Kiesler, Strentz, Stockholm syndrome has attracted media Schmidt, and Serio (1994), who exposed par- attention in numerous television shows and ticipants to simulated hostage situations. One in many kidnapping cases, such as in the group was assigned to use emotion-focused Elizabeth Smart and cases. In training, which teaches individuals strategies the 1974 Patty Hearst case, for example, for detaching from a stressor while (a) focusing Hearst (granddaughter of famous newspaper on feelings that are inconsistent with the stres- tycoon Charles Randolph Hearst) assisted in sor and (b) using feelings of assertiveness to POP PSYCHOLOGY DIAGNOSES 7 manipulate captors. The researchers concluded to a certain philosophy, such as veganism, that as hostages perceived their captors to be macrobiotic diets, or Paleo diets. The condition friendlier and less dominant, the more likely is not necessarily associated with a desire to they were to adjust positively to the kidnap- lose weight, but with a desire for biologically ping. Another research team interviewed seven pure foods lacking human-made additives and victims of a hostage situation, and found that chemicals. theonlyindividualwhodevelopedStockholm More recently, some scholars have attempted syndrome was a woman who reportedly had to delineate diagnostic criteria for orthorexia. the most positive contact with the hostage Vandereycken (2011) argued that orthorexia taker (Wesselius & DeSarno, 1983). requires that an individual experience a preoc- The unclear diagnostic features of Stockholm cupation with healthy eating and an abnormal syndrome, paucity of systematic research, concern regarding physical health. This preoc- and absence of reliable measurement pro- cupation presents itself as an avoidance of all cedures have precluded this condition from foods or ingredients viewed as unhealthy. This being included in extant classification systems. preoccupation must cause significant distress Researchers must identify mutually agreed in important areas of life, such as social and symptomsanddevelopvalidmeasurement occupational functioning. Individuals with tools before this disorder can cross over from orthorexia engage in highly selective eating, thepopularpsychologyrealmintothearenaof which may lead to malnutrition and weight formal psychiatric classification. loss. Finally, the symptoms of orthorexia must not be due to other disorders such as anorexia Eating Disorder Variants nervosa or illness (a DSM-5 condition similar to what DSM-IV termed Largely or entirely unvalidated labels describ- hypochondriasis). ing a host of disordered eating behaviors are rampant in popular psychology. For example, Despite the considerable interest in although chocoholism can refer to a mere orthorexia in popular culture, it has been proclivity for chocolate, some writers concep- the subject of little research. Catalina-Zamora, tualizeitasanaddictiontochocolateorits Bote-Bonaechea, Garcia-Sanchez, & Rios-Rial component chemicals. Presumably more seri- (2005) described a case study of the disorder in ous popular diagnoses include emetophobia, a 28-year-old woman who experienced severe which entails an avoidance of certain foods due malnutrition due to an extremely restrictive to a fear of vomiting or choking, and “night lacto-ovo-vegetarian diet. Research suggests eating syndrome,” which involves persistent that the condition is associated with especially late-night binge eating. frequent exercise and social physique anxiety (e.g., anxiety concerning negative evalua- Orthorexia Nervosa tions of one’s physique) in women, and an One popular diagnosis that has been the internalization of Western ideals concerning subject of increasing attention is orthorexia thinness/muscularity in men and women nervosa, more commonly called orthorexia. (Eriksson, Baigi, Marklund, & Lindgren, This condition was first identified in 1997by 2008). Steven Bratman, who described it as a “fixation Several authors have questioned the dis- on righteous eating” that can lead to negative criminant validity of orthorexia from other outcomes,suchasmalnutritionandlowbody conditions, especially anorexia nervosa and weight. According to Bratman and Knight bulimia nervosa. Nevertheless, proponents of (2001), individuals who suffer from orthorexia the disorder contend that orthorexics are not seek perfection and cleanliness in their diets, concerned with losing weight and do not fear depriving themselves of foods they identify gaining weight, as do individuals with anorexia as “bad.” They may rigidly follow diets tied and bulimia (Zamora et al., 2005). Some 8 POP PSYCHOLOGY DIAGNOSES have speculated that personality traits such regarding both overall appearance and muscle as rigidness and perfectionism may underlie tone and weight. Individuals with muscle the development of both orthorexia and other dysmorphia exhibit higher rates of mood dis- DSM eating disorders. orders, anxiety disorders, and eating disorders than do individuals in normal weight-lifting Muscle Dysmorphia comparison groups. One of the better researched popular diag- The etiology of muscle dysmorphia is poorly noses in the eating disorders domain is muscle understood, although researchers have pro- dysmorphia, also known as the “Adonis com- posed a biopsychosocial model that comprises plex,” “bigorexia,” “manorexia,” or “reverse biological features, such as withdrawal and tol- anorexia.” Muscle dysmorphia is characterized erance symptoms, and psychosocial features, by a pathological preoccupation with being such as impaired social relationships (Pope lean and muscular. The condition primarily et al., 1997). Some argue that the condition afflicts men and involves a distorted body stems from low self-esteem and concerns image—one in which sufferers perceive their regarding masculinity. These psychological bodies as smaller and weaker than they are. deficits may stem from social influences, such Affected individuals become obsessed with aspressurestobemusculararisingfrom exercising, often in the form of weightlifting, repeated exposure to muscular action figures and experience considerable anxiety regarding andimagesinthemedia.Inlaboratoryset- their physical appearance. Some researchers tings, individuals exposed to muscular male regard the condition as a variant of body dys- advertisements experience more body dissatis- morphic disorder, in which the focus is on faction than do individuals exposed to neutral muscularity rather than on a specific body part images (Leit, Gray, & Pope, 2001). (Pope et al., 1997). Critics have questioned muscle dysmorphia’s Pope et al. (1997) proposed three major discriminant validity from, and incremental diagnostic criteria for muscle dysmorphia. validity beyond other diagnoses, especially First, muscle dysmorphia involves a patholog- body dysmorphic disorder. Despite these ical obsession with the possibility that one’s questions, individuals with both body dys- physique is not adequately muscular. Second, morphic disorder and muscle dysmorphia this obsession must create significant difficul- exhibit a higher prevalence of suicide attempts, ties in social, occupational, or other areas of substance-use disorders, and steroid use than functioning (e.g., the individual misses impor- do individuals with body dysmorphic disorder tant activities to maintain a workout schedule, alone (Pope et al., 2005). On balance, muscle the individual avoids revealing his or her body dysmorphiaappearstobeapromisingbutpro- to others). Third, the focus is on insufficient visional diagnosis that merits further research. muscle mass rather than on a specific part of Although muscle dysmorphia has yet to be thebodyoronbeingobese. recognized as an independent condition in A small but promising body of research has DSM, it is now listed as diagnostic specifier for examined the correlates of muscle dysmorphia. body dysmorphic disorder in DSM-5. In a comparison of weight lifters displaying Returning to the Robins and Guze (1970) muscle dysmorphia with normal weight lifters, criteria set out at the outset of the entry, few Olivardia, Pope, & Hudson (2000) found of the pop psychology diagnoses examined that muscle dysmorphia was associated with appear to satisfy rigorous criteria for validity. increased checking of one’s appearance in In particular, lingering questions remain con- the mirror, increased time spent exercising, cerning the differentiation between most or and avoidance of activities due to a perceived all of these diagnoses and better established bodily defect. The disorder is associated with and validated conditions. In addition, there decreased body satisfaction and body image is a marked paucity of research documenting POP PSYCHOLOGY DIAGNOSES 9 that pop psychology diagnoses are useful for Cermak, T. L. (1986). Diagnostic criteria for predicting individuals’ family history, labora- codependency. Journal of Psychoactive Drugs, 18, tory or psychometric performance, or natural 15–20. history. As a consequence, it remains unclear Coleman, E. (1992). Is your patient suffering from how many of these proposed conditions pro- compulsive sexual behavior? Psychiatric Annals, 22, 320–325. vide surplus information above and beyond Dear, G. E., Roberts, C. M., & Lange, L. (2004). the behaviors they denote. At the same time, Defining codependency: An analysis of several of these conditions, especially sexual published definitions. Advances in Psychology addiction, orthorexia, and muscle dysmorphia, Research, 34, 63–79. warrant further investigation. Di Nicola, M., Martinotti, G., Mazza, M., Tedeschi, In sum, the watchword for pop psychology D., Pozzi, G., & Janiri, L. (2010). Quetiapine as diagnoses should be “caution.” Although sev- add-on treatment for bipolar I disorder with eral of these diagnoses capture clinically impor- comorbid compulsive buying and physical tant phenomena and merit additional research, exercise addiction. Progress in none is ready for inclusion in psychiatric classi- Neuro-Psychopharmacology and Biological fication systems, and their use in courts of law Psychiatry, 34, 713–714. is premature at best. Eriksson, L., Baigi, A., Marklund, B., & Lindgren, E. C. (2008). Social physique anxiety and sociocultural attitudes toward appearance impact SEE ALSO: Construct Validity; Definition of Mental on orthorexia test in fitness participants. Disorder; DSM-5; Robins, Eli (1921–94) Scandinavian Journal of Medicine and Science in Sports, 18, 389–394. References Fong, T. W. (2006). Understanding and managing Anderson, S. C. (1994). A critical analysis of the compulsive sexual behaviors. Psychiatry concept of codependency. Social Work, 39, (Edgmont), 3, 51–58. 677–685. Gold, S. N., & Heffner, C. L. (1998). Sexual Auerbach,S.M.,Kiesler,D.J.,Strentz,T.,Schmidt, addiction: Many conceptions, minimal data. J. A., & Serio, C. D. (1994). Interpersonal impacts Clinical Psychology Review, 18, 367–381. and adjustment to the stress of simulated Graham,D.L.R.,Rawlings,E.I.,Ihms,K.,Latimer, captivity: An empirical test of the Stockholm D.,Foliano,J.,Thompson,A.,Suttman,K., syndrome. JournalofSocialandClinical Farrington, M., & Hacker, R. (1995). A scale for Psychology, 13, 207–221. identifying “Stockholm Syndrome” reactions in Block, J. J. (2008). Issues for DSM-V: Internet young dating women: Factor structure, reliability, addiction. American Journal of Psychiatry, 165, and validity. Violence and Victims, 10, 3–22. 306–307. Grant, J. E. (2003). Three cases of compulsive Bradford, J. M. W. (2001). The neurobiology, buyingtreatedwithnaltrexone.International neuropharmacology, and pharmacological Journal of Psychiatry in Clinical Practice, 7, treatment of the paraphilias and compulsive 223–225. sexual behavior. Canadian Journal of Psychiatry, Greenberg, G. (2013). The book of woe: The DSM 46, 26–34. and the unmaking of psychiatry.NewYork: Bradshaw, J. (1988). Healing the shame that binds Penguin. you. Deerfield Beach, FL: Health Griffiths, M. (2001). Sex on the internet: Communications, Inc. Observations and implications for internet sex Bratman, S., & Knight, D. (2000). Health food addiction. Journal of Sex Research, 38, 333–342. junkies: Overcoming the obsession with healthful Koran, L. M., Farber, R. J., Aboujaoude, E., Large, eating. New York, NY: Broadway Books. M. D., & Serpe, R. T. (2006). Estimated Catalina-Zamora, M. L., Bote-Bonaechea, B., prevalence of compulsive buying behavior in the Garcia-Sanchez, F., & Rios-Rial, B. (2005). United States. American Journal of Psychiatry, 10, Orthorexia nervosa: A new eating behavior 1806–1812. disorder? Actas españolas de psiquiatría, 33, Leit, R. A., Pope, H. G., & Gray, J. J. (2001). Cultural 66–68. expectations of muscularity in men: The 10 POP PSYCHOLOGY DIAGNOSES

evolution of playgirl centerfolds. International Vandereycken, W. (2011). Media hype, diagnostic Journal of Eating Disorders, 29, 90–93. fad or genuine disorder? Professionals’ opinions Marks, A. D. G, Blore, R. L., Hine, D. W., & Dear, G. about night eating syndrome, orthorexia, muscle E. (2012). Development and validation of a dysmorphia, and emetophobia. Eating Disorders, revised measure of codependency. Australian 19, 145–155. Journal of Psychology, 64, 119–127. Wells, M., Glickauf-Hughes, C., & Jones, R. (1999). McCann,J.T.,Shindler,K.L.,&Hammond,T.R. Codependency: A grass roots construct’s (2003). The science and of expert relationship to shame-proneness, low testimony.InS.O.Lilienfeld,S.J.Lynn,&J.M. self-esteem, and childhood parentification. Lohr (Eds.), Science and pseudoscience in American Journal of Family Therapy, 27, 63–71. clinical psychology (pp. 77–108). New York, NY: Wesselius, C. L., & DeSarno, J. V. (1983). The . anatomy of a hostage situation. Behavioral Millon, T. (1975). Reflections on Rosenhan’s On Sciences and the Law, 1, 33–45. being sane in insane places. Journal of Abnormal Psychology, 84, 456–461. Further Reading Morgan, J. P. (1991). What is codependency? Journal of Clinical Psychology, 47,\break Blashfield, R. K., & Draguns, J. G. (1976). Evaluative 720–729. criteria for psychiatric classification. Journal of Mueller, A., Mueller, U., Silbermann, A., Reinecker, Abnormal Psychology, 85, 140–150. H., Bleich, S., Mitchell, J. E., & M. de Zwaan. Bratman, S. (1997). Health food junkie: Obsession (2008). A randomized, controlled trial of group with dietary perfection can sometimes do more cognitive-behavioral therapy for compulsive harm than good, says one who has been there. buying disorder: Posttreatment and 6-month Yoga Journal, 136, 42–46. follow-up results. Journal of Clinical Psychiatry, Choi, P. Y. L., Pope, H. G., & Olivardia, R. (2002). 69, 1131–1138. Muscle dysmorphia: A new syndrome in Olivardia, R., Pope, H. G., & Hudson, J. I. (2000). weightlifters. British Journal of Sports Medicine, Muscle dysmorphia in male weightlifters: A 36, 375–376. case–control study. American Journal of Cloninger, C. R. (1989). Establishment of diagnostic Psychiatry, 157, 1291–1296. validity in psychiatric illness: Robins and Guze’s Pope,C.G.,Pope,H.G.,Menard,W.,Fay,C., method revisited. In L. N. Robins & J. E. Barrett Olivardia, R., & Phillips, K. A. (2005). Clinical (Eds.), The validity of psychiatric diagnoses (pp. features of muscle dysmorphia among males with 9–18). New York, NY: Raven Press. body dysmorphic disorder. Body Image, 2, Cocores, J. (1987). Co-addiction: A silent epidemic. 395–400. Psychiatry Letter, 5, 5–8. Pope Jr., H. G., Gruber, A. J., Choi, P. Y., Olivardia, Olivardia, R. (2001). Mirror, mirror on the wall, R., & Phillips, K. A. (1997). Muscle dysmorphia: who’s the largest of them all? The features and An under-recognized form of body dysmorphic phenomenology of muscle dysmorphia. Harvard disorder. Psychosomatics, 38, 548–557. Review of Psychiatry, 9, 254–259. Robins, E., & Guze, S. B. (1970). Establishment of Pope, H. G., Katz, D. L., & Hudson, J. I. (1993). diagnostic validity in psychiatric illness: Its “Anorexia nervosa” and “reverse anorexia” application to schizophrenia. American Journal of among 108 male bodybuilders. Comprehensive Psychiatry, 126, 983–986. Psychiatry, 34, 406–409.