5. The headline-making but most predictable--and most predictably responded to--change is the loss of Asperger's and PDD-NOS, which have both always been considered part of the autistic spectrum, as distinct-from-autism diagnoses. Whatever their shortcomings, the loss of these diagnoses is another signal that autism is, officially and more so than ever, merely a series of deficits in overt typical behaviour.And here is a discussion of some suggestions that appear to be making it into the proposed changes being made to female sexual dysfunction (FSD). I received an email from the SSSS, looking for people to comment on the following proposals:
6. At the very least, the DSM-V strongly discourages any view of autism as an atypical cognitive phenotype involving relative (to nonautistics) cognitive strengths and weaknesses.
7. The changed criteria, which collapse the DSM-IV social and communication domains, overlook any role for manual and oral motor abilities in these two areas. And whose definition of the now-mandatory social reciprocity criterion will prevail? Here is John Constantino'sone-way-street definition:
Reciprocal social behavior refers to the extent to which a child engages in emotionally appropriate turn-taking social interaction with others.The closer-to-equal time, so to speak, now granted the previously-relegated RIRB (restricted interests and repetitive behaviours) domain could be seen as progress, ditto the disappearance of the "nonfunctional" assumption. But autistics will no longer have DSM-IV unusually focused and intense interests (a strength), we will instead be pathologically fixated.
Currently the FSD subcommittee has proposed four changes from the DSM IV-TR as follows:This obviously increases the standards to get a diagnosis, thus reducing the demand or potential insurance coverage for those marginal patients. You can imagine who would be against this, those clinicians who serve the marginal patients. (By marginal here I mean the people that met the DSM IV criteria but will not meet the DSM V criteria.)
Change 1: deletion of sexual aversion disorder and capturing it as an anxiety disorder
Change 2: redefining female orgasmic disorder as delay in or absence of orgasm and/or markedly reduced intensity of orgasm that must be present for at least 6 months and experience on at least 75% of occasions of sexual activity that causes distress
Change 3: merging desire and arousal diagnosis into one entity, replaced by SIAD, sexual interest arousal disorder. SIAD would be defined as a lack of sexual interest/arousal for 6 month duration as manifested by at least 4 fo the following:
a. absent/reduced interest in sexual activity
b. absent/reduced sexual/erotic thoughts and fantasies
c. no initiation of sexual activity and not receptive to partner's attempts to initiate
d. absent/reduced sexual excitement/pleasure during sexual activation at least 75% of occasions of sexual activity
e. desire not triggered by sexual/erotic stimulous
f. absent/reduced genital or non-genital physical changes during sexual activity at least 75% of occasions of sexual activity
which causes distress and is not due to a physiological substance or general medical condition.
Change 4: merge vaginismus and dyspareunia into genito-pelvic pain disorder defined as persistent or recurrent difficulties for 6 months or more with at least one of the following: