Can someone please explain the DSM?
It is not my understanding at this time that the DSM5 has 3 levels of ASD. What I see (on page 51) is two "severity specifiers" which correspond to "Diagnostic Criteria A" and "Diagnostic Criteria B" (on page 50). The two specifiers are "Social communication" (with three levels, 1 being lowest "requiring support", 2 being the middle "requiring substantial support", and 3 being the highest "requiring very substantial support" - for use with "Diagnostic Criteria A") and "restricted, repetitive behaviors" (also with three levels - for use with "Diagnostic Criteria B").
Page 52 is the complete rubric.
I will elaborate when I have more time.
The text also says the level may be below 1 (which suggest to me that there are fractional levels which may be used by a professional in a diagnosis). It also says the severity may fluctuate over time.
When my son was diagnosed with ASD he was given different levels for each, and one was "level 1.5".
As far as statistics - on page 55 it say the "Prevalence" of ASD is 1% of the population.
There is a lot of text in addition to the "Diagnostic Criteria", including "Recording Procedures" and "Specifiers" and so on.
_________________
ADHD-I(diagnosed) ASD-HF(diagnosed)
RDOS scores - Aspie score 131/200 - neurotypical score 69/200 - very likely Aspie
Info dumping.
I copied this from another web site - I tried to format it so it would fit in a post.
This is the DSM-IV (DSM version 4) diagnostic criteria for Asperger's Disorder and the DSM-V (DSM version 5) diagnostic criteria for ASM (Autism Spectrum Disorder - which absorbed the previous DSM-IV Asperger's diagnostic category).
If anyone still has a question about any of the specific language - as in "what does that word mean" OR a question of what this really means to you or someone you care about - your feeling of identity or your day-to-day living - please cut and paste the part that concerns you and ask your question to the Wrongplanet community.
From:
https://www.iancommunity.org/cs/about_asds/about_asds_dsm_iv_criteria_for_aspergers_syndrome
DSM IV Criteria for Asperger's Disorder*
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye
gaze, facial expression, body postures, and gestures to regulate social
interaction.
2. failure to develop peer relationships appropriate to developmental level.
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with
other people (e.g. by a lack of showing, bringing, or pointing out objects of
interest to other people).
4. lack of social or emotional reciprocity.
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities,
as manifested by at least one of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns
of interest that is abnormal either in intensity or focus.
2. apparently inflexible adherence to specific, nonfunctional routines or rituals.
3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements).
4. persistent preoccupation with parts of objects.
C. The disturbance causes clinically significant impairment in social, occupational, or
other important areas of functioning
D. 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).
E. There is no clinically significant delay in cognitive development or in the
development of age-appropriate self-help skills, adaptive behavior (other than
social interaction), and curiosity about the environment in childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder or
Schizophrenia.
Reference
*American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington DC: Author. (Pg. 84)
Additional Resources:
See
ICD-10 Diagnostic Criteria for Asperger's Syndrome.
https://www.iancommunity.org/cs/about_asds/icd10_criteria_for_diagnosing_aspergers_syndrome
See the
2013 DSM-5 Diagnostic Criteria for Autism Spectrum Disorder, which takes the place of Asperger's Disorder.
https://www.iancommunity.org/diagnostic-criteria-autism
https://www.iancommunity.org/diagnostic-criteria-autism
Diagnostic Criteria for Autism Spectrum Disorder
Date Published:
December 2, 2013
The following is an excerpt from the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
pages 50-51, 52.1
Autism Spectrum Disorder (299.00) [F84.0]
Diagnostic Criteria
A. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by the following, currently or by history (examples are
illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal
social approach and failure of normal back-and-forth conversation; to reduced
sharing of interests, emotions, or affect; to failure to initiate or respond
to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction,
ranging, for example, from poorly integrated verbal and nonverbal communication;
to abnormalities in eye contact and body language or deficits in understanding
and use of gestures; to a total lack of facial expressions and nonverbal
communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging,
for example, from difficulties adjusting behavior to suit various social
contexts; to difficulties in sharing imaginative paly or in making friends; to
absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive
patterns of behavior (see Table 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested
by at least two of the following, currently or by history (examples are
illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g.,
simple motor stereotypies, lining up toys or flipping objects, echolalia,
idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns
or verbal nonverbal behavior (e.g., extreme distress at small changes,
difficulties with transitions, rigid thinking patterns, greeting rituals, need
to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus
(e.g, strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory
aspects of the environment (e.g., apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive smelling or touching
of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive
patterns of behavior (see Table 2).
C. Symptoms must be present in the early developmental period (but may not become fully
manifest until social demands exceed limited capacities, or may be masked by learned
strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning.
E. These disturbances are not better explained by intellectual disability
(intellectual developmental disorder) or global developmental delay. Intellectual
disability and autism spectrum disorder frequently co-occur; to make comorbid
diagnoses of autism spectrum disorder and intellectual disability, social
communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder,
Asperger's disorder, or pervasive developmental disorder not otherwise specified
should be given the diagnosis of autism spectrum disorder. Individuals who have
marked deficits in social communication, but whose symptoms do not otherwise meet
criteria for autism spectrum disorder, should be evaluated for social (pragmatic)
communication disorder.
Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
(Coding note: Use additional code to identify the associated medical or genetic condition.)
Associated with another neurodevelopmental, mental, or behavioral disorder
(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition)
(Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)
TABLE 2 Severity levels for autism spectrum disorder
Severity level Social communication Restricted, repetitive behaviors
Level 3 Severe deficits in verbal and Inflexibility of behavior, extreme
"Requiring very substantial support" nonverbal social communication difficulty coping with change, or
skills cause severe impairments other restricted/repetitive
in functioning, very limited behaviors markedly interfere with
initiation of social functioning in all spheres. Great
interactions, and minimal distress/difficulty changing focus
response to social overtures or action.
from others. For example, a
person with few words of
intelligible speech who rarely
initiates interaction and, when
he or she does, makes unusual
approaches to meet needs only
and responds to only very
direct social approaches
Level 2 Marked deficits in verbal and Inflexibility of behavior,
"Requiring substantial support" nonverbal social communication difficulty coping with change,
skills; social impairments or other restricted/repetitive
apparent even with supports behaviors appear frequently
in place; limited initiation enough to be obvious to the
of social interactions; and casual observer and interfere
reduced or abnormal responses with functioning in a variety
to social overtures from of contexts. Distress and/or
others. For example, a person difficulty changing focus or
who speaks simple sentences, action.
whose interaction is limited
to narrow special interests,
and who has markedly odd
nonverbal communication.
Level 1 Without supports in place, Inflexibility of behavior
"Requiring support" deficits in social causes significant
communication cause noticeable interference with functioning
impairments. Difficulty in one or more contexts.
initiating social Difficulty switching between
interactions, and clear activities. Problems of
examples of atypical or organization and planning
unsuccessful response to hamper independence.
social overtures of others.
May appear to have decreased
interest in social
interactions. For example, a
person who is able to speak
in full sentences and engages
in communication but whose to-
and-fro conversation with
others fails, and whose
attempts to make friends are
odd and typically
unsuccessful.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Additional Resources:
Redefinition: Autism, Asperger's, and the DSM-5
https://www.iancommunity.org/cs/simons_simplex_community/dsm5_and_asd
_________________
ADHD-I(diagnosed) ASD-HF(diagnosed)
RDOS scores - Aspie score 131/200 - neurotypical score 69/200 - very likely Aspie
Sweetleaf
Veteran
Joined: 6 Jan 2011
Age: 34
Gender: Female
Posts: 34,487
Location: Somewhere in Colorado
It is just a book with the most current definitions and symptom lists for various mental disorders and conditions. They update it every few years to make it more accurate. Mostly mental health professionals use it, that said I kinda still want a copy of it just to read I have no interest in getting involved with mental health work though. But basically it is kinda like an encyclopedia or guide on mental health issues and conditions people can have.
_________________
We won't go back.
Gawd! Some folks asked to be walked through every little thing.
You COULD google terms you dont understand.
Executive Function/dysfunction has to do with managing things (in your life or job or whatever). Like a business executive. Doing the laundry, housework, balancing your checkbook, and like that.
An idiot savant (to take an extreme example) might be the greatest piano virtuoso in the world, but might not be able to dress themselves in the morning. That would be an extreme example of a person with a skill, but has executive dysfunction. Many autistics are like mild idiot savants like that. Have tunnel vision extreme skills but lack day to day survival or managing other folks skills.
Gawd! Some folks asked to be walked through every little thing.
You COULD google terms you dont understand.
Executive Function/dysfunction has to do with managing things (in your life or job or whatever). Like a business executive. Doing the laundry, housework, balancing your checkbook, and like that.
An idiot savant (to take an extreme example) might be the greatest piano virtuoso in the world, but might not be able to dress themselves in the morning. That would be an extreme example of a person with a skill, but has executive dysfunction. Many autistics are like mild idiot savants like that. Have tunnel vision extreme skills but lack day to day survival or managing other folks skills.
Sorry...must be my comprehension
Executive dysfunction means that the part of the brain which is supposed to do the "Executive Function" job isn't working as it should.
Executive Function is actual a complicated thing which really is hard to understand.
For me it goes like this:
the brain has many parts and each part has a job to do.
In a similar way the digestive system has many parts and each part has a job to do. The teeth, the tongue, the throat, stomach, the large intestine the small intestine are all part of the digestive system. The throat does a different job than the stomach does.
The parts of the brain are a bit harder to understand. One part is good at understanding the things we hear, another part at converting what we hear into ideas - it interprets language, words and "I think that sound was a bus". There are parts that allow us to speak and move our hands and feet. There are lots of parts to the brain - I have only mentioned some of them.
Several parts of the brain deal with memory and thinking - you need these parts for school. In the front part of the brain near and above where your eyes are is called the "prefrontal cortex" = the word "prefontal" means "the front part - the word "cortex" means "part of the brain". The prefrontal cortex has the job of trying to make all the other parts work well together. This job is kind or like the job of a "boss" in a big company. The boss in a big company is called "the executive". The boss might also have a secretary who is in charge of keeping the boss organized - making sure the phone is answered, and the mail is opened and the important messages get to the boss first - keeping the calendar up to date and making sure the boss doesn't miss his appointments. The secretary also keeps the mail and special reports filed in the filing cabinet and makes sure that the most important paper is on her desk - or on the boss's desk. The name of this job is "executive secretary". The executive secretary works for the boss, who is the executive.
The part of the brain that is supposed to keep all the other brain functions in order is sometimes called the "executive function" or the "executive functions". This part is important - sometimes the word is singular: "function" and sometimes it is plural "functions". The "executive function" (singular) is a group of functions that (should) work together to keep the rest of the brain parts working well together. Like a super hero team, like "The Avengers" or like a team or horses - six horses pulling one wagon - or like the boss and the 5 people who work just for him might be called "the executive team". The "executive functions" (plural) are the team members - like Cap and Iron Man and Wonda - or the individual horses - or like the people who are members of "the executive team".
The "Simple English Wikipedia" lists these functions:
https://simple.wikipedia.org/wiki/Executive_functions
Attentional Control - the ability to choose what to pay attention to
Cognitive Inhibition - the ability to tune out distractions
Inhibitory Control - the ability to practice restraint
Working Memory - the ability to store information temporarily in order to effectively perform complex tasks
Cognitive Flexibility - the ability to think about multiple things at the same time, and to switch between tasks
This is a good basic list - but the the real details are actually more complicated than that.
Scientists and psychologists and educators are really still trying to understand the brain. We know a lot but there is also a lot more we don't know. People are still coming up with ideas to help understand the "Executive Functions" and to find out how they work. The regular, normal English Wikipedia lists some of those ideas.
https://en.wikipedia.org/wiki/Executive ... ons#Models
Some teachers and coaches can help to improve a person's executive functions if they don't work well, but they cannot really be "fixed". Some people find that taking medicine like Ritalin helps to improve - or at least change - the working of the executive functions - but like being deaf in one ear it may nor be something that can really be fixed. A hearing aid might help some - but the real problem will never be "fixed".
When it comes to executive functions everyone can improve but only so much.
_________________
ADHD-I(diagnosed) ASD-HF(diagnosed)
RDOS scores - Aspie score 131/200 - neurotypical score 69/200 - very likely Aspie
How do each of these translate to everyday tasks and jobs?
Thank you.
Attentional Control - the ability to choose what to pay attention to
Cognitive Inhibition - the ability to tune out distractions
Inhibitory Control - the ability to practice restraint
Working Memory - the ability to store information temporarily in order to effectively perform complex tasks
Cognitive Flexibility - the ability to think about multiple things at the same time, and to switch between tasks
It’s still very confusing since kids may have talked on time but with very limited speech full of echolalia.
They would be classified as having Aspergers.
You would have kids with no noticeable speech problems in childhood who talk on time possibly like Ellon Musk labeled as Aspergers as well.
So two very different presentations under the same label
They say Aspergers kids can’t have ID for a diagnosis but ID also exists outside autism
_________________
"The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends upon the unreasonable man."
- George Bernie Shaw
Thank you.
Attentional Control - the ability to choose what to pay attention to
Cognitive Inhibition - the ability to tune out distractions
Inhibitory Control - the ability to practice restraint
Working Memory - the ability to store information temporarily in order to effectively perform complex tasks
Cognitive Flexibility - the ability to think about multiple things at the same time, and to switch between tasks
Here are some examples from my life. Perhaps some other people can give examples from their own lives.
Attentional Control: I am diagnosed ADHD - sometimes I have "hyper active attention" the thing my brain is paying attention to right now jumps around - like a kid who cannot keep still in his seat - but I don't need to move to change my attention - I might be having a conversation with someone and my mind starts to wonder - or I am doing something at work and I go to look up a word on the internet, then that reminds me of a song, so I try to find the lyrics, and that reminds me or a tv show so I go read about the show on wikipedia and it lists the actors and I am curious about the career of one of the minor character's actor so I look up what else that person did and (so on). At other times I "get stuck" on something and hyper focus - it may be one small thing that I HAVE TO FIGURE out or I might spend hours with steel wool getting the bottom of the pot perfectly shiny - I might keep talking about my favorite subject even though I know the people I am talking to have lost interest - or I may need to know EVERYTHING about a specific kind of computer - or software. Being too focused on the wrong thing (or even on the right thing) is called "hyper-focus" in ADHD circles. Being stuck on a special interest is called "Perseverating" in ASD circles.
Cognitive Inhibition - this is really another attentional thing - I have a set of noise-canceling earphones that I wear sometimes to cancel out conversations happening around me. Sometimes I cannot focus on my work when there is someone near by talking about another thing. The guy one cubical over may be talking about gummie bears (one of the other guys got some to share) and I start looking up the theme song from the "Gummie Bears" Saturday morning cartoon show from the 70s instead of doing my work (yes this really happened). Then I have to find a picture to go with the lyrics and format it to e-mail to the other two guys talking about gummie bears. Sometimes my boss will talk to another employee about a project they are working on - I will start researching the information on-line, solve the problem and e-mail them the results - but I don't get my own work done and hand it in weeks late.
Inhibitory Control - this one is easy - I say a pun or the lyrics to a song or a joke in the middle of a meeting - when it would be much better for me to just shut up. Or I will discuss an awkward subject at a party when the social rules suggest I should just listen. When I was a kid my parents one took me to a theme park called "Wild West City" - the voice on the speaker system announced there was going to be a "robbery" at the "bank" and all "deputies" should keep eyes open (every kid who entered the park got a tin "deputy" badge). I ran out into the middle of the dirt road serving as the Main Street in the fake town and didn't stop running until I got to the bank and went right in. When the actors playing the "bad guys" showed up on REAL horses I fired my toy gun at them and chased them out into the middle of the street and almost got trampled by the very real horses. My mother was none too pleased. Sometimes when I would do math in school I would spontaneously put in a plus where a minus belonged or other minor and totally spontaneous errors like that.
Working Memory - this one actually comes in to parts - pulling things IN to working memory and keeping things from falling OUT of working memory. The other is moving things around in working memory and keeping them in the right order. I often swap digits in my head so I am not very good at memorizing things like phone numbers - or correctly spelling anything - especially names or people and places. I also often have trouble calling the right word to mind - and might not be able to get it until hours or days later. The strange thing here is that I am good at higher math like geometry and calculus and have a very good vocabulary and am very well read. Sometimes I get steps out of order in a list of things. I once was tested by a computer and I can only hold about 3 or 4 things in my working memory at a time reliably - the average is 7 +/- 2 which works out to 5 to 9 "chunks" or working memory. My long term memory works just fine. The analogy is a desk in a dimly lit room with a small desk lamp casting a nice circle of light on the very middle of the desk, and filing cabinets behind the desk. The filing cabinets are "long term memory", the stuff on the desk is "short term memory" and the stuff in the little circle of light is "working memory". You can only really work with the stuff in "working memory". Moving things in and out of working memory takes time. Another analogy is a Scrabble game - the tiles on your tray are "working memory" the tiles on the table next to the tray (which have fallen off the tray) are in "short term memory" and the tiles in the bag are "long term memory". (no analogy is perfect). You are only allowed to rearrange things on your tray to make words.
Cognitive Flexibility - this one is very much related to working memory. This basically has to do with how well you keep the RIGHT things on the desk in the lamp light or the RIGHT tiles on the tray, and keep them from falling off when you add another tile. I good real life example of this one for me is cooking dinner - trying to get the potatoes and the chicken and the vegetables all cooked AND hot at the same time to serve dinner to a family of five. I almost never get it right. Frankly I have trouble making my self breakfast some days. In school this was trying to spend the right amount of time on all the subjects without completely dropping anything (like losing the assignment paper, forgetting to turn in homework that was already done - or completing an artsy project so well that there was no time to complete my math homework or study for the Spanish test). - or spend the right amount of time on Wrongplanet and the right amount of time keeping my boss happy at work.
_________________
ADHD-I(diagnosed) ASD-HF(diagnosed)
RDOS scores - Aspie score 131/200 - neurotypical score 69/200 - very likely Aspie
Great examples, Fenn.
The only thing I'd add is regarding Cognitive Inhibition. That can also involve our (in)ability to tune out overwhelming stimuli, and our adverse response to it. You described how it can distract our train of thought. I'd add the fact that sensory stimuli like misophonia, photophobia, etc., can be so disabling that we have meltdowns or cease to function because of a sensory shutdown. We can also ruminate and think in thought-loops. For example if I'm annoyed by misophonia I won't just lose my focus, but I'll continue to think about how upset I am by the noise for hours and hours (or days and days), at the expense of my quality of life. It can cause depression and anxiety, etc., and lead to other mental health conditions like OCD (trying to avoid the stimulus by routines), or Agoraphobia (being afraid to leave home at all because of panic attacks). In this respect our normal cognitive abilities are inhibited in an adverse way (DSM5 vocabulary), which affects our daily lives.
_________________
And in the end, the love you take is equal to the love you make.
Interesting. A benefits assessor told me that I was quite capable of cooking such a meal because I had a science job which was really the same thing (therefore I wasn't disabled, therefore not entitled to benefits). I was so taken by surprise that I didn't know what to say. But there's a world of difference. In a science experiment, you know exactly how long things will take. The "ingredients" are much more tightly standardised and the equipment controlling temperature etc. is a lot more precise. You can predict it all in advance and start each process at the correct time, according to a detailed, highly precise protocol. I can do that with my eyes shut. But cooking is done "by inspection," and one big reason why I can't do a multiple-course meal is just that. There's no way of knowing when the different procedures will be complete, so as far as my brain is concerned the job can't be done without a ton of careful multi-tasking. Strangely, the fatal fact that I've survived very well without ever having to create a multiple-course meal never came up. Still, I was turned down for the benefit, so job done.
I am a good cook for things like soup and sauces where the rule is "cook and taste". Things like candy making and other things that require a specific time and temperature I am not good at. I make a good "shepherd's pie" but the recipe is very forgiving and it never comes out the same way twice.
I work with computers for a job/career. Things that require precises timing or repetitive steps done quickly with no mistakes I make the computer do. I can make the computer do things ten times more precise and complex than a lot of other people. When I was trying to learn to play piano I would never get the fingering the same twice - no matter how much I practiced. I got a electronic toy when I was a kid that you could "program" notes into and it would play them back with consistent tempo and exactly in the right order - it was a HUGE ah-ha moment for me. I decided that this "computer" thing was something I really needed to know more about.
_________________
ADHD-I(diagnosed) ASD-HF(diagnosed)
RDOS scores - Aspie score 131/200 - neurotypical score 69/200 - very likely Aspie
I work with computers for a job/career. Things that require precises timing or repetitive steps done quickly with no mistakes I make the computer do. I can make the computer do things ten times more precise and complex than a lot of other people. When I was trying to learn to play piano I would never get the fingering the same twice - no matter how much I practiced. I got a electronic toy when I was a kid that you could "program" notes into and it would play them back with consistent tempo and exactly in the right order - it was a HUGE ah-ha moment for me. I decided that this "computer" thing was something I really needed to know more about.
You sort of "recapitulated" the history of computer programming in your own lifetime.
Only a couple of decades ago computers ran on key punched hollerith cards. And Hollerith cards evolved from player piano rolls of the nineteenth century.
Interesting. A benefits assessor told me that I was quite capable of cooking such a meal because I had a science job which was really the same thing (therefore I wasn't disabled, therefore not entitled to benefits). I was so taken by surprise that I didn't know what to say. But there's a world of difference. In a science experiment, you know exactly how long things will take. The "ingredients" are much more tightly standardised and the equipment controlling temperature etc. is a lot more precise. You can predict it all in advance and start each process at the correct time, according to a detailed, highly precise protocol. I can do that with my eyes shut. But cooking is done "by inspection," and one big reason why I can't do a multiple-course meal is just that. There's no way of knowing when the different procedures will be complete, so as far as my brain is concerned the job can't be done without a ton of careful multi-tasking. Strangely, the fatal fact that I've survived very well without ever having to create a multiple-course meal never came up. Still, I was turned down for the benefit, so job done.
"So, job done."
Indeed. The assessor's task is to weed out as many people as possible, because, as you know, everyone's a fraud. /s
I've lived through this recently due to a shoulder injury (which has since spawned another one in the opposite shoulder), and it's been terrible. My situation is temporary, thank goodness, but it's been interrupting my sleep, making my stomach churn, and has left me crying on countless occasions. To me, the worst part is that I've done nothing wrong, but apparently, telling the truth and asking for help is a no-no.
(I apologize for going off topic. We now return to your regularly-scheduled programming.)