Preliminary draft DSM-5 released

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Yes, what else would you expect to be described in a book about and entirely devoted to disorders?


That is not how that particular criteria item is applied in DSM-IV, so I doubt that it will be applied as you describe just because the edition number has changed.

To me, if interpreted sensibly, the problem with the criteria for adults, is not that the symptoms are missing in adults, but that they are much more difficult to observe, particularly in a clinical context. It would be much more plausible to observe lack of social reciprocity in a non-formal social setting for instance than in a clinical context.

I think it's great that the APA is actively seeking comments & suggestions regarding these proposed changes. Everyone has the chance to voice their opinion.

Last edited by zeichner on 10 Feb 2010, 2:20 pm, edited 1 time in total.

pandd,

I meant for people who have normal and appropriate social relations.

I think the new criteria are fine the way they are, but ONLY if they add a sub-clinical variant.

Why's it needed? Okay, consider these points.
1. Diagnosis is only useful when it leads to treatment. Therefore, things that don't need treatment, don't need diagnosis.
2. When a psychiatrist/psychologist treats a patient for one thing, he needs to know if the patient is atypical in one respect or another--even if that trait is not disabling. For example, he'd need to know that a patient was very introverted so he would know not to see social withdrawal as a depressive symptom; or he'd need to know that the patient came from an emotionally expressive culture so that he'd know not to assume the same strength of emotion as he'd assume from someone from a culture with more stoic emotional expression.

So those two things would seem to contradict each other. You don't need to diagnose something if it doesn't need to be treated; but you do need to make a note of it because the professional needs to know about it.

The solution is to add the sub-clinical variant. This would mean that all the people currently diagnosed, barely, with Asperger's, but not disabled by it, would be put in that sub-clinical category. That serves the purpose of a diagnosis admirably, because if people who are just-barely-diagnosable now need treatment, they tend to need it for things like depression, anxiety disorders, and social phobias--not for autism.

If they use this correctly, it would mean that the sub-clinical type would be put into your record, so that when you did need treatment, they would know that your social skills aren't too good, you tend to have obsessive interests, and you aren't very good with either language or conversation--but that your problem isn't that you need to be "normal"; it's that you have some other issue going on that's keeping you from living your life.

They seem to be adding sub-clinical variants (there was two), well, if the severity tier in the last update is adhered to.

I really hope so. It would be a travesty if people with these strong autistic traits were completely dissociated from the spectrum; even traits that aren't disabling have a large effect on your life, and need to play into any psychological treatment you might receive. If they don't recognize that autism fades into the typical, they will shortchange a lot of the borderline cases.

Will the number of symptoms (either individually from 1,2 or 3 or total amount of ~) be important? Or will it be that one symptom from 1, 2 and satisfying 3 will be enough?

It says all of 1 (the social and communication cluster), 2 of 2 (the repetitive behaviour cluster), in addition to 3 (the age of onset).

No doubt each cluster will be explained in its various manifestations, from severe to least severe (this can be seen as Wing's three levels of social severity, which were mentioned in the DSM-IV, but not in the point by point criteria), and then on to sub-clinical where people don't meet the criteria [but have one or two here and there that are affecting them and warrant a label].

What about those of us who weren't diagnosed using the DSM criteria, does this change apply to us? I've asked this question loads of times on these threads but no one's answered it yet.

Also I don't really want it to change, it was fine as it is.

if you weren't diagnosed with the DSM criteria- you weren't diagnosed....

have you been officail diagnosed? if so what was used to diagnose you if not the DSM? You might have to get rediagnosed

I'm an officially diagnosed Aspie, and what strikes me is that I don't consider myself impaired within myself. It is only the REACTION of NTs that leads to impairment. I write well and am articulate. You'd think communication would be A-OK. But NTs do not understand me or choose to interact.

So it is the behavior of others that leads to lack of peer relationships. It is my social regulation meter that is out of kilter with the norm out there. NTs sense a "difference" and stay away.

Ppl cannot relate to what I say. It seems I live in a different world, truly a different planet. My perceptions do not jive with theirs, but seem completely right to me.

I'm almost 50, and yes I can look other ppl in the eye, and speak, but it has no effect; it is as if I'm a wraith. What I say does not resonate as real to other ppl. But it is factual, 100% true, completely in accordance to reality.

Fortunately I take extreme relish in my special interests and am happy. But wraiths cannot function independently in this world. I'm disabled, but not because of me.

So I think the new criteria doesn't tell the whole story.

There are other criteria, such as ICD-10, Gilberg and Gilberg to mention two.

Well what do you know, NLD hasn't been included anywhere in the DSM. Again. ARGH!

But if all ASDs are now considered "Autistic Disorder" in the DSM, is the whole thing irrelevant? Would I simply be diagnosed with autism, not NLD, if I were retested, according to the DSM?

I don't get it

Yes I'm official. I used the DISCO (The Diagnostic Interview for Social and Communication Disorders) which is not as well known as the DSM and the gillberg, I think DISCO is only in Britain I'm not sure.

Last edited by MONKEY on 10 Feb 2010, 2:30 pm, edited 1 time in total.

Innawoodenhouse:
Why is NLD not included in DSM-IV under the PDD-NOS criteria? What are the characteristics of NLD that it is an Autistic Spectrum Disorder but fails to meet the criteria for PDD-NOS?

I always thought NLD was diagnosible in DSM as PDD-NOS, if not AS itself.