Autism Redefined: New Diagnostic Criteria More Restrictive
The proposed changes to the diagnostic definition would be published in the fifth edition of the American Psychiatric Association’s (APA) “Diagnostic and Statistical Manual of Mental Disorders (DSM-5).”
"Given the potential implications of these findings for service eligibility, our findings offer important information for consideration by the task force finalizing DSM-5 diagnostic criteria," said Yale Child Study Center (CSC) director Fred Volkmar, M.D., who conducted the study with CSC colleagues Brian Reichow and James McPartland.
Volkmar and his team found that in a group of individuals without intellectual disabilities who were evaluated during the 1994 DSM-IV field trial, it was estimated that approximately half might not qualify for a diagnosis of autism under the proposed new definition.
Volkmar stressed that these preliminary findings relate only to the most cognitively able and may have less impact on diagnosis of more cognitively disabled people. “Use of such labels, particularly in the United States, can have important implications for service,” he said. “Major changes in diagnosis also pose issues for comparing results across research studies.”
A Bad Case of the Brain Fags and other mental problems you probably won’t get in America.
In 1951, Hong Kong psychiatrist Pow-Meng Yap authored an influential paper in the Journal of Mental Sciences on the subject of “peculiar psychiatric disorders”—those that did not fit neatly into the dominant disease-model classification scheme of the time and yet appeared to be prominent, even commonplace, in certain parts of the world. Curiously these same conditions—which include “amok" in Southeast Asia and bouffée délirante in French-speaking countries—were almost unheard of outside particular cultural contexts. The American Psychiatric Association has conceded that certain mysterious mental afflictions are so common, in some places, that they do in fact warrant inclusion as “culture-bound syndromes” in the official Diagnostic and Statistical Manual of Mental Disorders.
The working version of this manual, the DSM-IV, specifies 25 such syndromes. Take “Old Hag Syndrome,” a type of sleep paralysis in Newfoundland in which one is visited by what appears to be a rather unpleasant old hag sitting on one’s chest at night. (If I were a bitter, divorced straight man, I’d probably say something diabolical about my ex-wife here.) Then there’s gururumba, or “Wild Man Syndrome,” in which New Guinean males become hyperactive, clumsy, kleptomaniacal, and conveniently amnesic, “Brain Fag Syndrome” (more on that in a moment), and “Stendhal Syndrome,” a delusional disorder experienced mostly by Italians after gazing upon artistic masterpieces. The DSM-IV defines culture-bound syndromes as “recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular diagnostic category.”
And therein lies the nosological pickle: The symptoms of culture-bound syndromes often overlap with more general, known psychiatric conditions that are universal in nature, such asschizophrenia, body dysmorphia, and social anxiety. What varies across cultures, and is presumably moulded by them, is the unique constellation of symptoms, or “idioms of distress.”
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