DSM-5 folded Asperger syndrome into a single autism spectrum
Published by the American Psychiatric Association in 2013, the DSM-5 redrew several familiar lines in psychiatry. Asperger syndrome stopped being a separate diagnosis and joined an autism spectrum, schizophrenia lost its subtypes, and the old five-axis diagnostic system disappeared. Critics questioned the evidence behind many changes and whether the pharmaceutical industry swayed its content.
The manual is the chief authority for psychiatric diagnosis in the United States, and a text revision, DSM-5-TR, followed in 2022. It is split into three sections labelled with Roman numerals. Section I explains the organisation and the revision process, which included field trials and public and professional review, and states an aim of lining up with the International Classification of Diseases wherever feasible.
Section II holds the diagnoses. Every disorder now sits there, since the axes are gone: Axis IV became notes on psychosocial and contextual features, and the Global Assessment of Functioning score was dropped. The catch-all Not Otherwise Specified labels gave way to other specified and unspecified disorder, letting clinicians either state why criteria were unmet or leave it open. Section III gathers dimensional measures, guidance on cultural formulation, an alternative model for personality disorders, and conditions flagged for research rather than clinical use.
Some changes were renamings: mental retardation became intellectual disability, and speech or language disorders became communication disorders, with stuttering listed as childhood-onset fluency disorder. Others reshaped categories. Autism spectrum disorder merged four earlier diagnoses, Asperger disorder among them, and groups symptoms into social communication difficulties and restricted or repetitive behaviours. For ADHD, the age by which symptoms must appear rose from 7 to 12, and autism no longer rules the diagnosis out.
Schizophrenia's paranoid, catatonic and other subtypes were removed in favour of rating severity, and the bereavement exclusion for depression was deleted. The reception was rough. Critics argued that many revisions lacked empirical support, that different clinicians often disagreed when applying the criteria, that some passages were confusing or contradictory, and that drug companies may have had too much influence.
Source: DSM-5
