Have you heard of Asperger's Syndrome?

medicine : The end of Asperger's

There is this pain that comes with people. Whenever they walk too close to her, it feels like knife wounds. For a long time Gabriele Fürst (name changed) thought that was normal. She wondered how other people throng the shopping streets. That should hardly be bearable.

Fürst, 32 years old, suffers from Asperger's Syndrome, a developmental disorder commonly defined as a mild form of autism. The pain that comes with being close is just one of the symptoms. It is not uncommon for great talents to face major social deficits. She can re-enact pieces of music on the piano after hearing them once without ever having learned to play the piano or read music. She sings in a classical choir, also in front of an audience. But she has problems with interpersonal contact and empathy.

Prince never cried. She doesn't know this emotion. It was a relief for the family when her sister brought a book about Asperger's and much of this book applied to Gabriele Fürst. It was the explanation.

But Asperger's disease may soon disappear from medical dictionaries. Not because it no longer exists, but because it will be called differently. It should be summarized under the autism spectrum. The American Psychiatric Society (APA) is discussing this. It publishes an important guide to mental illness, the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual was first published in 1952 and has been reissued on a regular basis since then. Diagnoses are summarized, added or deleted. In 1974 homosexuality was deleted as a behavioral disorder.

In order to make diseases distinguishable, comparable and thus treatable, they have to be clearly defined. If a cause can be identified, it's easy: AIDS is the disease caused by the immunodeficiency virus HIV. This is true even with some mental illnesses. Rett syndrome, a serious developmental disorder, is caused by a mutation in a gene.

In the case of many other mental illnesses such as Asperger's Syndrome, however, the cause has often not yet been clearly identified or there are various causes that trigger similar symptoms. It is difficult to define. Therefore one makes do with categorization systems: If the patient has this, that and the symptom, he has this disorder. There are two important such systems: the World Health Organization (WHO) classification and the APA's DSM Diagnostic Manual.

The APA only differentiates between autism and Asperger's. According to the WHO, however, there are four diseases that fall under the spectrum of autism: early childhood autism, highly functional autism, Asperger's syndrome and atypical autism. They differ in the severity and frequency of certain syndromes. By definition, this is not how an autistic person can speak. A highly functional autistic person did not begin to speak until they were four years old, and people with Asperger's syndrome often speak stilted, as children and adults.

They also have problems dealing with other people. Their looks avoid, they cannot hold small talk or memorize faces. Atypical autistic people have only isolated symptoms. What they all have in common are communicative weaknesses and a tendency towards extremely routine daily routines.

With Fürst this means, for example, that she takes a shower at 5:37 a.m. every day. Two minutes late and she panics. Or eat nothing other than black bread and butter vegetables for weeks. Not because she likes it so much, but because it's routine.

She never understood that you also have social contact with your colleagues at work, that you tell them private things. Coffee breaks and small talk took place without them. She lives her life according to lists that she writes down for each day. If the list says that she works from 9 a.m. to 4 p.m., that's all she does. “I'm here to work, not to talk,” she once told her colleague. Not because she's shy, not because she didn't like the colleague, but because it wasn't on her list. Of course, that didn't go down well. “It was always said: It's strange,” says Fürst.

For Ludger Tebartz van Elst, a psychiatrist at the Freiburg University Hospital, this is a typical Asperger pattern. Often the real reason why people suffer burnout or become depressed is because of Asperger's Syndrome. Although you could often perform extremely well in some areas, an over-structured daily routine just as often leads to conflicts.

Recently, the number of Asperger's diagnoses has increased. It used to be in the alcohol range, according to new surveys up to 1.5 percent of the population suffer from it. This is probably also due to the fact that Asperger's has reached a certain prominence and is recognized earlier.

Tebartz van Elst looks after many patients with Asperger's and various forms of autism. He is critical of the categorization. Where do you draw the line? Where does Asperger's end and where does highly functional autism begin? “For me, these are sham categories,” he says, and the transitions are fluid. It is arbitrary that the line between autism and Asperger's is drawn at three years of age in language development, for example.

The autism experts at the APA therefore suggest removing Asperger's from the new edition of their manual. This would no longer differentiate between different diseases, but would classify them within the autism spectrum. Tebartz van Elst finds this convincing.

But what does that mean for someone who says with a certain pride that he is an aspie, as people with Asperger's call themselves? There is great excitement about the discussion in the APA in internet forums. They fear that with the designation Asperger's, the diagnostic criteria for a psychological behavior disorder will no longer apply and that the doctor will say: “Sorry, you are not sick. Just behave normally. ”A fear that is unfounded. After all, only the name would change. Asperger's would then be about mild autism.

Nonetheless, Simon Baron-Cohen, director of the Autism Research Center in Cambridge, criticized the New York Times for not tearing down the boundaries between diagnoses too early. One would only unsettle those affected who would have found an appropriate name for their symptoms. In addition, Asperger's has only been in the APA's manual since 1994 and there is still evidence to ensure that there are no different biological causes that trigger Asperger's or autism.

Baron-Cohen became known for his extreme male brain theory. She explains autism as an extremely pronounced male brain that arose from increased testosterone uptake in the womb. In order for Asperger's to exist as an independent diagnosis, there would have to be another cause. If it could be proven, for example, that Asperger's is caused by an only slightly increased testosterone intake, Baron-Cohen also advocates grouping it under the autism spectrum.

“What they say is not important to me. The important thing is that I can handle it, ”says Fürst. In the meantime she has learned to face her illness. She looks for situations that challenge her. Can even imagine chatting about private matters while at work. Whenever she speaks to someone, she keeps telling herself: Look into their eyes! A conversation with the newspaper would have been unthinkable in the past.

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