The DSM criteria - please clarify, someone

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Okay, that's what the DSM says. But...

1. How much eye contact and such is enough? It said 'marked impairment', where do they draw the cut off line? Also, males tend to make less eye contact anyway, could this lead to more male diagnoses?

2. This one seems quite simple, but it could be a consquence of 1.

3. Again, how much is enough?

4. Like 2, this could be a consequence of 1, right?



1. Intensity or focus? I can understand the intensity part, but... focus? That's what you're interested in, right, such as being obsessed with toilets rather than plumbing in general?

2. How inflexible do they have to be to fit the criteria?

3. How much stimming is needed for the diagnosis?

4. Where does natural curiosity become too much?


The other parts are quite easy to understand, but A and B are the main parts. Unfortunately, they also seem the most ambigous.

Firstly, you need a qualitative impairment in social interaction. Then you need a couple of the pointers to such (which are the criterion).

Criterion 1., and all of them, require a clinically significant amount of presentation. Take for example when you have influenza, you will have a clinically significant "sore throat" as the doctor can see that it's red and inflamed, plus you say that it's sore. It means you lack "appropriate" eye contact, which can be none at all to staring intently at someone's nose, plus you also need more, like odd body postures/gaits, a monotonous or sing-song voice, the inability to read facial expressions and body language, as well as lacking facial expressions and body language.

3., is not at all, as in, you keep everything to yourself and don't share anything with others.

2., no friends due to the impairment in social interaction.

4., is a one-sided and verbose way of interacting to others, seemingly oblivious to their side; talking at people and not caring about their emotional state, for example.

As for the restricted behaviours, only the first one really applies to Asperger's (as per the expanded text of the DSM-IV-TR), the others are there for PDD-NOS, as that and AS have the same Axis coding. Anyway, the first one means you have an interest, say dinosaurs, that you pursue above all else; you collect facts, it's all you talk and think about (not the former if you don't share stuff, however), it's all you're interested in, and you pursue it when you should be doing other things, like schoolwork or working.

2., is sometimes there, and that's usually to a severe amount, i.e., if your routine is disrupted, you then can't do anything and you may also throw a tantrum due to being so uncomfortable.

I think what is and isn't impairment depends on what is considered "normal" in one's culture. For example, in Arabic countries, I heard it's disrespectful to make eye contact when disciplined by an authroity (eg. father, police officer). Therefore in these countries/cultures, it is not a sign of AS if someone doesn't make eye contact with their father or, for that matter,t he clinician asessing them (since that's also an authority figure). Of course sincen an American organization created the criteria, it's possibly biased against other cultures (as are most other disorders in DSM).

Regarding the preoccupation with parts of objects, I always thought that referred to non-function, repetitive behavior, eg. constantly turning hte wheels of car toys rather than playing with the car.

Marked impairment means it's noticeable and interfers with your life. If you are talking to someone and they think you are being dishonest or something else is going on because they notice you don't look at them while talking with them it's considered somewhat impairing. Others might think it's you being shy or that you lack confidence and respond to you based on their impressions. The more it interfers, the more of an impairment it is.


Not sure what you mean here...According to Free Dictionary, Qualitative means Of, relating to, or concerning quality.
How is your quality of life? Excellent? Good? Fair? Poor? Does the disorder reduce your quality of life, or doesn't affect it. Is it a mild inconvenience or does it make living in reality nearly impossible?


Focus means you keep interested in something for long periods of time. Sometimes it's really long periods. It's like time doesn't exist and you are entertaining yourself by focusing on something you are intensely interested in. I guess you could call it a comfort zone.


It has to be enough for others to notice and that it impedes you in some way. You are not as successful because of it.

But how much it impedes you doesn't just depend on you, it also depends on the other people. For instance: a failure to make friends could be a result that no-one wants to be friends with you... just because they've decided they don't like you arbitarily. If veryone does that, you have an inability to make friends, but it's caused by the other people.

But some people will have a problem with that, and others will be fine with it. People are all different, so some may think you are being dishonest whereas others won't find anything wrong.

Lack of social an emotional reciprocaty: that could quite easily be a result of criteria 1. Again, it depends on the person you are interacting with. If they said they were bored of the conversation, and as a result the person stopped giving a monologue, would they fit criteira 4?

These are interesting questions, Magneto.

You have to ask yourself Why do they not want to be friends?
If it's because you don't know how to establish the bonds of friendship and remain on friendly grounds it's considered a "qualitative impairment". It looks like it's because of other people and it's easy to blame them.
If someone doesn't like you you should ask why not? and what they say can give you clues to your own state of mind and social ineptitude. When they are saying stuff like "It's because everytime I tell you about my problems you don't appear to be listening", or "You hurt my feelings when you said I looked fat in that outfit" it tells you something about how they percieve you. They could say other things as well. All kinds of things. There are so many reasons why someone might not like another. Asking them though is like a reality check, if you really want to know the answer...I can't remember if I ever specifically asked someone this.

Most people are sensitive about that stuff and they notice. You might not realize how much they notice until you have to find a job and keep it and they "let you go" for some mysterious reason, or they cut your hours.

This means you aren't interested in being with other people or you aren't "there" for them emotionally.
I don't know if they would fit the criteria. If someone is talking about something, in a lectury way and others say they are bored it's not necessarily a lack of social reciprocity on the part of the person giving the lecture, though you could call it a lack of emotional reciprocity because the person giving the lecture continues even though others aren't interested in hearing it.
Magneto, you are right, the lack of social or emotional reciprocity could go either way. Originating in the person with AS or in the people who know him and are reacting to him. Either one could lack social and emotional reciprocity. People who know the AS person might lack it because the Aspie fulfills the previous criteria, good point.

But then that gets into the nature of the culture that the person being DXed lives in. I find it difficult to believe that someone can have a mental disorder in one culture, yet move the same eprson to another culture and they don't have it. For instance, I'm fine with people who don't make eye contact and such. If a group of like minded people thought that, that symptom of Aspergers would vanish within that group.

Are there any books I can get which explains the diagnostic criteria?

There's several, but they're expensive. And they're also meant to be used in conjunction with the university subject (there's a whole subject on the DSM).

Anyway, best to read the text from DSM-IV-TR itself, which I'll provide a link to (click on "more on ..." under the criteria to get the expanded text):

Here

Take this, and see how it explains more than the criteria itself, and it's only the first few sentences:

I've been reading it from the DSM-IV-TR. It still doesn't answer the questions of 'how much is enough' and 'how much is too much'. It was more Criteria A that I was wondering about. I think I understand the others, but...

Criteria A1, A3, and A4 are difficult to understand. I think I get A1, it's just the question of 'how cuh is enough?' Of course, that quastion also applies to criteria B.

Criteira A and B are the most improtant ones it seems, as the others are there to insure it's not other 'disorders'.

There are, theoretically speaking, three variables that tell abnormal and normal apart:
1. Statistics: "abnormal"is two or more standard deviations above/below average. This will not work for social adequacy until a reliable test for that has been devised (and none has at htis point), but it does work for IQ and such.
2. Psychological suffering/distress: this is the patient's own subjective feeling.
3. Social/occupational impairment or other significant impairment in functioning (criterion C in DSM). This is determined relatively objectively, eg. if you can't keep friends, can't hodl down a job, etc.
For some disorders, one variable is more important (eg. people with antisocial PD generally don't suffer subjective distress, but do have impaired functioning, eg. they get in trouble with the law), and for some, another variable is more important (eg. IQ below 70 is just statistical). But, of course, in practice, it's pretty much an educated guess how much of X behavior is too much, in relation to the suffering or impairment in functioning it causes or to the statistical average/norm.

One way several professionals determine 'how much is enough' is along the following thinking.

If it's obvious then there's no way it doesn't require some sort of treatment and if it's that obvious, it's obvious that the criteria are fulfilled.

If it's so mild in severity or presentation that it probably doesn't require treatment it's not obvious and there's no reason to diagnose AS or to ponder over whether any AS criterion or other label that will lead to similar/the same treatment is possibly or not can be met.

The purpose of medical labels isn't to seek the truth about people and disorders. It's to get people a label to get treatment. It needn't be the absolutely correct label, it just needs to be the label that gets them the treatment they need. So 'enough' is when treatment is needed or if a person cannot function without changes or support of any environment.


If for example a computer geek and IT specialist in a small company where there's little need to talk to anybody for days has AS, the way to figure out if they have it is to put them into lots of other situations. With kids it's easier - they have to attend school, may attend clubs, you can ask the parents at home and you can just put them into psychiatries to see if they start to behave in an atypical way.

That's why some professionals claim that adults with AS should only be diagnosed during stays in stationary 'care', just to see how they will react to an environment that usually doesn't suit their AS (if they have it).

That symptom would, yes, but what about the other symptoms. Besides, sometimes Aspies stare and that might be an insult in some cultures.
Most cultures have a certain degree of sociability or it would be a culture of one and there would be many. Which makes an interesting point. Each Aspie is a culture unto him or herself unless they share the same special interest.


Enough for the diagnostician to notice and enough for the people around you to, too. There has to be qualitative evidence that Asperger's impairs your life in some way or you don't qualify for the diagnosis. That is what the DSM says.

There is no such thing as too much as long as your IQ stays above 75

What do you mean? What does IQ have to do with it?

Your IQ must be above 70 for you to recieve an Asperger's diagnosis.

Not necessarily, there just cannot be a cognitive delay apparent in the first few years of life, though it can become apparent later in school years (or even later) for example.

But, yes, it's unlikely that with an IQ of under 70 there isn't at least some small developmental delay hinting at a cognitive delay at age 2-4 already, but it is possible.

That isn't in the DSM.