Push me, pull you. Also, The Rosie Project

A number of years ago when I was pregnant, I was diagnosed with Anxiety disorder and OCD. Hopefully the fact that I was pregnant at the time was accounted for in the diagnosis, but I guess it's not that big a deal. I made a lot of progress through cognitive behavioral modifications of various kinds. As we discussed anxiety disorder in abnormal psych last night I wasn't really sure whether I had more OCD or more GAD (General Anxiety Disorder), if it's just a case of comorbidity, or if (departing from the diagnostic manual) my symptoms would fall under Broader Autism Phenotype.

But what is interesting is how OCD and Anxiety disorders (and PTSD) are all separate chapters now (plus OC personality disorder). Not just different codeable diagnoses, but new and different chapters in the DSM-V. So much for a move toward spectra and dimensional diagnosis. I get that these disorders, especially the PTSD, have different apparent causes. Another argument is that they also involve different brain structures: the amygdala in the case of anxiety, and the cingulate gyrus in the case of OCD.

It feels like what has happened with Autism is that it's been shelved as far as etiology goes. Psychiatry is just going to look at symptoms until we can catch up to the neuroscience. My suspicion is that we will eventually find it is a pattern of alternate structures in the anxiety area, the OCD area, and also a social function area (such as the mirror circuits). Lately I've been thinking about the nature of the struggles I have in higher level social interaction. Intention is part of it, but so is relevance. One theory I've seen is that autistic toddlers have less neural pruning, so it's like they're always drinking from a firehose, in sensory terms.

Something I haven't really written about is my responses to The Rosie Project which I read this summer. A blurb on the cover talks about how everyone wants to fit in. My immediate reaction to that is "everyone wants to belong, not necessarily fit in." I also wondered about some of his reflections toward the end, about what it means to empathize with someone, and how that relates to the experience of love. The author gave into the idea that people with Asperger's don't feel romantic love. In my experience, it's not that I don't feel, but that feeling is difficult because I feel too much. It's the firehose again. Granted I'm a girl, but I think my brother is like this too. It's not that he doesn't understand people, it's that they are painful to be around.

Welcome to Pluto

So I'm taking Abnormal Psychology this semester, and this week we learned about diagnosis and the DSM-V, which did away with diagnoses of Asperger's Syndrome, PDD-NOS, and High Functioning Autism in favor of a single Autism Spectrum Disorder, with a system of quantifying a range of symptomology.

My lecturer guessed that personality disorders would come next, with others to follow. As she went on to discuss the issues of standardizing the language of diagnosis, I wondered to myself why they would start with Autism, a group that often features literalism and seeks semantic consistency. Maybe it's like New York, if you can make it there, you'll make it anywhere.

I have ultimately come to appreciate what they are trying to do. If you think of a map of the world, we previously had the disorders like continents you might be on. But what if you're in Asia minor Central America, or Greenland (which my son asked why it isn't considered a continent.) How is Europe its own continent, if you think about it?

What the new ASD diagnosis tries to accomplish is set up something like a coordinate system of the primary symptoms:

1. Social communication and social interaction deficits

2. Patterns of restricted or repetitive behavior/interests

Other conditions:

- Present from early childhood

- Impairment of function (social, occupational)

- Not better explained by intellectual disability or global developmental delay.



I think what a lot of self-proclaimed "Aspies" have been unhappy with in the category collapse (aside from the fact that it's a change) is that autism has been highly associated with intellectual disability. The new diagnosis places intellectual disability under specifiers that may co-occur with ASD, but is not an integral or expected symptom. There is no need to specify high functioning, because it is now assumed that ASD occurs alongside normal intellectual function.

So like Pluto, our disorders are no longer what we grew up thinking they were. But as with the demotion of Pluto, there should be an increase in general understanding of what it means to be a planet, and what the relative properties of bodies in our solar system are.