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?
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.
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?