Is FASD in the DSM-IV?
© 2002-2005 Teresa Kellerman
What is the DSM?
The DSM is the Diagnostic and Statistical Manual for Mental Disorders published by the American Psychiatric Association
(APA). This publication contains behavioral descriptors and diagnostic labels for a variety of "mental illnesses" disorders. The 4th edition has been revised by the APA and the current version is the
DSM-IV-TR (text revision). The APA is working on a new version, the DSM-V, which will be published in the future. For more information on the DSM-V project, see
http://www.dsm5.org/
Historical
Perspective
The following is from an article by mental health therapist Kenneth Dunning, M.S.,
C.M.H.C., N.C.C. in a 1996 newsletter published by FAS-FRI in Lynnwood, Washington:
http://www.fetalalcoholsyndrome.org/undrstnd.txt
“Screening & Diagnosis: This stage is difficult because FAS/E is not in the current American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM IV). But to try conventional, cognitively-based interventions alone, for any standard presenting diagnosis, is like trying to stop a client from sneezing, while ignoring pneumonia. Alcohol Induced Persisting Dementia is a diagnosis in the DSM IV which I believe accurately describes the phenomenon of FAS/E. But I have never seen it used in that manner. I have considered using it because the public’s familiarity with dementia would give them a reference point as to the seriousness and impact of FAS/E.”
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code for FASD is 760.71. This code applies to noxious influences affecting the fetus or newborn through placenta or breast milk, specifically alcohol, and therefore includes FASD. The code does not specifically mention FAS, and may reflect maternal alcohol consumption during pregnancy or other adverse effects of alcohol on the fetus. (Centers for Disease Control newsletter, MMWR Weekly, April 07, 1995 / 44(13);253-255,261)
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00036711.htm
A study was conducted where all cases in a specific period of time with a diagnostic code of 760.71 were abstracted. About one-fourth of these children had symptoms that met the criteria for a diagnosis of full FAS. In the remaining 75%, at least one physiological feature of FAS was present. (Same CDC newsletter)
These two resources were published 10 years go. As more up-to-date resources are available, they will be added to this list of references.
More information on how the ICD categorizes disorders related to prenatal exposure to alcohol and other drugs can be found here:
http://165.112.78.61/DEPR/Assessing/Guide9.html
Axis Categories for Diagnoses in the DSM-IV
Not all diagnoses listed in the ICD are included in the DSM-IV-TR. Diagnoses in the DSM-IV are listed by categories in the following Axis order:
•Axis I Clinical Disorders (Mental Health)
•Axis II Personality Disorders (includes Mental Retardation)
•Axis III General Medical Conditions listed in ICD
•Axis IV Psychosocial and Environmental Factors
•Axis V Global Assessment of Functioning
More detailed descriptions of the diagnoses cover by the Axis categories can be found here:
http://www.hopeallianz.com/Resources/MI2.html
DSM-IV Code Example for Person with Undiagnosed FAE
•Axis I – Major Depressive Disorder, Alcohol Dependence
•Axis II – Dependent Personality Disorder
DSM-IV Code for Child with FAS
•Axis I – Attention-deficit hyperactivity disorder, hyperactive-impulsive type
•Axis II – Mental Retardation, Mild
•Axis III – Fetal Alcohol Syndrome
DSM-IV Code for Adult with FAS
•Axis I - Impulse Control Disorder
•Axis II – Mental Retardation, Mild
•Axis III – Fetal Alcohol Syndrome
These are single cases of classic fetal alcohol disorders. Most cases of FASD are more complex and cover a wide array of disorders and diagnoses. For a more detailed list of disorders that might be covered in the axis categories of the DSM-IV, visit http://www.hopeallianz.com/Resources/MI2.html and navigage the links at the left.
Anolther
helpful article about FAS in the DSM can be found here: http://come-over.to/FAS/DSMFAS.htm