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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.