The DSM Fails Neurodivergent Women and Minorities
The Diagnostic and Statistical Manual of Mental Disorders (DSM), the so-called “bible of psychiatry,” has long been criticised for its myopic and biased diagnostic criteria when it comes to neurodevelopmental ways of being like autism. A recent article by autistic psychologist Dr. Amy Marschall highlights how these biases result in women, LGBTQ+ individuals, and people of colour slipping through the cracks and missing out on vital support.
Dr. Marschall shares her own story of not being recognised as autistic until well into adulthood, despite being a psychologist trained in identifying autism. She cites several childhood traits that were clear signs in hindsight - like precocious language development, intense special interests, and sensory sensitivities. However, because she had a close childhood friend and didn't cause ‘problems’ for authority figures, her autism was overlooked.
Sadly, Dr. Marschall’s story is all too common, especially for those who don’t fit the stereotypical image of autism. As she notes, “BIPOC autistic people [are] less likely to receive an accurate diagnosis at a young age. Women, trans, and nonbinary autistics also go undiagnosed compared to cisgender men and boys.”
These disparities stem directly from the DSM’s narrow conceptualisation of autism and the US mental healthcare system’s overreliance on it. The diagnostic criteria are based predominantly on studies of white, cisgender boys and men. Traits more common in other groups, like masking and imitation in autistic women, are left out. Racial and cultural biases also lead to people of colour being underdiagnosed or misdiagnosed.
The DSM’s flawed autism criteria then get codified into screening tools and rating scales used across the country. Insurance companies rely on DSM diagnoses to authorise services. As a result, countless neurodivergent individuals who don’t check the right boxes are denied identification and support. Autistic masking and burnout are exacerbated as people force themselves into neurotypical molds to survive.
It’s long past time for a radical overhaul of the DSM and the US mental health system to better serve all neurodivergent people. We need research and diagnostic criteria that include the full diversity of the neurodivergent population. Clinicians must be trained to understand how autism and other conditions present differently across genders, ethnicities, and cultures.
Neurodivergent people deserve a mental health system that sees and supports them for who they truly are - not one that erases their experiences because they don’t fit a narrow mold. The DSM’s biases have done untold damage to under-recognised neurodivergent communities. True acceptance and support requires expanding our understanding beyond the pages of an outdated diagnostic manual.