The Asperger’s Diagnosis Problem and Why it Matters

Asperger’s Syndrome was made an official diagnosis in the DSM-4 (1996) and was removed as a specific diagnosis in the DSM-5 (2013) by being bundled together with the broader diagnosis of Autism Spectrum Disorder. Today, I discuss what this change means for aspies, for those looking to be diagnosed, and the wider implications. If any of that sounds interesting, go ahead and give this article a read!

What’s the Deal with the DSM?

The Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, is the most respected and commonly used guide for diagnosing mental disorders in the United States (as well as many other countries). In it, medical professionals receive a template of what various mental disorders look like and the criteria for diagnosing various mental disorders.

In the case of Asperger’s, the DSM-4 uses these criteria for a diagnosis (data from DSM-IV-TR 299.80):

A: Severe and sustained impairment in social interaction
B: The development of restricted, repetitive patterns of behavior, interests, and activities.
C: Clinically significant impairment in social, occupational, or other important areas of functioning
D: No clinically significant delays or deviance in language acquisition
E: No clinically significant delays in cognitive development (other than in social interaction)

The above data has been edited down for brevity

Upon the creation of the DSM-5, Asperger’s as a diagnosis was removed and instead bundled with Autism Spectrum Disorder (ASD). The criteria for ASD is as follows (data from DSM-V 299.00):

A: Deficits in social communication across multiple contexts, as manifested by the following:

• Deficits in social-reciprocity, ranging from abnormal social approach; to reduced sharing of emotions.
• Deficits in nonverbal social interactions ranging from poorly used verbal and nonverbal communication skills; to a total lack of facial expressions and nonverbal communication.
• Deficits in developing and maintaining relationships, ranging from difficulties adjusting behavior to suit various social contexts; to absence of interest in peers.

B: Restricted, repetitive behavior
C: Symptoms must be present  in the early developmental period
D: Clinically significant impairment in social, occupational, or other import areas of functioning

The above data has been edited down for brevity

As can be seen with the above diagnosis criteria for Asperger’s and Autism Spectrum Disorder respectively, they clearly have notable differences. As such, I will now run through the differences I find most significant.

Asperger’s and Emotions

Aspies simply do not lack emotion. Unfortunately, the DSM-5 leans strongly to the side of those with Autism Spectrum Disorder not having emotion as a neurotypical might. Meanwhile, the DSM-IV holds more to the side of those with Asperger’s not being as capable of expressing those emotions in a typical fashion. This is a key difference, as the DSM-5 suggests those on the spectrum are unfeeling (objectively false), while the DSM-4 suggests that aspies simply express their emotions differently (frequently with significant difficulty).

The difference is massive and is one example of why Asperger’s should not be so simply bundled with Autism Spectrum Disorder in the DSM.

If you are interested in learning more about the relationship between aspies and empathy/emotion, I recommend checking out my article “Do Aspies have Empathy.”

Asperger’s and Social Ignorance

Another significant difference between the DSM-5 and the DSM-IV is the analysis of natural social ability. On one hand, there is the DSM-5 stating that those on the Autism Spectrum (including aspies) may show a complete lack of non-verbal communication and facial expressions. This view is extremely damaging as it reinforces doubts aspies already have about their social ability when such doubts need not be so large.

It is my opinion that the DSM-IV’s view on aspies’ social ability is more accurate, as it describes social deficits in a much more mild manner by suggesting that aspies simply have difficulty getting certain social interactions just right, rather than continually completely missing them.

In addition to this, aspies are perfectly capable of learning how the details of certain social interactions work. As can be seen in my article “How Aspies Improve Socially”

Asperger’s and “Typical” Desire for Relationships

The final major difference between the DSM-5 and DSM-IV is the analysis of if aspies desire relationships. The DSM-5 states that some aspies have a complete lack of interest in peers. Meanwhile, the DSM-IV only goes as far as to say that younger children might show little interest in making friends but will almost certainly seek out friendships later in life.

Takeaway

The differences between the two sets of criteria presented in the DSM-5 and the DSM-IV respectively are extremely problematic. What any version of the DSM has to say about a given mental disorder is critical to accurate diagnosis, appropriate help, and the mental health of the person receiving the diagnosis as well as those close to that person.

While the DSM-5 paints a picture of Asperger’s being little more than a disability, the DSM-IV has a tone of hope by suggesting that Aspies only struggle with specific problems (such as sensory and social interactions), rather than being generally disabled. The DSM-IV’s diagnosis of Asperger’s rather than Autism Spectrum Disorder provides a more precise and helpful diagnosis to both the Aspie being diagnosed and the support he or she has through family and friends.

As always, if you have any questions send them my way at “wouldaspie@gmail.com”

With that, I wish you all the best and thanks for reading!
Luke