Asperger’s is Not a Mental Disorder

by KLS

Asperger’s is not a mental disorder. You’ll find our diagnosis called one frequently in the popular press. Although the autism spectrum is a diagnosis in the DSM-5, which is a “diagnostic and statistical manual for mental disorders,” to be accurate, we should refer to Asperger’s as a “neurodevelopmental condition.”

I’ll begin by unpacking why I prefer “condition” as the second term in this descriptor for Asperger’s.

First, I use the term “condition” because, as many of us and our allies have pointed out, Asperger’s embodies a developmental difference that can bring with it gifts (such as a fine eye for detail, a tendency to think outside the box, and a predisposition to rational decision making) as well as just plain divergence in our experience of both the social and physical worlds. Second, I use the term “condition” because the term connotes that perhaps it’s not entirely positive. Many of us and our allies have pointed this out as well: that to suggest Asperger’s in particular, or autism in general, are entirely positive or neutral experiences is to downplay the challenges of living with it, which for most of us is a reality and for some of us can be so profound that we require disability assistance or are driven to imagine an early way out.

Now, I’ll unpack why I prefer “neurodevelopmental” over “mental” as the first term in this descriptor for Asperger’s. When Asperger’s is referred to as a “mental” disorder, the focus is on an experience entirely in our heads, whether cognitive or affective. The reality is that autism in general, and Asperger’s in particular, is also very much an embodied experience.

In neurodevelopmental conditions, the brain and/or central nervous system diverges from a neurotypical standard of normative development. This impacts many aspects of embodiment that go beyond Asperger’s defining characteristics, such as “qualitative impairment in social interaction” (DSM-4); “restricted repetitive and stereotyped patterns of behavior, interests, and activities” (DSM-4); limited cognitive empathy and theory of mind; and weak executive functioning and central coherence. Several mental and mood disorders commonly co-occur with Asperger’s, including obsessive-compulsive disorder, generalized and social anxiety, and depression, but these are likely to have been responses to the condition rather than causes of it. The only defining trait of Asperger’s that is often associated with physical experience is sensory sensitivity, but since that often understood as (merely) perceptual, this is often implicitly taken as more of a mental than a physical concern.

Although autism research continues to search for definitive biomarkers and genetic signatures that can serve as physical indicators for autism, the field has found many physical conditions that correlate with embodiment on the spectrum. In enumerating these, I hope to give a sense of what living in an autistic body means. Not all autistics share all of these physical conditions, but these are experienced by many of us with greater frequency and with increased co-occurrence than in neurotypical populations. Except for seizures (which I have not had), and leaky gut (which I could not confirm either way), I have all of the physical conditions listed below.

  • Sensory Processing Disorder (including Auditory Processing Disorder): The brain has difficulty processing the sensory information it receives. In Auditory Processing Disorder, for example, someone may seem to have normal hearing in quiet environments but has difficulty filtering out speech or desired noises from background noise, poor memory for anything heard, and may have difficulty distinguishing between near sounds. — At school and work, I compensate for APD by always taking notes.
  • Hyper- and hypo-stimulation: Increased and decreased sensory response to stimuli (such as insensitivity to cold but increased response to heat, chemical smells, tactile sensations, or certain sounds).
  • Heightened perception: The ability to perceive better or more than is typical, such as through “super vision.” — For me, this is, unfortunately, a heightened sense of smell.
  • Slower pupil response: The pupil contracts more slowly than is typical to flashes of light. — For me, this made night driving almost impossible.
  • Larger pupil size: The last time the optometrist went to use eye drops to dilate my pupils, he remarked that he didn’t know why he bothered: My pupils are so large, they seem naturally, permanently dilated. I generally have sensitivity to light and prefer dim spaces.
  • Faster heart rate
  • Apraxia of speech: Difficulty in producing speech in the way that it is thought or planned. — I have high verbal ability but also this (which causes me to think one word and say another). I have much greater difficulty with speaking than writing in this respect.
  • Autoimmune disorders, including a higher prevalence in our families (e.g., asthma, eczema, allergies including food allergies, thyroiditis, arthritis), sometimes paired with endocrine dysregulation. — For me, this is a form of hypothyroidism: Hashimoto’s Syndrome.
  • Obesity
  • Irritable bowel syndrome
  • Leaky gut: When the intestines are “too permeable” and “leak their contents into the bloodstream.”
  • Low muscle tone and core muscle weakness (aka hypotonia, leading to trunk instability)
  • Joint hypermobility (particularly among women on the spectrum, perhaps because of estrogen levels)
  • Poor sensorimotor integration
  • Dyspraxia: A deficit in gross (clumsiness, altered gate, poor coordination and balance) and fine motor skills (e.g., handwriting difficulty).
  • Insomnia and other sleep disorders: We take an average of 11 minutes longer to fall asleep and more of us have seriously disordered sleep.
  • Seizures
  • Stimming (i.e., self-stimulation, a repetitive physical movement or vocalization that is relaxing / pleasurable, used to relieve stress and increase inward focus), with the “dark side” of stimming being self-injury (this can be as mild as excoriation). In the research, often associated with our “restricted repetitive and stereotyped patterns of behavior,” and so we come full circle to find that one of our “mental” traits is indeed linked to the physicality of our condition.