Similarities & Differences: Why the DSM-V Makes Sense

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fragileclover
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09 Mar 2012, 4:59 pm

TheSunAlsoRises wrote:
Your link works perfectly, now.


Were you able to read the whole article? I managed to read the first paragraph, but then it re-directed to a page that said the article was for members only, and I had to register. I tried to read it again, with the same result. The article does initially show up, but only for a few seconds.


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Diagnosed with AS and Anxiety Disorder - NOS on 03/21/2012


TheSunAlsoRises
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09 Mar 2012, 5:12 pm

fragileclover wrote:
TheSunAlsoRises wrote:
Your link works perfectly, now.


Were you able to read the whole article? I managed to read the first paragraph, but then it re-directed to a page that said the article was for members only, and I had to register. I tried to read it again, with the same result. The article does initially show up, but only for a few seconds.


Yes, I was able to read the full article (initially i was redirected) but here is an alternative link.

http://www.psychologytoday.com/blog/dsm ... tion-dsm-5

It appears Dr. Frances has written extensively on the subject matter.

http://educationupdate.com/allenfrances/


TheSunAlsoRises



Dillogic
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09 Mar 2012, 5:28 pm

fragileclover wrote:
All it says is that the deficits are severe (compared to what?), and they interfere with, not prevent, the acquisition of basic skills. ... If the DSM-IV took ability to function into consideration, there wouldn't be high-functioning and low-functioning people with the same diagnosis. I think that is clear.


It's severe compared to a normal extroverted personality (that's what it's referring to). Interfere means exactly that, that it'll hinder it so some extent, which must be applied over Criterion C.

High functioning and low functioning aren't diagnostic terms; one just needs to meet the criteria, which by definition points to a disability. See:

Quote:
The disturbance must cause clinically significant impairment in social adaptation, which in turn may have a significant impact on self-suffiency or on occupational or other important areas of functioning (Criterion C). The social deficits and restricted patterns of interest, activities and behaviors are the source of considerable disability.



fragileclover
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09 Mar 2012, 5:52 pm

Dillogic wrote:
fragileclover wrote:
All it says is that the deficits are severe (compared to what?), and they interfere with, not prevent, the acquisition of basic skills. ... If the DSM-IV took ability to function into consideration, there wouldn't be high-functioning and low-functioning people with the same diagnosis. I think that is clear.


It's severe compared to a normal extroverted personality (that's what it's referring to). Interfere means exactly that, that it'll hinder it so some extent, which must be applied over Criterion C.

High functioning and low functioning aren't diagnostic terms; one just needs to meet the criteria, which by definition points to a disability. See:

Quote:
The disturbance must cause clinically significant impairment in social adaptation, which in turn may have a significant impact on self-suffiency or on occupational or other important areas of functioning (Criterion C). The social deficits and restricted patterns of interest, activities and behaviors are the source of considerable disability.


I never said that they were diagnostic terms. I said that the DSM-IV doesn't take level of functioning into account when diagnosing Autism vs. AS vs. PDD-NOS, and you argued it did. I don't see anything in your arguments to prove that. Yes, it mentions that the ability to function 'normally' is impacted, but since function and disability are both scales, that language leaves people who are severely disabled or unable to function with the same diagnosis as someone who is mildy disabled and able to function. That is a problem, as I see it.

With the DSM-IV, take away the development of language ability on time from the Asperger's diagnosis, and those with classic autism would qualify, which means that we ALL have a certain diagnostic set of autistic traits, no matter what our official diagnosis (Autism, AS, or PDD-NOS), but it's the severity of our traits that really sets us apart. Who is more likely to share experiences...a high-functioning person who developed language on time and a low-functioning person who developed language on time...or two high functioning/low functioning persons, one who developed language on time, the other who didn't? I think it would be obvious the people who have similar levels of function would be the most similar.

With that in mind, I think the DSM-V makes more sense than the current DSM. I'm by no means saying it's perfect...it's flawed, but no more flawed than the current edition, as far as I can tell.


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Aspie Quiz: AS - 141/200, NT - 77/200 (Very likely an Aspie)
AQ: 34/50 (Aspie range)
EQ: 32 / SQ: 68 (Extreme Systemizing / AS or HFA)
Diagnosed with AS and Anxiety Disorder - NOS on 03/21/2012


enrico_dandolo
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09 Mar 2012, 8:21 pm

I feel the most important aspect of the new criteria is the elimination arbitrary distinction between high-functionning autism and Asperger's syndrome. From what I have read, there was no methodologically valid distinction between the two conditions.

The ASD diagnosis basically says: "Welcome to the spectrum! Ask for the help you need, and don't receive that which you don't want." In the old one, it plainly means that if you had no speech delay, then you don't have "autism proper", which means you have Asperger's or something else, which seems to be understood as "mild" -- just because you could speak at the same age as the others. I don't think that makes sense.

The idea of the spectrum existed before DSM-V. I mean... the banner here says "The online resource and community for Autism and Asperger's". The assimilation of high-functionning autism and Asperger's syndrome was already something that was discussed.

From what I have seen, for all disorder categories I have checked (of which there are few, but anyway), the new DSM seems to be much more adaptable to clinical situations. There are fewer tags and labels, but leave more space to particularities of every case, of every patient. Go check the personality disorders: they cut half of them out and replaced them with a trait system. I am obviously not an expert, but it seems more comprehensive and flexible, prima facie.

For the "perception by others" aspect, "multiple personality disorder" is dead and burried in the DSM, and people still say that. I don't believe a treatment that works will be changed just because the criteria have changed. I doubt the publication of the new edition will be have far-reaching consequences, for better or for worse, to anyone but academics and searchers.



Rascal77s
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09 Mar 2012, 8:52 pm

TheSunAlsoRises wrote:
fragileclover wrote:
TheSunAlsoRises wrote:
Your link works perfectly, now.


Were you able to read the whole article? I managed to read the first paragraph, but then it re-directed to a page that said the article was for members only, and I had to register. I tried to read it again, with the same result. The article does initially show up, but only for a few seconds.


Yes, I was able to read the full article (initially i was redirected) but here is an alternative link.

http://www.psychologytoday.com/blog/dsm ... tion-dsm-5

It appears Dr. Frances has written extensively on the subject matter.

http://educationupdate.com/allenfrances/


TheSunAlsoRises


Thanks for finding these I'm going to call you TSAR if you don't mind. Easier to type and the word for Russian kings :wink:



Dillogic
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09 Mar 2012, 8:53 pm

It doesn't need to take level of impairment into account insofar as just meeting the threshold of symptoms and severity (which is level of impairment in reality). The point is that you need to be disabled in the ways outlined; it's not a competition, so if you meet what is outlined, you have that. Someone may be better or worst than you, but that's really of no concern as far as a diagnosable entity is concerned (take for example any mental disorder and you have the same thing).

Somewhat, yes, the symptoms overlap as of AS and AD, though each criterion has a different manifestation as per the the expanded text; problems with reciprocal interaction are two different things for AS and AD, as it points out in the text, for example. They're removing this, probably because people often ignored the expanded text (this is professionals), and went with their own subjective clinical experience with labels.

Your problem with various levels of severity is the point of the "spectrum", though as defined, the mildest diagnosable end needs considerable disability in the ways outlined (DSM-IV-TR and the proposed DSM-V), so it's moot in regards to reality. If you have it, you have it, and comparing yourself to others isn't going to help anything. It's not a club where people go into their little respective corners and hang together.



Rascal77s
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09 Mar 2012, 8:55 pm

enrico_dandolo wrote:
I feel the most important aspect of the new criteria is the elimination arbitrary distinction between high-functionning autism and Asperger's syndrome. From what I have read, there was no methodologically valid distinction between the two conditions.

The ASD diagnosis basically says: "Welcome to the spectrum! Ask for the help you need, and don't receive that which you don't want." In the old one, it plainly means that if you had no speech delay, then you don't have "autism proper", which means you have Asperger's or something else, which seems to be understood as "mild" -- just because you could speak at the same age as the others. I don't think that makes sense.

The idea of the spectrum existed before DSM-V. I mean... the banner here says "The online resource and community for Autism and Asperger's". The assimilation of high-functionning autism and Asperger's syndrome was already something that was discussed.

From what I have seen, for all disorder categories I have checked (of which there are few, but anyway), the new DSM seems to be much more adaptable to clinical situations. There are fewer tags and labels, but leave more space to particularities of every case, of every patient. Go check the personality disorders: they cut half of them out and replaced them with a trait system. I am obviously not an expert, but it seems more comprehensive and flexible, prima facie.

For the "perception by others" aspect, "multiple personality disorder" is dead and burried in the DSM, and people still say that. I don't believe a treatment that works will be changed just because the criteria have changed. I doubt the publication of the new edition will be have far-reaching consequences, for better or for worse, to anyone but academics and searchers.


Many practicing clinicians would disagree with you.



enrico_dandolo
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09 Mar 2012, 9:54 pm

On what points precisely? It is a half-informed opinion, so if you want to give me the other half that might make me fully informed, you may.



Tuttle
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09 Mar 2012, 11:17 pm

Dillogic wrote:
Somewhat, yes, the symptoms overlap as of AS and AD, though each criterion has a different manifestation as per the the expanded text; problems with reciprocal interaction are two different things for AS and AD, as it points out in the text, for example. They're removing this, probably because people often ignored the expanded text (this is professionals), and went with their own subjective clinical experience with labels.


And what do you do with someone who fits some of the AS examples, and some of the classic autism examples.

It's not nearly so clear cut as you're discussing it.



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10 Mar 2012, 12:56 am

enrico_dandolo wrote:
On what points precisely? It is a half-informed opinion, so if you want to give me the other half that might make me fully informed, you may.


Would you like to scroll up and click the links or do you want me to paste them again? Oh NM..... Thank you for allowing me the opportunity to fully inform you oh great one (bowing down as I type). Lets start with this one and if you are still not feeling fully informed let me know and I'll copy and paste the other one from a few posts up.

http://www.psychologytoday.com/blog/dsm5-in-distress/201201/apa-should-delay-publication-dsm-5



enrico_dandolo
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10 Mar 2012, 1:11 am

Yes, I had read it. I found it very informative, but I don't think it adressed what I was saying.



Dillogic
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10 Mar 2012, 1:58 am

Tuttle wrote:
And what do you do with someone who fits some of the AS examples, and some of the classic autism example.


It actually says that in a percentage of people it's hard to tell between the two. This would be the HFA and AS overlap and where they meet on the "spectrum". Hence, the DSM-V and the "spectrum".



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10 Mar 2012, 2:16 am

Dillogic wrote:
Tuttle wrote:
And what do you do with someone who fits some of the AS examples, and some of the classic autism example.


It actually says that in a percentage of people it's hard to tell between the two. This would be the HFA and AS overlap and where they meet on the "spectrum". Hence, the DSM-V and the "spectrum".


I was mostly meaning that for the people who are being anti-DSM-5. I'm solidly pro DSM-5 and in general not splitting people into different labels and making people deal with the stereotypes of the label they have.

The DSM-5 is far better for describing me than the DSM-IV is, I'm sure.



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10 Mar 2012, 4:07 am

enrico_dandolo wrote:
Yes, I had read it. I found it very informative, but I don't think it adressed what I was saying.


I think the fact that a bunch of psychiatrists feel that standards set by the DSM 5 are nearly impossible to use in a clinical setting is pretty significant. It's one thing to feel that the standards apply to you, because you know yourself. It's another thing for a clinician to figure out how they apply to you because the clinician can't be you. Basically the gripe is that the tolerances are too tight considering the clinician is dealing with many kind of impairments. If some of you feel that the DSM 5 is more clear at the expense of a bunch of people being f****d over and losing access to services thats your perogative. But life isn't a research study and what's missing from the DSM 5 is the human factor.



enrico_dandolo
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10 Mar 2012, 5:22 am

Rascal77s wrote:
enrico_dandolo wrote:
Yes, I had read it. I found it very informative, but I don't think it adressed what I was saying.


I think the fact that a bunch of psychiatrists feel that standards set by the DSM 5 are nearly impossible to use in a clinical setting is pretty significant. It's one thing to feel that the standards apply to you, because you know yourself. It's another thing for a clinician to figure out how they apply to you because the clinician can't be you. Basically the gripe is that the tolerances are too tight considering the clinician is dealing with many kind of impairments. If some of you feel that the DSM 5 is more clear at the expense of a bunch of people being f**** over and losing access to services thats your perogative. But life isn't a research study and what's missing from the DSM 5 is the human factor.

I didn't say it applied better to me. The opposite would be true, but then, I'm not yet officially diagnosed, so maybe neither apply. I didn't say it was clearer either. I never said any of that. What I said what, basically, that it seems nicer and shinier, and that it seemed easier to adapt to individuals, instead of just creating labels for every slight variety of the same thing.

Actually, I don't even remember your link mention Asperger's at all, though I may be wrong. It attacked the DSM-V in general.

One thing I said, though, is I strongly doubt that clinicians will magically change their methods because of a change in the DSM. If so many of them disagree with it, they will continue using the DSM-IV, or ICD-10, or whatever they want. The practical consequences of this change on individuals seems overblown to me.