The Diagnostic and Statistical Manual of Mental Disorders (DSM), is the psychologist’s bible for diagnosing mental illnesses. Used by clinical psychologists, psychiatrists and doctors to determine the mental condition of a patient, the DSM has been an excellent tool for categorizing illnesses. The current manual in service is the DSM IV, which has been in use since 1994. For the past several years, planning has been underway on the next version of the manual, the DSM V. Due to be published in 2013, the DSM V revamps several categories of illnesses, sometimes combining or removing various disorders. Major changes have been planned for the Cluster B personality disorders (antisocial personality disorder, borderline personality disorder, etc) from set diagnostic categories to a personality spectrum based on symptoms. Similarly, Asperger’s Syndrome is planned to be placed alongside Autism within the Autism Spectrum Disorder. This decision, more than any other proposed change, has led to a great deal of criticism from many in the Asperger’s community. People with Asperger’s and relatives or those close to them believe that Asperger’s Syndrome has unique needs that would not be met if those affected were treated as autistic, and that it would lead to further discrimination as it would be classified as a disability rather than a difference.
According to the American Psychiatric Association the DSM has been in service in various forms since 1952. Similar to the International Classification of Diseases (ICD), which is used by physicians as well those in medical coding to classify diseases, the DSM has been used to treat mental conditions and disorders. A diagnosis is made using the DSM by seeing what symptoms the patient suffers from and, more importantly, how much of an effect these symptoms have on the patient’s life. Only trained mental health professionals are able to use the DSM to correctly diagnose mental disorders, as a layperson does not have the training to realize what symptoms are important in a diagnosis. While the DSM is the best tool available for diagnosing mental disorders, new medical advances and changing social conditions necessitate revisions to the DSM over time. The most famous of these was the removal of homosexuality as a disorder in the DSM III, as by the mid ’70s homosexuality was no longer publicly viewed as a mental illness.
Autism and Asperger’s Syndrome are currently listed as separate disorders in the DSM IV. Both conditions are considered Autism Spectrum Disorders – both indicating similar symptoms, but with different levels of functionality. The Centers for Disease Control and Prevention classifies Autism as a broad disorder, with sufferers showing differing levels of cognitive and emotional development. Autism typically becomes apparent during infancy or early childhood, with the child showing multiple impairments to learning and cognitive ability. Symptoms include repetitive or compulsive behavior, inability to form natural speech, decreased learning capacity and self injurious behavior. Those on the spectrum also often experience multiple social impairments such as the inability to empathize, understand others emotions or read body language. The cause of autism is currently unknown, but diagnoses thereof have increased dramatically over the past ten years.
On the other hand, The National Institute of Neurological Disorders and Stroke point out sufferers of Asperger’s experience many of the emotional and social impairments of Autism, but few of the cognitive disabilities. Patients diagnosed with Asperger’s typically exhibit the same levels of social inability and repetitive behaviors as those suffering from Autism. However, Asperger’s patients are generally high functioning, and do not need the level of care and supervision Autism sufferers require.
The removal of Asperger Syndrome from the DSM V has caused a great deal of criticism from Asperger’s support groups. The community worries about the possible side effects the removal of Asperger’s from the DSM might have. According the article “Away with the Asperger’s Diagnosis: What’s it all About?” by Jean Mercer, Ph.D. featured in Psychology Today, one common concern is that some high functioning Asperger’s sufferers may have symptoms that are too mild for inclusion in the Autism Spectrum, and that they would not be able to get the treatment and therapy they may need the disorder is no longer recognized.
Others believe that the new Autism Spectrum will be much too broad, with the severity of a diagnosis being based on the current physician’s opinion rather than set standards. Yet clinical psychologists and psychiatrists working on the DSM believe that this new Autism Spectrum will give physicians more freedom in diagnosing patients. For instance, with the current DSM, many patients with Asperger’s are understood to suffer from Attention Deficit Disorders, as the two disorders have significant overlap in symptoms, and they are often prescribed medicines as such regardless of their actual needs. With the new system, the physician would be given greater latitude to decide the best course of treatment for the patient.
While the views of the clinicians and the Asperger’s community may never agree, the work on the DSM V continues. The American Psychiatric Association has posted the potential changes to the new version of the DSM online and has invited comments and criticism. Society’s opinion of the nature and and effects that mental disorders have are important and, as shown by the removal of homosexuality previously, the psychiatric community has come to realize this. As such, it appears the future of Asperger’s Syndrome and the Autism Spectrum will be informed by the merging of ideas from the medical community and public opinion.
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{ 8 comments… read them below or add one }
Unfortunately there are some social workers that are not fully trained that are misdiagnosing individuals also. They know just enough to think they can diagnose and treat based on something they have read. People with a MSW degree should limit their practice to Social Work and not Psychology. There has been some damage done because their clients trust them. If they suspect Aspergers or Autism they should refer to the proper Psychologists for diagnosis and treatment.
How is this so ? I work in the mental health field and a Diagnostic Assessment is still needed by a Psychiatrist, Psychologist or MD before the diagnosis is legitimate. In my state if someone other than the 3 I mentioned does the DA it is not valid. With out a valid DA and individual does not get Medicaid funded services or can get Insurance paid services. Please suggest this to any one you know who is seeking treatment for any issue they have.
The APA must get out of the ASD arena, and return to their analytical-cognitive talk therapy… but they won’t, ’cause they’re losing billings, what with psychotropic and behavioural interventions on the rise. . . the APA DOES NOT KNOW what they’re doing, they are clearly making things up on the fly, all in an effort to maintain their grip on cash-flow via the DSM. Different ends of the spectrum should stop arguing with each other; we need to point out that the Emperor (APA) is not wearing any clothes.
At the very least, they should lose the role of insurance gate-keeper for conditions that are based on physiological antecedents… and stick to bad parents and little red wagons.
I’ve got Asperger’s, but my symptoms aren’t immediately obvious; people just think I’m strange or weird and shun me, bully me and exclude me. I fear that if I’m re-classified as merely having ‘mild autism’ I’ll lose what little support I’m already receiving.
I still believe it’s a bad idea. And here is why. Though there is indeed alot of overlap between AS and other ASDs, the severity of how both are affected can be drasticly different. I’ve already been put through years of useless therapies that are great for others on the spectrum, but do absolutely nothing for someone with AS. I see no reason why someone with AS would need ABA therapy, for example. Perhaps I should only speak for myself, but I think the helps and the supports that I need as well as the specific issues I face are very different from the rest of the spectrum.
My stems are pretty much entirely under my control, and are so small that are practicly un noticable to anyone but me or a very trained eye. I have great difficulty socializing outside of work with anyone who isn’t at least a little eccentric. Small talk makes me freeze up, or just get angry because it sounds like nonsense. As well as the things they tend to talk about. And I tell them it sounds like nonsense. You can guess how many people outside my AS circles I have as friends.
I would need help with things like that, which seem small, but would make a huge difference.
We need help with things like how to deal with job interviews, how to interact with fellow employees, (This is EXTREMELY difficult for me to this day to do if I’m just expected to socialize instead of talking about something work related or something in one of my core areas of interest. My difficulties as a kid was showing family members that I care in a way that they would understand, having to think and act out emotions in my facial expressions because they did not appear automaticly on my face or show in my vocal tone, eye contact, starting conversations (this is true still to this very day), things of this nature. I often say things in a brutally honest manner, and people get offended and I wonder why. After all, the truth is simply the truth! I never sugar coat anything and I don’t think I should have to just to spare someone’s feelings. (does that make me awful?)
I know I’m kind of rambling. My point is, the issues those of us with AS face are different than those on the otherside of the spectrum. We can’t be all grouped together and expect for treatment to get better, because though once again, we are very similar to our other peers on the spectrum, the severity is different, as well as the impact. Or to put it another way, the common cold and puemonia overlap in many areas. Aches and pains, difficulty breathing, coughing, fevers. But there are vast differences between the two due to the severity. Therefore the Common Cold is treated differently than someone with Puemonia. It should be the same here. Start creating programs and supports that make sense for people with Asperger’s Syndrome instead of giving a bunch of therapies and supports we don’t need and can’t afford and none of the therapies and the supports we DO need.
” My difficulties as a kid was showing family members that I care in a way that they would understand”
It’s *excellent* that you’re aware of the importance of communicating to other people whom you’re trying to reach *in a way that they would understand*! Some other people (including many who have no ASDs themselves!) deliberately ignore that importance and then complain when their audiences don’t get their messages. You’re socially smarter than those people deliberately ignoring that importance!
“I often say things in a brutally honest manner, and people get offended and I wonder why. After all, the truth is simply the truth!”
…*and* brutally is simply brutally! Ever tried saying something in a politely honest manner instead of a brutally honest manner? If yes, then how did that work out?
“I never sugar coat anything and I don’t think I should have to just to spare someone’s feelings. (does that make me awful?)”
Does it make you awful? That depends. Would it make someone else awful if he or she didn’t think he or she should have to do something just to spare *your* feelings?
“Or to put it another way, the common cold and puemonia overlap in many areas. Aches and pains, difficulty breathing, coughing, fevers. But there are vast differences between the two due to the severity. Therefore the Common Cold is treated differently than someone with Puemonia. It should be the same here.”
Brilliant comparison (even if many common colds don’t come with rises in temperature noticeable enough for someone with a cold to realize “hey, I have a fever”)!
Actually, no. I have been told I am strange, because I always have preferred the brutal truth, no matter how ugly. Even though it may hurt to hear, it is the way I most likely will actually use the information and make a change for the better.
I spent a good chunk of my life trying to spare other people their feelings and to make them happy, only to always have it blow up in my face and to have a colussal amount of hurt feelings and confusion all around. Because of that, I simply tell it all as it is. And yes it can hurt sometimes. But at least it is clear where I stand, and no one walks away with any confusion as to what needs to be worked on. To lighten issues is to cheapen them in my opinion.
Honestly I think you guys are being the jerks in this case. The poster had a legitimate concern and you are turning him into some bad guy you can project onto. He wants a chance at a normal education and a normal life, and is concerned he will be stuck lumped in with low functioning autistics and there associated stigma.