Published on 12, July, 2020
Many years ago my local AS support group studied DSM-IV and ICD-10 in order to decide which of the two they would use as their primary reference and diagnostic manual for psychiatric and mental health conditions. ICD-10 was eventually selected for a variety of reasons.
At the time nobody was aware that the diagnostic codes associated with each condition in DSM originate from ICD, and that DSM simply appropriates these codes.
ICD-9 was published in 1978. It does not include Asperger syndrome.
DSM-III was published in 1980. It does not include Asperger syndrome.
DSM-IV was published in 1994. It includes Asperger syndrome.
ICD-10 was published in 1994 – and adopted by most nations in the late 1990s. It includes Asperger syndrome.
DSM-5 was published in 2013. It deletes Asperger syndrome and submerges it into ASD.
All diagnostic codes in DSM-III and DSM-IV originate from ICD-9, which does not include Asperger Syndrome. Therefore the DSM-IV code for Asperger syndrome was technically an “unspecified autism” code.
In 2015 the US finally retired ICD-9 and adopted ICD-10, which includes Asperger syndrome.
History reveals a bizarre and confusing irony in that between 1994 and 2013 American clinicians who were diagnosing patients with Asperger syndrome (in terms of a DSM-IV code) were technically diagnosing patients with “unspecified autism” instead, and since 2013 most American clinicians have believed that it is no longer possible to diagnose patients with Asperger syndrome because it is no longer in DSM-5, but in 2015 they actually could because it is in ICD-10 that the US began using that year.
This raises the questions:
1. Does Asperger syndrome officially exist in the US?
2. If the answer to (1) is yes, then has Asperger syndrome only officially existed in the US since 2015?
3. If the answer to (2) is yes, then was Asperger syndrome an unofficial (or even a potentially bogus) condition in the US between 1994 and 2013, yet it existed as an official condition in other countries in the year that they adopted ICD-10 – 1995 for the UK?
4. If the answer to (3) is yes, then was Asperger syndrome deleted from DSM-5 because there was no corresponding diagnostic code for it in ICD-9 which was used in the US in 2013?
5. If the answer to (4) is yes, then does ICD-10 officially override DSM-5 in the US when it comes to diagnosing ASD because it was introduced into service in a later year?
6. If the answer to (5) is yes, then does this mean that DSM-6 must restore Asperger syndrome because its diagnostic codes will originate in ICD-10 which has a diagnostic code for Asperger syndrome?
I'm inclined to say:
1. Yes.
2. Yes.
3. Yes.
4. Needs more investigation to confirm it.
5. From 2015 American clinicians are at liberty to diagnose psychiatric and mental health conditions under either DSM-5 or ICD-10 as they see fit. ICD-10 was adopted for medical applications in the US in 2015 and there appears to be no exemption order for psychiatric or mental health conditions that they have to be diagnosed under DSM-5. Whether ICD-10 must (or should) be used rather than DSM-5 when a conflict exists between the two, because it was introduced into service later in the US, is a question that needs to be answered.
I think that Kitsun has failed to realise that a person diagnosed with AS in Britain back in 2000, under ICD-10, has an official diagnosis of AS, but a person diagnosed with AS in the US back in 2000, under DSM-IV, may well have an unofficial diagnosis of AS as in reality they have a diagnosis of “unspecified autism”. This is because the DSM-IV diagnostic codes originate from ICD-9, which does not include a diagnostic code for Asperger Syndrome. DSM is NOT completely independent of ICD as it carries across ICD diagnostic codes. If anything, DSM is an extension of ICD as it includes the ICD diagnostic codes along with some "unspecified" conditions that are not listed in DSM. The trouble with both DSM-IV and DSM-5 is that they are based on ICD-9 when at the times they were published ICD-10 existed.
6. Asperger Syndrome still technically exists in ICD-11 with its own distinct diagnostic code 6A02.0 Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language.
community.autism.org.uk/.../does-asperger-syndrome-still-exist-in-icd-11
It is not known when (or even if) the US will adopt ICD-11. It took the 21 years for the US to adopt ICD-10 whereas in most European countries it took less than 5 years. Therefore a strong possibility exists that ICD-12 will be out in the rest of the world before the US has even got round to adopting ICD-11. In the meantime it's possible that a DSM-6 will be developed which will be based on ICD-10 if the US has not got round to adopting ICD-11.
My own personal view is that both ICD-10/11 and DSM-5 should both be replaced by a single international reference and diagnostic manual for psychiatric and mental health conditions.
1. Only if someone has previously been diagnosed with it according to the DSM-IV when it was in use. It can not now be diagnosed since they have switched to the DSM-5 criteria for assessment and diagnosis.
2. Aspergers was an available diagnosis in the US from 1994 as that was when the DSM-IV was published and available for use, regardless of whether or not all clinicians had switched over to using it. It was still an available diagnosis.
3. No. It existed in the DSM-IV and was an official diagnosis while the DSM-IV was in use.
4. No Asperger Syndrome has been deleted for a variety of reasons, please note that is has also been deleted from the new 1CD-11 which is already being used by some centres in the UK and will be fully in use come 2022. Reasons for it's deletions are many but include the discovery of Hans Aspergers involvement in the Nazi Euthanasia program of persons with mental impairment!
https://www.spectrumnews.org/news/new-evidence-ties-hans-asperger-nazi-eugenics-program/
5. Codes in the ICD or DSM do not override each other. They are separate and both perfectly legitimate diagnostic manuals. As a rule of thumb, the DSM is used in the US while the ICD is used in the UK but this isn't 100% accurate. Ultimately it's up to the individual clinician which one manual they use.
6. No
The removal of AS from DSM-5 when it was published back in 2013 created a bit of a stir. However, it now appears that:
1. AS was only an unofficial condition in the US between 1994 and 2013, whereas it was an official condition in the UK between 1995 and today.
2. AS became an official condition in the US in 2015 but few Americans in the psychiatric and mental health profession have noticed it.
The nub of the matter was the (excessively?) long delay in the US adopting ICD-10 which resulted in the US being more reliant upon DSM for psychiatric and mental health conditions than in the rest of the developed world between 1994 and 2015. DSM-IV (1994) was deemed to be more modern than ICD-9 (1978) and ICD-10 was not available in the US because it hasn't been approved.
Does the NAS have any comments about the situation?
1 - Maybe. I don't think it matters.
2 - n/a
3 - n/a
4 - n/a
5 - n/a
6 - n/a
What matters is being able to help people understand themselves and find ways to improve their lives. "Aspergers Syndrome" as a label isn't required for this.