Friday, July 27, 2012

Let's talk about the DSM-IV

The DSM-IV is an important document in today's mental health field. Honestly... it is the MOST important document in the field.

DSM is an acronym for Diagnostic and Statistical Manual. It is a catalogue of Mental Disorders as defined by the American Psychiatric Association. In the US, it is used to describe, classify and diagnose mental illness. I say in the US because I have no idea how they do it in the rest of the world.
For those of you who don't play D&D, this is what
it used to look like. Now, it just looks like a complete
library of geeky goodness. 

Since the book was published in 1952, it has been revised 5 times. In 1994 they published the DSM-IV (that's the fourth version)... Then they released a "text revision" in 2000... I don't know what that means... I mean, really... I have no clue. The image that pops into my head is the old monstrous manual from Advanced Dungeons & Dragons.

Okay... I know, it's boring as hell, but trust me when I tell you that there is a good reason for talking about it.

You see... sometime this year they are releasing an entirely new version of the DSM. It is the DSM-V. The fifth revision of the manual.

I am concerned. According to the information I have received in recent days, there are some uncomfortable changed involved in this revision of the DSM. I am sure there are other changes... Many changes that I am not aware of... but I am only concerned with one change.

According to my sources (which has been the review committee for the American Psychiatric Society), Asperger's Syndrome is not going to be in the DSM-V.

Let me explain a couple things. According to recent studies, incidents of Autism have skyrocketed in recent years. The CDC states that 1 in 88 children has an autism spectrum disorder. Further, 1 in 8 children has a pervasive developmental disorder.

The reasons for this sudden explosion of Autistic Spectrum Disorders are manifold. Some argue that vaccines have been causing brain damage. Others state it's diet... or cell phones or alien DNA... immune deficiencies, food allergies, nutritional deficiencies... There are crazier theories... but I have a personal one.
Crazy theories abound... right?

First of all, as the DSM has advanced and the information spread, Mental Health Professionals were given comprehensive diagnostic criteria and as such, Autism Spectrum Disorders were diagnosed more often.

Speaking of more often... In an effort to ensure that patients were taken care of, mental health professionals were looking for a diagnosis for the people that had problems socializing. Asperger's seemed to fit, so they slapped it onto the patients.

While the doctors thought they were helping, they were doing more harm than good.

You see, in my opinion, most of the people that are diagnosed with Asperger's Syndrome are diagnosed incorrectly. Every geek and nerd I have met feels that they fit the diagnostic criteria for Asperger's Syndrome. As such, too many people have been diagnosed with a disease they don't have.

It hurts them, as they are subjected to treatment plans that include Rx (drugs) that they don't need, therapy that is geared to training the AS brain to understand Neurotypical behavior, and ridicule from those who don't understand what it means to be on the spectrum.

Worse yet, these people who have NT brains, but simply lack social skills are subjected to ridicule from Spectrum individuals and more significantly, Aspies. It is hard on the misdiagnosed... I will admit, I have been guilty of the harsh behavior to those that are misdiagnosed. It's not their fault, but their behavior is (typically) rude, pushy and obnoxious. They have a sense of entitlement that just... rubs me the wrong way.

I can't blame them for clinging so strongly to their diagnosis. They have grown up not belonging and finally end up with someone with a certain level of expertise tells them that they have a disease (Yes, it is a disease... we'll go into that some other time.). Then, they are able to say "Oh, thank god! That's what's wrong with me!"

We, as primates, have this need to be accepted. The diagnosis fulfills that need. If you are sick, you have a reason to be odd. If you are odd because you are... just odd... you don't belong. That trap of cognitive dissonance holds them in a vice grip that most cannot escape.

Yes, I am saying it... the prevalence of autism in the United States is pretty much due to misdiagnosis. I do not blame the healthcare professionals for it. They are under an astounding amount of pressure from parents to find out what is wrong with their children.

I don't blame the parents... they want what is best for their children.

I blame the DSM-IV for it. The diagnostic criteria for Asperger's Syndrome is relatively vague...

Here it is:
(I) Qualitative impairment in social interaction, as manifested by at least two of the following:
        (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial 
        expression, body posture, and gestures to regulate social interaction
        (B) failure to develop peer relationships appropriate to developmental level
        (C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, 
        (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
        (D) lack of social or emotional reciprocity

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
        (A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is 
        abnormal either in intensity or focus
        (B) apparently inflexible adherence to specific, nonfunctional routines or rituals
        (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex 
        whole-body movements)
        (D) persistent preoccupation with parts of objects

(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

As you can see, the DSM needs revision. It needs to be rewritten to have more stringent diagnostic criteria.

Ironically, this is why I am upset. In the DSM-V, Asperger's is no longer a valid diagnosis. It has been removed. It's gone. Kaput.

This seems like a mistake to me. While this will cut down on the incidents of spectrum disorder diagnoses. There will be a lot of people who will just have to accept that there is nothing wrong with them. They just stared at the TV, played video games and lived on the internet and as such missed out on the cognitive development and socialization that most children get naturally.
Being a geek or a nerd doesn't make
you mentally ill!

Seriously... There are a lot of people that will just be nerds, geeks and misfits. And you know what? That's absolutely fine. If you are a nerd, geek or a misfit... REVEL IN IT. BE THAT AND BE PROUD!

That being said, the DSM-V NEEDS to have Asperger's Syndrome in it. While very few of those that are diagnosed with it are actually on the spectrum, those that are... NEED those treatment regimens. They need the help, the therapy and the Rx for their beleaguered brains. Getting rid of the illness in the manual does not remove it from existence.

I am outraged. You should be, too. If you're not... you're not paying attention.

Images in this issue were SHAMELESSLY stolen from the following sources:

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