DSM 5 Text Revision & Autism
What are the changes?
What do they mean?
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), American Psychiatric Association 2022
The Diagnostic and Statistical Manual of Mental Disorders is a reference used by psychiatrists for the purposes of insurance in the US.
Because it defines and classifies mental health conditions, it is also used all over the world.
The last version (the 5th edition, 2013) combined Asperger’s Syndrome and Autistic Disorder into Autism Spectrum Disorder. This affected Autistic people seeking diagnosis and how we describe our differences.
In March 2022 an update (Text Revision) was published.
The latest version changed gendered language to be truer to lived experience. It introduced a new diagnosis (Prolonged grief disorder).
It also made a small but significant change to the criteria for Autistic Spectrum Condition
Section A of the diagnosis for Autistic Spectrum Disorder has three Criteria.
1. Deficits in social-emotional reciprocity
- Deficits in non-verbal communication
- Deficits in forming, keeping and understanding relationships.
This has been updated to make it clear that all criteria need to be met. Previously it could be read as only needing one or two.
The Problem (1/3)
The wording of the criteria haven’t been updated to reflect Autistic people’s internal experience.
For example, Autistic people may develop sophisticated theories of behaviour to help them understand relationships in a way that works for them. It doesn’t make them less Autistic but might make them harder to diagnose.
The Problem (2/3)
By making the criteria stricter there is less room for the variety of Autistic experiences, making it harder for some groups to get a diagnosis and support. It might exclude:
• Late Diagnosed Adults (who may develop, often taxing, coping mechanisms)
• Autistic Females (who may have been socialised to “mask” better)
• Autistic people from ethnic minority backgrounds (who may show traits differently)
The Problem (3/3)
The Text is still written from an outsider’s perspective and does not reflect what Autism is like from the inside.
It still relies on old research and stereotypes about autism and puts emphasis on deficits, not difference.
What We Want instead
The language of the DSM needs to be updated to reflect our actual experiences, including hyper-empathy and broad ranges of interest.
Autistic people should have the say on what it’s like to be Autistic.
→ The key difference between Gaslighting and a misunderstanding is that gaslighting is intentional.
→ Many of us have had experiences of gaslighting at work or from “friends”. We recognise how taking things at face value makes us susceptible to this.
→ It is a confusing paradox how narcissists can inflate their ego and appearance but secretly have a very fragile self-image.
→ Healthy self-image values and tries to improve the self but also honestly admits shortcomings or faults.
→ Autistic people can be accused of being narcissistic because we can be blunt and miss social conventions. This is mistaken for a lack of empathy.
These are behaviours that are manipulative, cruel, dishonest, arrogant or exploitive.
A narcissistic person will engage in these behaviours because they have a grandiose sense of self-importance and an impaired sense of empathy for others. They will believe they are entitled to break rules and hurt someone to get what they want.
They will use social skills to get away with this, which autistic people may be especially vulnerable to.