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Q: bipolar disorder and autism ( Answered 5 out of 5 stars,   0 Comments )
Subject: bipolar disorder and autism
Category: Health > Conditions and Diseases
Asked by: mlmegr-ga
List Price: $5.00
Posted: 08 Jan 2003 06:21 PST
Expires: 07 Feb 2003 06:21 PST
Question ID: 139220
I am trying to find out how the diagnostic criteria for autism and for
bipolar disorder have changed/expanded from DSM II to today's DSM IV.
Subject: Re: bipolar disorder and autism
Answered By: luciaphile-ga on 09 Jan 2003 12:06 PST
Rated:5 out of 5 stars
Hi mlmegr-ga,

Thanks for your question.

Just to start out, this site gives a timeline and does a nice job of
explaining differences in organization and expansiveness between the
various editions.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

And this site provides from information abut the DSM

Frequently Asked Questions/Diagnostic and Statistical Manual of Mental


DSM-II: Autism, or autistic disorder as it is referred to in the most
recent editions of the DSM, is not included under that name. Instead,
it is referred to as schizophrenia, childhood type.

Assigned a code of 295.8 (in later editions, autism is classified
under 299.0,) there is one paragraph describing the disorder, stating
that “this category is for cases in which schizophrenic symptoms
appear before puberty . . . condition may be manifested by autistic,
atypical and withdrawn behavior; failure to develop identity separate
from the mother’s; and general unevenness, gross immaturity and
inadequacy in development.” It goes on to say that it is possible that
mental retardation may result.

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:
American Psychiatric Association, 2nd ed., 1968, p. 35.

This web site includes some of the history behind autism and mentions
some of the terms used to describe the disorder.

Autism and ABA

Another site has it that “the DSM II ‘Childhood schizophrenia’ was
partially replaced by DSM III ‘childhood onset pervasive developmental


DSM-III: In this edition, autism is now coded with 299.0, classified
as “infantile autism” and falls under “Infancy, Childhood or
Adolescence Disorders.” Diagnostic criteria is broken out under a
separate subheading and for this disorder includes:

“A. Onset before 30 months of age.

B. Pervasive lack of responsiveness to other people (autism)

C. Gross deficits in language development

D. If speech is present, peculiar speech patterns such as immediate
and delayed echolalia, metaphorical language, pronomial reversal

E. Absence of delusions, hallucinations, loosening of associations,
and incoherence as in Schizophrenia.”

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:
American Psychiatric Association, 3rd ed., 1980, pp. 89-90.

DSM-III-R: This edition classifies autism as “autistic disorder”
(using the same code 299.0). They break down the diagnostic criteria
in much greater detail than in previous editions.

A. Qualitative impairment in reciprocal social interaction
lack of awareness of others’ feelings or even others’ existence; does
not seek comfort in cases of distress or seeks abnormally; “no or
impaired imitation”; lack of or abnormal play; “gross impairment” in
making friendships

B. Qualitative impairment in verbal and nonverbal communication, and
in imaginative activity
no mode of communication; abnormal nonverbal communication; lack of or
no imaginative activity; “abnormalities in form or content of speech”;
“marked impairment in the ability to initiate or sustain a
conversation with others”; markedly restricted repertoire of
activities and interests; stereotyped body movements”; “preoccupation
with parts of objects”; upset about small aspects of changed
environment; insistence on not deviating from routines; limited range
of interests and a preoccupation with narrow interest

C. Onset during infancy or childhood

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:
American Psychiatric Association, 3rd  revised ed., 1987, pp. 38-39.

DSM-IV: The shift from the DSM-III to IV is not quite as dramatic as
it was from I to II. The four principal headings are the same,
although there is some difference in language and in examples. The
site below has the diagnostic criteria:

Diagnostic Criteria for 299.0 Autistic Disorder

DSM-IV-R: No changes from DSM-IV

This site does a nice job of breaking down some of the changes from
the various editions.


This article by Peter Szatmari	 discusses some of the differences in
the diagnosis and classification of autism specific to DSM-III to the
current edition.

Thinking about Autism, Asperger Disorder and PDD-NOS


DSM-II: The term used in this edition is “Manic-depressive illnesses”
or “Manic-depressive psychoses.” They describe these as “disorders
marked by severe mood swings” and being recurring. The disorder is
then subcategorized as being one of the following: manic type (296.1),
depressed type (296.2) or circular type  (296.3)

Manic type is characterized by primarily manic episodes, although
brief periods of depression can occur. Symptoms include: “excessive
elation, irritability, talkativeness, flight of ideas, and accelerated
speech and motor activity.”

Depressed type, according to the DSM-II, is characterized exclusively
by depressed episodes. Depressed mood, mental and motor retardation,
stupor, apprehension, agitation are some of the symptoms.

Circular type is characterized by both a depressive and a manic
episode. There are two subclassifications: 296.33 Manic-depressive
illness, circular type, manic and 296.35 Manic-depressive illness,
circular type, depressed.

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:
American Psychiatric Association, 2nd ed., 1968, pp. 36-37.

DSM-III: In this edition, the disorder is now referred to as Bipolar

296.6x refers to Bipolar Disorder, Mixed; 296.4x is Bipolar Disorder,
Manic and 296.5x is Bipolar Disorder, Depressed. There is some change
of language, but the essence is the same. Mixed is the successor of
the DSM-II's "Circular."

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:
American Psychiatric Association, 3rd  revised ed., 1987, p. 217.

There is greater detail in terms of describing what goes into a manic
or into a depressed episode.

Major Manic Episode
A. Having had one or more periods with a "predominantly elevated,
expansive, or irritable mood."

B. Duration of at least a week with at least 3 symptoms below (4 if
only irritable):
increase in activity/physical restlessness; highly talkative than
normal; flight of ideas; inflated self-esteem; lower need for sleep;
easily distracted; excessive involvement in activities that are
risky/potentially dangerous.

C. "Neither of the following dominate the clinical picture when an
affective syndrome is not present"

Major Depressive Episode
A. Dysphoric mood

B. At least 4 of the symptoms below present for at least 2 weeks: 
poor appetite/weight loss; insomnia or hypersomnia; psychomotor
agitation or retardation; loss of pleasure/interest in
activities/decrease in sex drive; loss of energy; feelings of
worthlessness/inappropriate guilt; "complaints or evidence of
diminished ability to think or concentrate;" recurrent thoughts of
death, suicide, suicide attempt.

C. "Neither of the following dominate the clinical picture when an
affective syndrome is not present"

For both manic and depressive episodes, they cannot be "superimposd on
either Schizophrenia, Schizophreniform Disorder or a Paranoid
Disorder" or due to an Organic Mental Disorder (e.g. alcohol

“Diagnostic and Statistical Manual of Mental Disorders.” Washington:
American Psychiatric Association, 3rd  revised ed., 1987, pp. 208-209;

DSM-III-R keeps the same terminology and essentially the same criteria
although now, there is mention of "seasonal patterns"

Some of the criteria can be viewed here:

Recognizing Bipolar Disorder

DSM-IV: Among other changes, the distinction is now between Bipolar I
Disorder and Bipolar II. The criteria are expanded The site below has
the diagnostic criteria online:

Bipolar I Disorder

Bipolar II Disorder

DSM-IV-R: No changes from DSM-IV

An overall look at some of the changes in diagnosis that may be of

Update on Bipolar Disorder: Epidemiology, Etiology, Diagnosis, and

Some of the general changes between the DSM-III-R and the DSM-IV can
be found at this site:

DSM-IV: What's Different - What's Not

Search strategy:
Google search: 
autism dsm
"autistic disorder" dsm
"bipolar disorder"dsm
"manic depressive" dsm
Also looked through print copies of the various editions.

I hope this answers your question. If you need additional information,
please ask for clarification before rating my answer.

mlmegr-ga rated this answer:5 out of 5 stars and gave an additional tip of: $1.00
very thorough and helpful response!

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