Asperger's Syndrome: No Longer a Real Condition?

Asperger’s syndrome is starting to make its way into mainstream consciousness, but for many mental health experts, its time as a distinct condition has already come and gone.

Thanks to changes made to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), one of the definitive resources for diagnosing mental illness, the future of Asperger’s diagnoses is uncertain. These changes, while confusing, will hopefully lead to more accurate diagnoses and improved treatment for patients.

Here is some information that will hopefully make the picture a bit clearer for you—including why the DSM is so important in diagnosing mental conditions, the state of Asperger’s before the DSM changes, and its status afterwards.

DSM-V Background

The American Psychiatric Association has been publishing the Diagnostic and Statistical Manual of Mental Disorders since 1952, with the fifth edition being released in 2013. Colloquially, it’s known as the “bible” of mental health because it contains extensive diagnostic information about all major mental health issues. While the DSM is not without criticism, it plays an authoritative role in the diagnosis and treatment of mental disorders in the United States. In fact, most insurance companies will not sign off on treatment unless a patient has been screened using DSM criteria.

Since its creation, the DSM has undergone five major revisions. Between editions, it’s not uncommon for disorders to undergo major criteria changes or be eliminated entirely. In some sense, these changes make giving an accurate diagnosis difficult, but at the same time they also keep the DSM relevant and up-to-date with the most current research. As with many conditions before them, Asperger’s and similar disorders have been subject to significant revisions within the manual.

Asperger’s Before the DSM-V

Asperger’s was officially added to the fourth edition of the DSM in 1994, along with several other developmental disorders associated with autism. Diagnosing these conditions required looking at long-term patterns of behavior instead of just a few isolated symptoms. However, unlike autism, Asperger’s did not require language-learning disabilities for an official diagnosis.

Instead, its symptoms primarily centered on difficulties with normal socialization. For example, a lack of empathy and an inability to show interest in others were two of the major warning signs of this condition. In addition to these, restrictive and repetitive interests—such as memorizing important dates or other data—were another sign of Asperger’s. While the diagnostic criteria did not include any problems in terms of speech production, people with Asperger’s often struggled with the finer elements of speaking, such as pitch and figurative language.

Asperger’s in the DSM-V

In some sense, Asperger’s syndrome has ceased to exist, because the DSM-V has eliminated it as a condition entirely. However, the implications behind this removal are a bit more complex.

In addition to conditions such as pervasive developmental disorder and childhood disintegrative disorder, Asperger’s has been placed under the umbrella of the “autism spectrum disorder.” These disorders have been grouped together as one because of the many symptoms they share in common. However, as the new name implies, these symptoms occur on a spectrum—with some patients having more severe ones than others. By bringing these related conditions together, mental health experts hope to bring more consistency to the diagnostic process, which was a common complaint under the DSM-IV.

While the changes are radical, they will hopefully lead to better treatment for patients. For example, many insurance companies would cover treatment for autism but not Asperger’s syndrome. However, under the new autism spectrum system, patients may qualify for treatments they wouldn’t have been able to before.