Preliminary draft DSM-5 released

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What singer? What are you talking about?



Well, yeah, of course. They aren't in the habit of labeling well people. If one is healthy but different, one doesn't get a diagnosis. Yeah, it would be nice if they recognized the value of labels for understanding of self and others even when is a variation rather than a disfunction. But they don't.



I really like what you had to say. The whole thing, even though I only quoted the first bit and not the reasoning that followed.

I don't think they will. But I think some psychologists/psychiatrists/therapists will, on their own, recognize a subclinical version. I know I've seen that with ADD/ADHD when reading about it. A person can have ADD traits, but not have the disorder.

No, having and maintaining only one friend outside of the family/carers is seen as "normal" and within the confines of appropriate, as long as the age is around the same and all of that other superficial stuff is met. I've had some lengthy discussions with professionals on this matter, and what they see as appropriate.

An "appropriate" spouse is the penultimate peer relation.

I'm betting they're using the statistics I've read, and that's saying only around 1%/2% of those with AS actually marry/have a long term relationship. And those that do this, are the highest of functioning too, and they tend to hover in the land where "disorder" and "normal" both reside and become blurred.

Note the "and" part of it too. There's no "or". It's failing at developing, and if someone else develops it for you, you can't maintain it without allowances.

DSM is published by the American Psychiatric Association. There's more to the world than the U.S.

Presumably these would not be the same professionals who explain the problem of girls being overlooked, as often being in part caused by the girl being sheltered by one or two female friends (Attwood for instance, who also runs seminars for spouses of people characterized by AS).

I have to say, that of the people I know with a diagnosis, none of them would actually get a diagnosis if the criteria were interpreted as you describe (including one individual with borderline normal IQ and who is often mistaken for a Kanner Autistic by support workers). They clearly have a clinically significant condition of some kind, and nothing else in the DSM fits.

The criteria is also exceptionally poorly worded if the intended interpretation is as you describe; why refer to relationships if what is meant is "any relationship whatsoever, full stop"? Why not say it straight and plainly, as in "a failure to develop and maintain so much as a single relationship appropriate to age"?

It seems rather odd to base diagnosis on something that is environmentally determined. After all, the current DSM is very clear in explaining that those with AS (for instance) often do seek relationships; supply that person with someone who will put up with them and is in the range of "an age appropriate peer", then suddenly the person does not have AS even if they clearly had it the day before they finally found someone who would put up with them? If that one person who puts up with them then dies or moves away or decides after several years to not put up with them anymore, do they become Autistic again? This all seems rather transient for a life-long developmental condition.

These professionals would have to do a lot of explaining before I could accept their interpretation as even being clinically coherent.

Whatever their interpretation may be (the professionals I've seen), there's only one way I can see that said criterion can be interpreted.

How else can it be taken in regards to "autism" (which is primarily a social disorder)?

You have a, "failure to develop", which is self-explanatory, a "and maintain", which again, is self-explanatory, and then on to "appropriate to developmental level", which again..., again, is self-explanatory. The previous DSM-IV-TR fails to describe it all that well, other than saying older individuals may desire peer relations, but that they lack the social understanding (it abruptly ends there).

It seems quite clear cut to me, i.e., can't make friends [around your same age] and can't maintain them if they're somehow made [by those around your same age].

I know of Attwood (who himself says AS marriage is a rare event), and also...the people who "have" Cassandra Syndrome, but if these people are no longer seen as disordered by what they can and can't do.... I don't know if Attwood had much say in these proposed changes.

Apparently you have interpreted it to mean
"a failure to develop and maintain any peer relationship appropriate to developmental level"
which is not the most obvious interpretation as the word "any" is rather small, easily inserted and rather mysteriously absent if the interpretation you are preferring is the intended interpretation.


Cannot make friends and cannot make a single friend are not the same thing.

For an adult, a single friend does not constitute an age appropriate set of relationships. A typical adult has a range of peer relationships. If the criteria were meant to refer to a complete absence of even a single peer relationship appropriate to their age, then I would expect it to specify this rather than using language that appears to apply to the set of relationships that a person is able to develop and maintain. Specifying such would be as easy as qualifying the criteria by including the word "any" in the appropriate place.


Attwood is an example of one of the many currently widely respected authorities whose conception of AS and diagnostic practices are not consistent with the interpretation you are positing. A significant proportion of currently diagnosed people would not be diagnosible if the criteria are interpreted as you are interpreting them. They clearly have a clinical condition of some kind, nothing is proposed in place of AS that describes this condition. I doubt that APA intends these people to no longer be clinically diagnosible with a clinical condition described in the DSM.

The most sensible conclusion in my view, is that the interpretation you are making is probably not the interpretation intended by APA.

I'd interpret the use of the plural "relationships" as the different types of relationships that are possible, rather than it meaning more than one person. Basic interaction with workmates and schoolmates would be exempt from this.

I've seen adults who have "only" one friend, and there's nothing wrong with them; they can socialize fine with others. There's a couple who live on my street here who are like this.

I think that these criteria represent an improvement over DSM-IV.

1) The diagnostic criteria are more focussed, instead of the broad shopping list of clinical criteria from DSM-IV.
2) Furthermore, the requirement to meet all of the criteria under social communication and interactions and two of the three under behaviours keeps the diagnoses focussed on people who demonstrate the full range of autism traits, rather than selective characteristics.
3) Finally, the use of the term, "clinically significant" keeps the diagnosis focussed on those for whom the traits present a functional deficit that merits intervention, rather than mere inconvenience that can be accommodated or overcome.

Had these criteria existed when I was a child or a teenager, I would have been a slam dunk diagnosis.

However, as an adult, most of the time I will not present "clinically significant" traits. I have learned coping skills and developed filters to address my deficits, and most of the time these allow me to function quite happily. When my skills and filters break down, though then I drop back into "clinically significant" presentations.

Have I dropped off the spectrum? I don't think so. From time to time my presentations still trigger the "clinically significant" standard. But most of the time, I don't need professional help to get on with my life, so it stands to reason that during those times, I would not present traits that merit diagnosis.

Well, no one is arguing that having only one friend means one is autistic. Only that having one friend doesn't mean one isn't autistic.

That does not really make sense. If they mean plural to exclude people on the basis of the age of a single friend or a spouse, then what do different types of relationships have to do with anything? They could easily cover the kind of relationships you refer to by referring to "non-casual, voluntary social relationships". There are any number of ways the information could be conveyed without confusing the issue as this presentation does, if a single friendship or marriage-like relationship were intended to exclude a person from diagnosis.


If they can socialize fine with others (if they therefore choose to not develop and maintain relationships, rather than fail to do so) then they are not who the criteria refers to.

If your interpretation is correct, under this criteria, someone can be Autistic one day, not Autistic for a year, then when the one friend who will put up with them moves away, or dies, or stops putting up with them, they become Autistic again, even though Autism is construed as a stable developmental condition, (or in other words a condition that is not considered to be intermittent). I do not believe APA intends Autism diagnosis to be a potentially intermittent entity, determined by circumstantial factors rather than the functioning of the individual assessed.

There's various types of peer relationships people can have as they age; there's friends and the different types of such and there's romantic partners and the different types of such that come under here, both of which are the big ones and they come under the plural "relationships".

I've been doing some research, seeing how various professionals on the 'net interpret this criterion in the old DSM-IV-TR, and they say that it's a complete lack of social relationships/relations due to the difficulties of the ASD.

The DSM-IV-TR puts it as:

That's its complete description. It's hard to interpret, but I'm seeing an inability to develop such here ("lack of understanding" leads on to the social isolation that it describes elsewhere).

True. I wasn't told what they used to diagnose me with.

Definitely.

I was at my monthly meeting with the psych today. (I have to go once a month if I want the anxiety meds). I asked if I would still be diagnosed under the new criteria seeing that I am married. He said absolutely yes.

He hypothetically pointed out just becuase one is married, it doesn't mean ones relationship is appropriate at the proper developement level. For example, people get married for a whole host of reasons. Marriages of convienence, marriages because someone got pregnant, pre-arranged marriages (I work with someone who is in a pre-arranged marriage), mail-order brides (my brother has one of those), gold-diggers, Countless number of marriages have absolutely no relationship, but they stay together for the kids. His point was just becuase one is married, it doesn't mean it is at the appropriate developement level. People are married for allot of reasons other than relationships.

He also pointed (which I think was directed at me. I wish he'd use my name so I'd know for sure.) That even if you have an appropriate relationship in your marriage, you've never had one male friend in your 41 years of your life and that is developementaly inappropriate. Its not that I haven't tried or desired one, I just can't figure it out.

I think they are talking about Elvis.

OT- but I can't resist it:

someone said "slicing up meatloaf". meatloaf is a singer (who incidentally kinda looks like a meatloaf) it'd be cruel to slice him up.

To return to the other discussion all I can say is that the psychologist and neuropsychiatrist who diagnosed me considered me a clear case even though I've had boyfriends, a few friends when I was younger and now a husband and kids (the husband is hardly age appropriate though). I also have one friend I see on a regular basis but we usually talk mostly about autism.

I trust these diagnosticians, they're at the top of their field, alongside Gillberg, in Sweden.