Tuesday, November 22, 2011

My review of the DSM IV

       Clinical information like you'd find in the DSM can be easily taken out of context and sometimes sounds worse than it is. I don't really blame the DSM since it was written the way it was for a reason and meant for professional use. Not much is black and white in psychology. The manuals are good for identifying patterns not necessarily as absolutes. As time goes by these tend to change as more is understood about certain conditions and new categories form. What I will do here is go through the lines in the DSM describing Aspergers Syndrome (only on form of Autism) and explain how it affects my life and give an "unprofessional" point of view.
(BTW I need to add I am going to presume some knowledge on the part of anyone reading this to have some background about what Autism or Aspergers is. I don't want to rewrite all of the good information that is already on the net. If a word is not familiar or if one needs more info they could ask me or just highlight a word or phrase and Google it.
Now to start with these "symptoms":

[The following is from Diagnostic and Statistical Manual of Mental Disorders: DSM IV]
(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. This is one of the big things. Eye contact can be a problem for those on the spectrum. Many autistic people have a problem managing eye contact and either avoid it, or use it too intensely. Either extreme can cause a person to be severely misunderstood. Also there is difficulty with non-verbal communication. I'm OK with the basics of it but I'd want to point out that there is more to it than "body language". We communicate non-verbally all the time and don't realize it yet most people take it for granted. Everything from tone of voice, the way we dress, our mannerisms, our actions and many other things are part of non-verbal communication. Context orientation is also a big thing. Although written communication and sign-language may be non-verbal in a technical sense it is still direct communication and usually not as much of a problem for Autistic people as higher context communication.
    (B) failure to develop peer relationships appropriate to developmental level  When I was little I tended to get along better with kids who were a little younger, OR better yet, with older adults. I think part of this is the more differences between people and their "peers" the less people notice differences or compare you to them. One is therefore judged less. When there is a generational or even a cultural difference, people tend to overlook some minor eccentricities thinking it must be a generational or cultural thing. Lets say you have an acquaintance from a foreign country and you display odd behavior, a person my dismiss it as a cultural difference they they don't yet understand if they even notice any difference at all.
    (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) This I think can go one extreme or another. Sometimes the person can share their interests too aggressively and miss signs that others are not interested. And sometimes, we know our interests are unusual and just don't want to bore anybody. Generally I do like to share my interests to those who are interested and I will in this blog. The beauty of a blog is that if people are not interested, they don't have to read it.
    (D) lack of social or emotional reciprocity OK this one gets severely misunderstood. Literally the term "autistic" means self centered. We hear terms such as "ego-centered" and lack of empathy. Much of the problem is people misunderstand what these terms mean. Empathy for example is not the same as compassion. There are different types of empathy and to save me a little time look up the word "empathy" on Wikipedia. This does not mean Autistic people cannot be altruistic or compassionate. It does not mean that we can't understand or apply "The Golden Rule", we just might take it too literally at times. Ego-centered does not mean egotistical or Narcissistic. It also does not mean we can't understand basic "give and take" but sometimes we might have a delay in applying it spontaneously. Empathy is a gift and a tool. It can be used for good or evil just like fire. Compassion on the other hand is a virtue more tied with a person's character.  
    (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 The term "stereotyped" here I think is just a clinical term for compulsive behaviors not the "All Italians eat pasta" kind of stereotype.
    (B) apparently inflexible adherence to specific, nonfunctional routines or rituals This does not mean that we are boring people who never want change or would never try anything new. I for example love trying new things, especially food. I think this has more to do with adapting to sudden or unexpected changes that we have no control over.
    (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements) These "self-soothing behaviors sound at first like something typical of those who are mentally challenged. Yet if we think about it we all have a little bit of this in us. People figit, tap their foot, talk to themselves, use rocking chairs all the time and never question why their doing it. Autistic people just do this stuff more and might lack the social awareness to know when to do these things and when not to. Most people know not to talk to themselves in public but some might not be as aware that other people are nearby and observing them.
    (D) persistent preoccupation with parts of objects Hmmm, do I love parts of objects? This one sounds strange. I'd say the point of this one refers to fragmented thinking and a tendency to see things in terms of parts as opposed to holistic thinking.
    (III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning. Absolutely, there are people who show traces of Autistic traits but will go on to lead normal lives and never get diagnosed or have any need to. Also conditions like Obsessive Compulsive Personality Disorder can have overlap traits which can be mistaken for mild Aspergers at times but is not the same thing. For more on what OCPD is (which is also not to be confused with OCD), just google the terms.
    (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)This part is what really seems to distinguish Asperger Syndrome from classic Autism. I know I learned to talk early yet many on the spectrum talk late or not at all. For me I think learning to talk and even read early was a way of compensating for difficulties in non-verbal communication.
    (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."
      Good point, I think many people who may have been diagnosed with mild Schizophrenia years back may have been mildly Autistic. Before Schizophrenia was understood, people would have all sorts of theories all the way down to demonic influence.

1 comment:

  1. a good description of a confusing disorder....