Hi Bonzo.

It is not that people with the signs and symptoms that are currently given a diagnosis called Aserger's will no longer be considered to have a psychiatric condition. The name of the diagnosis will change. There will be several other pervasive development diagnoses that will also go away and will also be included under the diagnosis "Autism Spectrum Disorder." My understanding is there will be a number of qualitative and/or quantitative specifiers than will be used to connote variation and severity. It is similar to what happened with what are now the Bipolar diagnoses. The original diagnosis was manic-depression, a diagnosis that no longer exists, but a term that is still commonly used, which more or less corresponds to what is now called Bipolar I Disorder. At present there is Bipolar I (with several specifiers, Bipolar II, Bipolar Disorder NOS (Not Otherwise Specified) and Cyclothymia.    The current range of diagnoses reflect to some extent the wide variation in the number of symptoms and severity of symptoms along the spectrum. I'd much prefer "Bipolar Spectrum Disorder" because I have often had patients who clearly have bipolar spectrum symptoms sufficient to lead to difficulties in functioning in one or more domains, or that cause substantial subjective distress, but who really don't meet the diagnostic criteria for any one of the 4 currently available Bipolar spectrum diagnoses. (I'll manage to wedge them in somehow or another, as will any clinician who recognizes the medical necessity for treatment for that individual)

There will be many changes in diagnostic nomenclature and categories in the DSM-V. The process of revising diagnostic manuals is a long one. Changes are always controversial, and there are always many battles among those who sit on the committees and panels that ultimately take the votes and make the decisions.    There are many, many different factors that are considered. No one is ever entirely happy, but guess what, no one is ever entirely happy. There are a lot of different stake holders with differing perspectives, wants, needs and expectations. Believe it or not, all voices get heard. Research, politics, social/societal implications, and personal agendas and egos all come into play, as they do in any human endeaver.

Regardless, the DSM-V, when out, will be the official code from which I must practice, and I will do so. Also understand that even as the "V" comes out, work will be starting on the VI, initially based on what turned up or stirred up in the process of arriving at the final V.


About the DSM   While I think there is legitimacy to the criticisms noted in the wiki article, I have also observed bonafide efforts to address those criticisms with each new revision.

I trained in graduate school on the DSM III. When the IV came out, the changes were not so great that I couldn't read up on them and feel comfortable with it. For the DSM-V, I've already sent in the money to attend a continuing education seminar for training purposes.

Will it be perfect? Far from it.

But Guys and Gals, only 30-35 years ago the most generally accepted professional understanding of schizophrenia was it was caused by bad mothering. With the advent of the DSM, common nomenclature and standardized diagnosis were first seriously and widely introduced to psychiatry and psychology in the USA. That marked the real beginnings of a basis from which to begin research and to design research studies that have rapidly and radically advanced and changed our understanding of mental illness and normal psychology. Classification serves to advance science, research methodology and understanding of mental health and mental illness. In the USA, (the ICD is more commonly used in Europe - and closely but not entirely corresponds,) the effects of the first DSM (and the army manual with which it started) of fostering improved research and research design represented a significant attempt toward a Linnaean taxonomy for mental "disorders." We've got a long way to go. Much more road stretches ahead than behind. But we have come a long way since Freud first set us on a path, and look at all the branches taking off from that path. For those of us who work in mental health, even folks toward the end of their careers like me who sometimes have difficulty integrating and making meaning from the flood of new data, it is very exciting and very hopeful.

We are a long way from understanding autism, but we know something about it now, whereas only a decade or two ago, we really had nothing other than the observations of the experiences of people with autism.

Diagnosis, at least to this point in our knowledge and science, will rarely be completely standardized and is still as much "art" as it is science in many instances. Personal and professional experience, intuition, personality, culture and class of the clinician compared to the patient or client, training and personal and professional paradigms (meta-considerations) will all influence diagnosis, as well as how important the clinician perceives making an accurate diagnosis to be. That is true in the medical field also for many, many diagnoses.

While changes in classifications will always have pros and cons, winners and losers, these are not static endeavers or decisions, and the road, over time, generally leads forward.