Tag Archives: DSM-5

G – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter G. This was a pretty hard letter for me, so most of the words I chose are not specifically related to mental health.


There is an increasing interest in gender-specific medicine, ie. medical research and practice that takes into account how medical (including psychiatric) conditions affect women differently from men. For example, autism spectrum disorders and ADHD used to be thought of as typically male conditions whereas borderline personalitty disorder was thought to affect females primarily. It now turns out that many women have been misdiagnosed with for instance BPD when they really have an ASD and/or ADHD. The reverse is also true: eating disorders are stereotypically thought of as female disorders, so men with eating disordes often remain undiagnosed.

Men and women also differ in their treatment-seeking patterns. Women seek counseling more often, whereas men are overrepresented in psychiatric hospitals and are sectioned or taken into forensic treatment more often.


When DSM-5, the current edition of the psychiatrist’s manual, was being prepared, initially they wanted to use a dimensional diagnosis with genetics on one axis. However, they finally decided too little is known about the gentics of mental illness yet. Mental illness is not a purely genetic thing and it isn’t purely caused by life events. For example, when I studied psychology in 2007, there was some recent research into the interplay between a particular gene called the lazy MAO A gene and one’s upbringing in causing antisocial behavior. MAO A is an enzyme that breaks down certian neurotransmitters in the brain. When people have the lazy MAO A gene, they produce too little of this enzyme. This is linked to antisocial behavior. However, even if a person had this lazy gene, upbringing played a role in the risk for developing conduct disorder in childhood and antisocial personality disorder in adulthood. The two factors together cause people to become antisocial.


Geriatrics is the branch of medicine specializing in older people and diseases of the elderly. Geriatrists may work in mental health care, but more often on units for people with neurocognitive disorders (dementia). The city institution I used to reside in had several units for older people, some of whch specialized in neurocognitive disorsers where behavior was particularly dysregulated. On these units, geriatrics and psychiatry are combined.


Everyone in the Netherlands (and other countries with socialized healthcare) is entitled to the care of a general practitioner (G). Most peope in long-term inpatient mental health treatment don’t have a GP where they used to live. I for one have yet to find a GP near the tiny village. Therefore, the hospital employs GPs. GPs in mental hospitals do not generally involve themselves with the patients’ mental health and psychiatrists do not generally take care of the patients’ physical health. In this sense, a GP in a mental hospital has a different role than in the community. In the community, GPs are the gatekeeper to all care whether it’s mental or physical, after all.

What Are Personality Disorders? #Write31Days

31 Days of Mental Health

Welcome to day 10 in the #Write31Days challenge on mental health. Today, I will discuss the broad category of disorders I’ve been diagnosed with: personality disorders. Though there is some debate as to whether borderline personality disorder should be conceptualized as a personality disorder, it currently is.

A personality disorder is a pervasive pattern of dysfunctional thought, behavior and emotion that is stable across time and across situations. It is out of line with cultural expectations and causes distress or impairment. It usually emerges in early adulthood, though adolescents may be diagnosed as being at risk for developing a personality disorder. In fact. when I attended a conference on BPD in 2013, a psychiatrist specializing in this said that BPD can be reliably diagnosed from age sixteen on. In other disorders, such as antisocial personality disorder, there is a specific age requirement of being over eighteen.

The Diagnostic and Statisticla Manual of Mental Disorders, both DSM-IV and DSM-5, divides specific personality disorders into three subcategories, called clusters. These are:

  • Cluster A includes paranoid, schizoid and schizotypal personality disorders. Individuals exhibiting these disorders often appear odd or eccentric. The disorders in this cluster can precede schizophrenia. I tend to think of cluster A personality disorders as “psychosis light”.

  • Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders. Individuals with disorders in this cluster are often seen as dramatic, emotional or erratic. People with cluster B personality disorders are often perceived as among the most difficult people to get along with. When peope think of personality disorders in general, they mostly mean cluster B disorders. The same goes for treatment programs focused on personality disorders.

  • Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Individuals with cluster C personality disorders tend to be anxious or fearful.

In DSM-5, it is stated clearly that the clustering of personality disorders, while it has some merit, may not be very useful in clinical practice. After all, many people exhibit traits of personality disorders across clusters. When a person has features of more than one personality disorder but doesn’t teet the full criteria of any, they may be diagnosed with an unspecified personality disorder. People with other specified personality disorder display behavior that is seen as a personality disorder but isn’t listed specifically in DSM-5. Examples include passive-aggressive and self-defeating personality disorder.

There are some clear gender differences in how commonly personality disorders occur. Antisocial personality disorder occurs far more often in males than females. Borderline, histrionic and dependent personality disorder occur more in females. Though this may reflect real gender differences, it is also likely that stereotypical views shape clinicians’ diagnoses. For example, I once read that BPD is really about as common in males as in females but is overdiagnosed in women and underdiagnosed in men. Women misdiagnosed with BPD are often later found to have ADHD, which interestingly used to be seen as a typical male disorder.

diagnosticians always need to be aware of a patient’s cultural background and life history. After all, in some cultures, behavior that is seen as disordered in the western world may be normal. People who experienced extreme stress or trauma may also exhibit long-lasting dysfunctional behavior patterns and be misdiagnosed with personality disorders when they really have PTSD. Veterans are disproportionately often diagnosed with personality disorders, for example.

Defining Mental Illness #Write31Days

31 Days of Mental Health

For my first post in the 31 Days of Mental Health series, I will discuss how mental health conditions are diagnosed. As you probably know, there is no objective test for mental illness, like a blood or urine test. The diagnosis of mental illness is based on the symtpoms and signs a patient presents with.

The main classification system for mental disorders in use in th United States and elsewhere is the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. In 2013, the fifth edition, DSM-5, was published. However, some countries, like the Netherlands, still use the previous edition, DSM-IV.

DSM-IV uses a multi-axial system of diagnosing mental disorders. There are two axes for mental disorders: Axis I for clinical disorders like depression, schizophrenia and ADHD, and axis II for intellectual disability and personality disorders. The reason for the existence of axis II is that the creators of DSM-IV felt that intellectual disability and personality disorders are particularly hard to treat and relatively stable over time. Later research found this is not necessarily the case for certain personality disorders in particular. In DSM-5, personality disorders and intellectual disabiltiy are listed under the same section as other mental disorders.

In DSM-IV, there are three more axes for diagnostic classificaiton: Axis III for physical disorders, axis IV for psychosocial and environmental factors, and axis V for one’s global assessment of functioning (GAF) score. This score indicates how well or ill a person is in general. A GAF score of 100 indicates excellent mental health, while a GAF score of 50 indicates severe symptoms or severe impairments in one area of functioning (eg. work, school, social life). A GAF socre of 1, the lowest score, indicates persistent danger of seriously harming self or others. My GAF socre is 40, meaning some problems in reality testing or communication or significant impairments in more than one area of functioning.

The GAF score is, as the name suggests, a global scale. As such, it does not determine how severe each disorder a person may be diagnosed with is. Also, if a person has problems in maintaining their personal hygiene, they automatically get a lower GAF score than those who have problems functioning at work or school. It is apparently thought that, if you neglect your personal hygiene, you will be unable to function at school or work. This at least hasn’t been the case with me. In DSM-5, the GAF scale was dropped and severity can be coded for each disorder a person has been diagnosed with. The World Health Organization (WHO) Disability Assessment Schedule is included in the assessment tools section of DSM-5.

You may’ve noticed that I mostly refer to mental disorders, not mental illnesses. The word “mental illness” is not used within the DSM, rather, DSM uses the word “mental disorder” to encompass all conditions listed in their classification system (with some exceptions, eg. medication-induced movement disorder). A mental disorder is defined in DSM-5 as a syndrome characterized by clinically significant disturbance in a person’s cognition, emotion regulation or behavior. It reflects a dysfunction in the psychological, biological or developmental processes underlying mental functions. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expected or culturally approved response to a stressor, such as the loss of a loved one, is not a mental disorder. Religious, political or sexual deviance or conflicts between the individual and society are not mental disorders, unless the conflict originates primarily within the individual.

A mental disorder is not the same as a need for treatment. Need for treatment is determined through a complex process of assessment of symptom severity, presence of certain symptoms (eg. suicidal ideation), the person’s distress or disability related to their symptoms, risks and benefits of available treatment, and possibly other factors (eg. if a person’s mental disorder impacts another illness). Because of this, people who do not meet all criteria for a diagnosable mental disorder but who demonstrate a clear need for care, may be taken into treatment.

Section II of the DSM-5 describes all mental disorders that are currently being recognized by the American Psychiatric Association. Mental disorders, for clarity’s sake, include neurodevelopmental and neurocognitive disorders (eg. autism or dementia), addictions, as well as those disorders more commonly thought of as mental illnesses. Personality disorders are not always seen as mental illnesses. For example, in the UK’s Mental Health Act, they are called “psychopathic disorders”. Nonetheless, I see both personality disorders and disorders such as schizophrenia and depression, as mental illnesses.


One of the Friday Reflections prompts for this week is to write about anxiety. How does it affect me and what do I do to cope? I will write here about my experiences with various types of anxiety. It ties in nicely with last Monday’s post, in which I share tips for relaxation. However, throughout this post, I will share some coping strategies that have and haven’t worked for me too.

In the psychiatrist’s manual, DSM-5, there are various types of anxiety disorders. Now I don’t have a diagnosis of any of these disorders, but they are a good reference point for the various types of anxiety that people may experience.

Generalized anxiety disorder (GAD) is a condition in which a person feels anxious or worried about a variety of situations. This worry is accompanied by a feeling of restlessness, fatigue, difficulty concentrating, irritability, sleep disturbance and/or muscle tension. Generalized anxiety disorder often co-occurs with depression.

Though I haven’t had a diagnosis of GAD, partly because my owrrying can be explained by my autism, I have been a chronic worrier all my life and experienced many of the associated symptoms I mentioned above. Antidepressants can help this type of anxiety and in fact are more effective for GAD than for depression. I have been taking the antidepressant Celexa since 2010 with moderate success.

Some people worry about specific things happening to them. For example, I have a lot of anxiety about getting a serious illness. This is called hypochondria or health anxiety. In the psychiatrist’s manual, it is classified as a somatic symptom disorder rather than an anxiety disorder, but the symptoms overlap with those of anxiety disorders. Some doctors have tried antidepressants for health anxiety and documented significant improvement in their patients. It is also commonly thought that people’s health anxiety lessens, ironically, when they do get seriously ill.

My health anxiety is associated with compulsive behaviors. For example, when I was a child, I was afraid of contracting leprosy. As a means of keeping my worry at bay, I’d count my fingers and toes, since I heard that people who had leprosy had those fall off.

Later on, when I lived independently, obsessive worrying and the resulting compulsive behaviors extended to other situations. For example, I’d be afraid of carbon monoxide poisoning and would have to check that my heating was off and windows open at night. I often checked this twenty or thirty times a night.

Obsessive compulsive disorder (OCD) is classified in DSM-5 under its own category separate from anxiety disorders. The obsessive compulsive spectrum also includes disorders that aren’t commonly seen as anxiety disorders, such as hoardng and trichotillomania (compulsive hair pulling). However, OCD used to be seen as an anxiety disorder. Antidepressants can help, but so can exposure and response prevention. In this type of psychotherapy, the patient is gradually taught to lessen the compulsive response (eg. checking) to a feared scenario. For example, people who have hygiene-related compulsions gradually move from say a three-hour shower down to normal shower time, decreasing their time under the shower by one minute a day. For me personally, my obsessions and compulsions related to the risk of carbon monoxide poisoning decreased dramatically when I was hospitalized.

Another type of anxiety disorder is specific phobia. Everyone probably has something they are fearful of, but a specific phobia is only diagnosed when the fear and resulting avoidance of situations greatly impairs the person’s daily functioning. Similar to OCD, specific phobias are treated with exposure therapy, where the person is gradually intrduced to the feared situation or object and learns to endure the fear. For example, a person with a spider phobia might be first intrduced to pictures of spiders, then videos, then look at a live spider, etc. You can also be asked to simply imagine the feared scenario (eg. looking at a spider). After all, with certain phobias, it is not feasible for the therapist to take the client on to the real experience.

A final type of anxiety is social phobia. A person with social phobia is extremely fearful of social situations because of the fear of making mistakes or being criticized. As a result, people with social phobia avoid certain or all social situations. Many autistic people develop social anxiety as a result of their real social ineptness. I for one do not consider myself that socially anxious, but when I filled out a social phobia questionnaire online, it said I had very sevre social phobia. This is probably because I get overwhelmd by social situations easily and avoid them because of this.

People with social phobia, often children, may also suffer from a co-existing condition called selective mutism. This is an inability to talk in certain situations (eg. at school) while the child has adequate speech in other situations (eg. with parents). I displayed signs of selective mutism as a teen. Though this was in part anxiety-related, it also related to my autism.

There are still many other types of anxiety and related disorders, such as panic disorder and agoraphobia. Post-traumatic stress disorder (PTSD) also used to be classified as an anxiety disorder. I used to have a diagnosis of PTSD and still have some of its symptoms, but I may discuss this at a later time.

Reflections From Me

Impulse Control Disorders

In 2008, I read my treatment plan one day and saw my DSM-IV diagnostic classification. I had not only been diagnosed with Asperger’s Syndrome, which I already knew. In addition, I had been given a diagnosis of impulse control disorder not otherwise specified. This diagnosis has since been taken off my records, for which I am thankful, since my idea of the disorder was pretty negative. Since one of the writing prompts on Mama’s Losin’ It for this week is to write a post inspired by the word “impulsive”, I thought I’d educate you about impulse control disorders.

In DSM-IV, the psychiatrist’s diagnostic manual in use at the time of my diagnosis (and still in use in the Netherlands now), impulse control disorders make up their own diagnostic category distinct from disruptive behavior disorders and personality disorders that may include impulsive and/or antisocial behavior. It was in fact made very clear to me by an educated peer that impulse control disorders are quite different from antisocial behavior, because the underlying idea behind impulse control disorders is that you have little control over your impulses. Those with disruptive behavior disorders (eg. conduct disorder and oppositional defiant disorder) willfully misbehave.

The treatment, I found out, is also quite different. Whereas those with conduct disorders need to be punished for their behaviors, those with impulse control disorders need to learn what sets them off, so that they can prevent their impulsive behaviors. This is significant, because at the time of my diagnosis, I still resided on a locked unit and had seclusion used against me to “get me to take responsibility for my behavior”. Now seclusion and other restrictive behavior management techniques cannot legally be used as punishment anyway. I am, instead, all for expecting people who display aggression to make up for the damages they cause.

So what is an impulse control disorder? In DSM-IV, impulse control disorders included kleptomania, pyromania as well as pathological gambling. Pathological gambling is now, in DSM-5 (the current edition of the psychiatrist’s manual), classified as a behavioral addiction, but kleptomania and pyromania are still listed as impulse control disorders. The category in DSM-IV also includes intermittent explosive disorder (IED), the disorder which I was most close to meeting the criteria of.

IED is described in DSM-IV as characterized by several discrete episodes in which the affected person is unable to resist aggressive impulses. The aggression leads to serious assaultive acts or destruction of property. The aggression displayed during these episodes is grossly out of proportion to the psychosocial stressor(s) that may’ve led to it. The disturbance is not better explained by any other mental disorder (eg. antisocial or borderline personality disorder, conduct disorder, ADHD, psychosis or mania) and is not due to the direct physiological effects of a medication used or a substance of abuse.

In DSM-5, impulse control disorders such as kleptomania, pyromania and IED are lumped together with conduct disorder, oppositional defiant disorder and even antisocial personality disorder. The authors of the chapter on disruptive, impulse control and conduct disorders do make it clear that there is a distinction between an inability to control one’s emotions (like anger in IED) and disruptive behaviors (as in conduct disorder). They however seem to mean that in all disorders in the chapter, there is some focus on both emotional and behavioral dysregulation.

How are impulse control disorders treated? For IED and other impulse control disorders, antidepressatns have been found somewhat effective, although none have been approvd by the FDA. In one study cited on Wikipedia, people with IED responded relatively well to particularly fluoxetine (Prozac). In addition to medication, cognitive-behavioral psychotherapy is used. People with IED need to learn to relax, use alternative coping skills and resist aggressive impulses. Psychoeducation about their disorder in a group setting can also help.

IED, for clarity’s sake, does by definition lead to aggression and may lead to criminal behavior. It, therefore, does cause a disruption to other people’s lives and may lead to violations of societal norms. With my focus on an inability to control oneself rather than willful misbehavior, I did not mean to minimize the suffering others experience at the hands of someone with IED. I have not been physically aggressive towards people since adolescence, but this is one reason I was diagnosed with an impulse control disorder not otherwise specified.

Mama’s Losin’ It

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A Lighter Shade of Blue?: Dysthymic Disorder

Most people think they know what it’s like to be depressed. We’ve all had a day or two when we’ve felt down and hopeless, had a hard time sleeping at night and dragging ourselves out of bed in the morning, and had a decreased or increased appetite. While these all are symptoms of depression, in major depressive disorder they are severe and occur for weeks or sometimes months on end. They also manifest as a clear deviation from one’s normal functioning

On the surface, dysthymic disorder (or dysthymia) seems less severe, which is why I’m using the metaphor of a lighter shade of blue. Dysthymic disorder, as it was described in the previous edition of the psychiatrist’s manual, DSM-IV, manifests itself in a depressed mood most of the day, on more days than not, accompanied by at least two of the following symptoms:

  • Poor appetite or overeating.

  • Insomnia or hypersomnia.

  • Low energy or fatigue.

  • Low self-esteem.

  • Poor concentration or difficulty making decisions.

  • Feelings of hopelessness.

However, while the symptoms of major depression need to last for at least two weeks, those of dysthymia last for at least two years (or one year in children and adolescents). Therefore, while everyone can probably tick off some (or even most) of the symptoms mentioned above every now and again, that is quite different from having dysthymic disorder. I have had symptoms of depression on many occasions, but I can’t say I’ve had them for most of the time persistently over a two-year period.

In the current edition of the psychiatrist’s manual, DSM-5, dysthymic disorder has in fact been replaced with persistent depressive disorder. This category includes both the “lighter shade of blue” of dysthymia, as well as chronic major depression. After all, the creators of DSM-5 felt there is no meaningful difference between chronic major depression and dysthymia. The difference between persistent depressive disorder and major depressive disorder is, thereby, no longer one of severity but one of pattern or course of development. In major depressive disorder, individuals tend to relapse and remit (get better and worse). Persistent depressive disorder tends to linger for years.

I do not have dysthymia. Why, then, am I writing this post? Quite frankly, just for the sake of raising awareness. When I found out that Mumturnedmom’s prompt for this week is “blue”, this is what I thought of. I hope I have educated a few people, including myself. I am a member of some groups on Facebook for depression, and I don’t know that I should be. I, after all, do not know what it is like to be severely depressed or persisistnetly depressed for a long time.

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Sensory Processing Difficulties in Autism #AtoZChallenge

Welcome to another day in the A to Z Challenge, in which I write about autims. Today, I write about an important aspect of difficulty in autistic people: sensory processing. Sensory processing disorder (SPD) is sometimes also diagnosed in non-autistic children. Therefore, this piece may be useful for both people interested in autism and those dealing with SPD kids.

Sensory processing refers to the way the nervous system receives and interprets messages from the senses and turns them into appropirate motor or behavioral reactions. There are many different ways in which sensory processing difficulties can manifest themselves in people with SPD or autistic people.

The most common type of sensory processing disorder is sensory modulation disorder, which means an affected person over-responds or under-responds to sensory stimuli or seeks sensory stimulation. In autistic people, the stereotypcal (self-stimulatory) movements that are a core symptom of autism, are usually interpreted as a sensory modulaton issue. In fact, unusual sensory responses are a core symptom of autism in DSM-5. Some people are mostly sensory seekers, sensory over- or under-responders, while others exhibit mixed features.

In addition to sensory modulation disorders, sensory-based motor disorders (eg. dyspraxia) and sensory discrimination disorders are other subtypes of SPD. The symptoms of these disorders are not autism core symptoms but they are common in autistic people too.

I myself have many different symptoms of sensory processing difficulties. For example, I avoid certain textures. I wouldn’t wear jeans until age twelve, still hate the feel of brushing my teeth and dislike getting my hands dirty sometimes. These are symptoms of sensory over-responsiveness. So are being a picky eater and sleep problems, both of which are common among autistic people.

Symptoms of sensory under-responsiveness include appearing unreactive and slow, having extreme difficulty waking up, lacking awareness of pain and difficulty with toilet-learning (because of not feeling the urge to go). I myself do not have most of these symptoms.

Sensory seekers might appear impulsive. They often fidget excessively, climb or jump when it’s not appropriate, bite or suck on clothes, pencils, etc. I did/do many of these things.

I also have many symptoms of sensory-based motor disorder (dyspraxia), such as being uncoordinated and clumsy. Lastly, people with sensory discrimination disorder often have difficulty with tasks such as dressing and eating, have poor handwriting and will drop objects constantly.

How to tell if your child with sensory processing difficulties has SPD or autism? Since many of the sensory processing difficulties listed above are common in autistic people too, this may be hard. Sometimes, getting an autism diagnosis might be beneficial for the sake of treatment, because many health care systems do not fund therapy for sensory processign disorder. There are, however, difficulties in autistic people that those with “pure” SPD do not have. For example, autistic people often have difficulties with theory of mind (the ability to understand and respond to others’ motives and feelings) and executive functioning (organizational skills). If, in addition to sensory processign problems, your child particularly has social communicative problems, it may be advisable to have them evaluated for autism.

Obsessive and Compulsive Behaviors in Autism #AtoZChallenge

Welcome to day fifteen in the A to Z Challenge on autism. Today, I will focus on obsessive and compulsive behaviors as they occur in autistic people.

The obsessive-compulsive spectrum encompasses a number of disorders that may co-exist with autism spectrum disorders. Even people with autism without an additional diagnosis often display obsessive an compulsive behaviors. In fact, the repetitive behaviors that are a core symptom of autism are often thought of as obsessive.

The first way in which obsessive and compulsive behaviors present themselves is in autistic people’s obsessive interests. Autistic people often engage in one specific interest that may be unusual in either intensity or focus. I will focus on unusual fasicnations when we arrive at the letter U. The obsessive nature of interests however also manifests itself in the way in which people often are hard to break free from their special interest. Many autistic people are cheerful or even elated as long as they can engage in their special interest and get a bit depressed when they’re being redirected.

Collecting is a common type of special interest in autistic people. This can go to the extreme of hoarding, which is on th eobsessive-compulsive spectrum. The main feature of hoarding is an irrational, persistent difficulty to discard things that the person no longer needs and that aren’t of value. This is a long-standing pattern, not just related to a single life event (such as the inability to discard something inherited from a loved one). Hoarding is not simply the passive acccumulation of stuff that a person doesn’t discard; it involves an actual effort not to discard objects. Autistic people commonly collect seemingly worthless items such as bits of string or paper scraps. This may be easily seen as hoarding by non-autistic family members. When compulsive collecting interferes with a person’s organizational or decision-making skills, it is time to seek help.

As I said, more classic obsessive-compulsive traits or even full-blown obsessive-compulsive disorder (OCD) are also common in autistics. This may be related to unusual fears, which I will also discuss in my letter U post. Obsessive-compulsive behaviors may involve repeated counting, checking or washing, but in my own case, repeatedly asking the same questions was also part of it. Repetitively talking about the same subject, may also be a compulsion for an autistic person. For example, my husband and I are trying to prepare for me to go live with him. A lot is still unclear, but I have a compulsion to tell the staff every detail of what we’re trying to work on repeatedly.

Lastly, the stereotypical, self-stimulatory behaviors that are a core symptom of autism, may also be seen as compulsions. For example, trichotillomania, the compulsive pulling out of one’s own hair, is on the obsessive-compulsive spectrum in the DSM-5 (the psychiatrist’s manual). This condition is also fairly common in autistics, as are other seemingly compulsive movements. Then again, these behaviors can also be seen as a sensory symptom, which I will discuss in my letter S post.

Asperger’s as Mere Genius

Just came across a question on an Asperger’s page on Facebook. Someone asked whether we could name any historical genius without Asperger’s. Most people couldn’t, but this made me think of the validity of the whole Asperger’s concept in highly intelligent people, and whether it’s not just their genius that makes these people appear autistic.

If everyone who is a little quirky gets labeled with Asperger’s, it erodes the meaning of Asperger’s as a disability. I know that probably the people who can’t name a genius without Asperger’s, don’t see Asperger’s as a disability. That’s fine with me, but I for one do see it as a disability, having an Asperger’s diagnosis and clear difficulty functioning.

That’s in my opinion what it boils down to. Most geniuses can function quite well in life. They may have some trouble making friends with the average person, but that’s because they are highly intelligent and the average person isn’t. I did not start suspecting an autism spectrum disorder in myself until I found out that I couldn’t interact with my classmates at the high level high school either, while around 30% of them were gifted. In this sense, I feel the fewer labels the better, and I don’t see why you need a disability label if you’re going to see it as all positive. We already have the label of giftedness for that.

The reason I eventually sought an autism diagnosis, was not that I had a hard time making friends actually. It was because I was overwhelmed with even the simplest of daily tasks. If I didn’t have this many problems, I would be fine just being gifted. It wouldn’t mean I’d have absolutely no issues, because after all I’d still be a misfit among all average peers. But autism isn’t about fitting in or being able to make friends. If that were the case, many more people would qualify for the label of autism than is currently the case.

I was discussing this whole labeling thing with my parents yesterday. My father, who says I’m merely gifted and not autistic, said that Hans Asperger probably didn’t intend merely quirky kids to get his label. Rather, the kids he intended the label for were most likely unable to have any form of meaningful interaction and were completely preoccupied with their own special interest. I wouldn’t be an Aspie in this situation, but neither would anyone on the Facebook page. Now I don’t necessarily agree with this analysis of what Asperger intended his label to mean, and I don’t have his study at hand to look it up. However, DSM-5 backs up this portrayal of autism spectrum disorder in its description (and to some extent criteria) of ASD. I am not sure myself that I meet DSM-5 criteria for ASD, and I can see that many people diagnosable as Aspie under DSM-IV, don’t.

In my case, this has nothing to do with the criterion about the symptoms limiting people’s independent functioning, like many parents of severely autistic children say. I am most definitely impaired in my functioning. The problem areas I’m having are just not the core ASD impairments. But I am impaired.

For most all-genius-people-are-Aspies proponents, the opposite is true: they do have core ASD symptoms as their primary reason for being misfits, but they aren’t limited in their daily functioning. In this sense, I can totally see why parents of severley autistic children would not want them on the autism spectrum. Why lump people with no impairments together with those with severe impairments? That’s either stigmatizing the people with no impairments or invalidaitng the people with severe impairments. One of the main reasons people are fighting to keep Asperger’s on the autism spectrum, is because we most definitely have impairmetns and are in need of support. If Asperger’s is reduced to mere genius and the accompanying and inherent misfit status, I am not saying I want no part in it. Identifying as an Aspie would then be similar to identifying as my Myers-Briggs personality type, after all, and I do participate in places for that. It would, however, mean that I and many others who do have significant impairments, would need an additional label to justify their need for support.

Six Myths About Autism

I haven’t written about autism in a long while. It is mostly because I have been busy writing other things, such as posts chronicling my eating disorder recovery journey and posts inspired by writing promts. I also don’t want to write too involved posts that are unreadable to a large majority of my readers. However, just today, I came across a really interesting post dismantling five myths about cerebral palsy. I am not a total laywoman on the subject of cerebral palsy, but even I could learn from thhis post. So I thought maybe I could do the same on autism. Here are some common myths, some of which even autistic people or parents of autistic children buy into. I did get rather caught up in details I think, but if some of my readers learn something from this, I’m content.

1. There is one single, known cause of autism. Most autistic people claim that autism is 100% genetic. Some people, mostly parents of autistic children, claim that autism is caused by vaccines, pesticides, or other environmental factors. These claims are often politically motivated. The autistics want a genetic cause because it means they are truly wired this way, while the people who claim vaccines or other environmental facotrs cause autism, want to argue that autism is a disease that can and should be cured. The reality is, the cause of autism is unknown. While the vaccine theory has been disproven, other environmental factor theories have not and twin studies show that autism isn’t 100% genetic. Other factors, such as premature birth and pregnancy complications, have been named too. Even if autism were 100% genetic, there are likely more than a few genes that contribute.

2. Autism is a physical illness. Related to the vaccine theory mentioned above, some people believe that autism is caused by “leaky gut”, an inability of the bowel to digest certain proteins that will leak through the bowel wall into the bloodstream and also through the blood-brain barrier. Until very recently, I thought that “leaky gut” is a fake condition propagated by alternative medicine. It isn’t. In fact, there are several conditions speculated to be due to this problem, for which the genes have been located on chromosome 16. The most logical example is Celiac disease, but other bowel conditions (eg. Crohn’s Disease) and in fact neurological conditions (eg. multiple sclerosis) may be partly caused by this problem. Therefore, it is not entirely impossible that autism in some cases may be partly due to “leaky gut”, but this is still just a theory. Research in this area (eg. whether gastointestinal problems are more common in autistics) shows mixed results. If a child or adult with autism has gastrointestinal symptoms, they may feel better after treatment for these symptoms. That doesn’t mean that autism is physical in nature. It could be related to “leaky gut”, but that doesnt’make the condition itself a physical health problem. By the way, there are no treatments so far that solve “leaky gut”. Avoiding gluten and dairy may help, but its effects have not been proven in those who do not have diagnosable Celiac disease.

3. Autism is a mental illness. This is somewhat of a political statement, and so is the stateement that it definitely is not a mental illness. I don’t particularly care if someone says autism is a mental illness, but most people disagree. There is no strict definition of a mental illness (contrasting it with a developmental disability) in the psychiatric manual (DSM-5). There is a definition of a mental disorder in DSM-5, but this includes autism too. There is also a definition of a neurodevelopmental disorder, the category under which autism is classified. This category includes conditions like ADHD, intellectual disability, Tourette Syndrome, and autism of course. This is a similar category to the categories of schizophrenia and other psychotic disorders, obsessive-compulsive spectrum disorders, or any other category within DSM-5. Formal categorization aside, however, most people say that autism is not a mental illness because it is developmental in nature. It is a common myth however, often held by autistics who have had negative experiences in psychiatry, that absolutely no treatment originally designed for other mental disorders, can be used for neurodevelopmental disorders such as autism.

4. All autistic people have an intellectual disability. Autistics span the full range of intellectual abilities. The most pessimistic (if an intellectual disability is seen as a negative outcome) studies show that around 40% of people with autism spectrum disorders have an intellectual disablity. However, IQ is hard to measure in people with severe social and communicative deficits, so those with more severe autism are likely to score lower on a standardized IQ test (such as the Wechsler scales) than their actual ability. Others, particularly those with good verbal skills, may score higher than their real-world functioning would suggest.

5. Autism affects children only. The fact that it is developmental in nature, doesn’t mean that autism doesn’t affect adults. Autistic children gorw into autistic adutls just like for example children with Down Syndrome grow into adults with Down Syndrome. Children and adults with autism may improve in daily functioning, but they won’t become non-autistic.

6. Autism can be cured. Autistics, like people with other developmental disabilities, can learn adaptive skills to function as well as possible in daily life. That again doesn’t make them non-autistic. The most evidence-based intervetnion is applied behavior analysis, an intensive behavioral training. Even this approach can merely teach autistics to act like a non-autistic person in the situations they’ve been trained in. Some people cliam they have “cured” their autistic children with biomedical interventions. I won’t call these people liars, but there is no scientific evidence to support their claims.

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