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Hello, this is Dr. Grande. Today's question is how can we differentiate
Autism Spectrum Disorder (ASD) from personality disorders?
So here specifically when I talk about autism spectrum disorder
I'm referring to the high-functioning end of the Autism spectrum and
a presentation that doesn't have intellectual impairment.
I'm using a couple of different articles for this video and I'll put the references for those articles in the description for this video.
So we know that when we talk about Autism Spectrum Disorder and we're talking about high functioning
Autism without the intellectual impairment, we know that this particular type of presentation is often diagnosed late in life.
It's often misdiagnosed
and a lot of the time it's confused with personality disorders. So somebody may be diagnosed with a personality disorder
instead of Autism Spectrum Disorder and one of the difficulties here is that Autism Spectrum Disorder and
personality disorders share a few different things in common and one of those features is they're both egosyntonic.
Which means that there's a lack of insight. It means when somebody looks at their
behavioral characteristics and their thinking and their feelings, they find them acceptable
even though they lead to dysfunction.
That's what ego-syntonic means. Now distinguishing Autism Spectrum Disorder as I'm talking about it here
with personality disorders is challenging and it does require careful assessment
including childhood behavior and development over the lifespan and there's really a lot to it. There's a lot of components that have to be
assessed
when you're trying to differentiate these
disorders. But here in this video,
I'll be talking about some of the elements that are in
common between personality disorders and Autism Spectrum Disorder and some of the dissimilarities,
some of the areas that might help to
differentiate these disorders from one another. So to help with this differentiation, I'm going to be looking at Autism Spectrum Disorder and
specifically 2 personality disorders: Borderline Personality Disorder and Narcissistic Personality Disorder
because these are the ones featured
in one of the articles that I read but also these two personality orders are the ones that are most likely to be confused with
Autism Spectrum Disorder. We see that every now and then
Autism Spectrum Disorder is confused with other personality disorders, but it's just not that common.
So let's take a look at these disorders individually.
So with Autism Spectrum Disorder,
we know that this is listed in the Diagnostic and Statistical Manual (DSM-5)
and here we see this disorder is characterized by deficits in social communication and social interaction.
As well as restrictive, repetitive patterns of behavior,
interests, and activities.
Now when we move over to the personality disorders again specifically
Borderline and Narcissistic (BPD and NPD) we see that these are both Cluster B personality disorders.
So they're both in the same cluster, the dramatic erratic cluster. With Borderline
we see a pattern of unstable relationships, unstable mood, impulsivity,
identity disturbance,
anger, a chronic feeling of emptiness and we also see an increased risk of suicidal ideation
(gestures, threats and other behaviors) With Narcissistic Personality Disorder (NPD)
we see characteristics like being arrogant, being jealous other people, having a lack of empathy,
requiring excessive admiration,
a tendency to manipulate people and having a sense of entitlement
So there is some overlap between BPD and NPD but usually we can distinguish these two
from one other. It's also important to remember that Borderline and Narcissistic personalities can be co-morbid
and Autism Spectrum Disorder (ASD)
Can also be co-morbid with these personality disorders.
So just because somebody has a diagnosis of ASD doesn't mean that the personality disorders would be excluded.
Somebody could have
Borderline & ASD, Narcissistic & ASD or all three of these disorders. Co-morbid
presentations are a little more complex (when somebody has been one disorder) and
specifically, we know that when somebody has ASD and BPD at the same time,
there's an increased risk of suicidal ideation.
So it is important to correctly identify and diagnose these disorders because the risks are different depending on what
combination of disorders somebody presents with.
If we look specifically at
NPD and compare it to ASD and look at some of the similarities and dissimilarities
we see that individuals with NPD tend to focus predominantly on themselves and
we also see this with ASD. We also see reduced
empathic abilities. So a decrease in empathy. And I mentioned that lack of empathy
specifically with NPD. We also see that with ASD. Now the way the lack of empathy
appears in each disorder is a little bit different and it gives us some idea of how we can differentiate between the two disorders.
With NPD, we see someone who has
reduced *emotional empathy.
For example, they don't demonstrate as much sympathy and compassion. With ASD
we see more impaired *cognitive empathy, which is a difficulty recognizing and
defining emotional expressions in other people. Now something else that's interesting about NPD is
that individuals with this disorder usually don't have difficulty identifying the feelings of others
but they're less interested in other people's mental states.
So this is why we believe we see less empathy and compassion, it's the level of interest that's actually decreased.
So those are some of the differences between NPD and
ASD but what about
BPD and ASD? (Borderline Personality Disorder and Autism Spectrum Disorder)
Well here we see a lot of similarities. We see similar levels of social avoidance, callousness,
restricted expressiveness,
persistent difficulties in interpersonal relationships and we also see intense anger in both of these disorders.
There's another characteristic shared between these disorders as well. It's called
Systemizing and
Systemizing is when somebody can identify rules and patterns, and actually it's considered a strength
and the level of
Systemising that we see for BPD is actually quite similar to what we see with ASD.
Another similarity is self- injurious behavior.
We see this with both BPD and ASD.
But just like the lack of empathy that we see with NPD and ASD,
we believe the mechanism and the manifestation is a little different. So when we talk about self-injurious behavior with ASD
we usually think of it as
reducing aversive inner tension caused by a sensory overload.
So somebody is in an environment where there's just too much going on, there's too much stimulation and that self-injurious behavior
kind of releases tension. (This is with ASD) Now with BPD
we see kind of a different setup when it comes to self-injurious behavior, a different characteristic.
We see someone who is
injuring themselves because of interpersonal reasons. Maybe they're angry or trying to get attention
We also see emotional or affective reasons like to relieve anxiety
or to decrease emotional pain. We also see cognitive reasons
like if somebody's trying to punish themselves
or if they're feeling numb. So we see a lot of differences there between these two disorders when it comes to the self-injurious behavior
And again, really
understanding the details of *why somebody is engaged in that behavior can help us to
differentiate. It can help us to know which disorder may be present. Another characteristic
that's shared between BPD and ASD is suicidal ideation and
specifically with the type of presentation of ASD I'm talking about here,
(high-functioning and without intellectual impairment)
We know that with this type of presentation, rates of depression are fairly high and suicidal ideation is high.
Of course, when we see higher levels of depression, we normally do observe higher levels of suicidal ideation.
This is really to be expected. And with BPD,
Suicidal ideation is fairly common as well. So again, this construct is something that's shared between BPD and
ASD. So those are some of the ways to differentiate
these disorders based on
symptoms and how the symptoms manifest and why they manifest but what about
personality? Are there personality differences between ASD, NPD and BPD?
This is actually a really interesting question because we know that NPD and BPD are both personality disorders.
So the personality characteristics of those who have those disorders has been studied fairly extensively and
this particular study that I referenced in the article that deals with
ASD, NPD and BPD really looked at how
ASD was different than NPD and
BPD, what we could see in autism spectrum disorder that may be able to be used
diagnostically. Now the way they compared the
personality characteristics was using a model called the five factor model and the five factor model is very popular and
it's well studied. There are five big traits in the model. I remember them through the acronym OCEAN,
openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.
And what we see here is that when we compare ASD to NPD,
ASD has lower openness to experience and lower extraversion. So being more
Introverted. We also see higher
conscientiousness and we see roughly the same levels of agreeableness and neuroticism. When comparing ASD to BPD,
There are some similarities and some differences in terms of what we saw with the NPD comparison.
We still see lower scores with ASD on openness to experience and extraversion but in terms of conscientiousness
we see much higher conscientiousness with ASD as compared to BPD and
lower neuroticism with ASD as compared to BPD, but the agreeableness trait is
the same between both of these disorders.
So there we have some ways to differentiate these disorders based on the symptoms and characteristics as well as
personality profiles.
Although this research did note that we don't have a lot of information about these particular differences. So we have to be careful
jumping ahead and using these
diagnostically as if they're 100% valid. They may be helpful
diagnostically, but the results of the study are far from definitive.
Now when we talk about
autism and personality disorders,
I've received a lot of questions on this topic and that's of course why I covered it in this video
And it's interesting because I think in the mental health community
there's this idea that autism is *easy to spot and rarely comorbid with other conditions and
you really wouldn't expect
somebody to have autism spectrum disorder and to go into adulthood without it being detected and of course, we know that
Autism spectrum disorder is not easy to spot. It's often comorbid with other disorders and it's often undetected.
So I think there's a lot of misinformation and misunderstanding around autism.
I think also on the mental health community, clinicians tend to look at autism spectrum disorder and
just kind of put it way off in a category by itself.
So they create a lot of distance conceptually
between autism spectrum disorder and
personality disorders. But really, they're closer
to each other than one may think. And again, that's what these studies really looked at.
These disorders can be easily confused with one another.
If you have any thoughts on autism and personality disorders. If you agree or disagree with something that I indicate in this video,
please put those thoughts and opinions in the comments. As always,
I hope you found this description of autism spectrum disorder and personality disorders to be interesting. Thanks for watching.