Complex PTSD and Autism

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15 May 2013, 4:54 pm

I found this from Wikipedia and thought a lot of these (definitely not all) sounded strikingly like autism. Can someone explain how this could be?

Quote:

Cook and others[32][33] describe symptoms and behavioural characteristics in seven domains:

1. Attachment - "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other's emotional states, and lack of empathy"

2. Biology - "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"

3. Affect or emotional regulation - "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"

4. Dissociation - "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"

5. Behavioural control - "problems with impulse control, aggression, pathological self-soothing, and sleep problems"

6. Cognition - "difficulty regulating attention, problems with a variety of "executive functions" such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with "cause-effect" thinking, and language developmental problems such as a gap between receptive and expressive communication abilities."

7. Self-concept -"fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".

http://en.wikipedia.org/wiki/Complex_PTSD

animalcrackers
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15 May 2013, 6:38 pm

Autism is not the only condition that is characterized by atypical development....

The thing is that ASDs are technically idiopathic (while there are suspected causes, there is no known/established cause of autism), while Complex PTSD does have a known cause....both autism and chronic trauma can result in deviations from normal development, and it's not the symptoms so much as the etiology/underlying cause(s) for the symptoms that separates them. (This is probably sort of oversimplified...I think if you look closely at the symptoms you'd likely find some distinct differences.)

I don't know if that explains anything...I think I know what you're asking (but I might not) and I can see the difference and similarities in my head but I don't think I'm describing my thoughts very well.

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15 May 2013, 6:51 pm

animalcrackers wrote:

Pretty sure the DSM only looks at observed behaviors but does not inquire into cause. Am I wrong?

I think that it's theoretically possible for some to have autism through nature (most likely the majority) and some to have autism through environmental causes, feral children being an extreme example of LFA.

animalcrackers
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15 May 2013, 7:01 pm

Tyri0n wrote:

Pretty sure the DSM only looks at observed behaviors but does not inquire into cause. Am I wrong?

My understanding is that autism is not supposed to be diagnosed if something like trauma better explains the symptoms.

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15 May 2013, 7:05 pm

animalcrackers wrote:

Tyri0n wrote:

Pretty sure the DSM only looks at observed behaviors but does not inquire into cause. Am I wrong?

My understanding is that autism is not supposed to be diagnosed if something like trauma better explains the symptoms.

And they expect people to talk about their trauma fluently and comfortably in the psychiatrist's office and also to remember it perfectly. And to realize that it is relevant without being asked.

The criteria for autism only looks at observed behaviors. It does not look at other things, like cause. Cause is not in the DSM criteria.

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15 May 2013, 7:27 pm

I am not sure one can accurately characterize feral children as autistic. Being isolated in childhood from other humans does cause severe developmental issues as I think neurological development depends on having other people around.

I think that there should be something about distinguishing complex PTSD from autism, given they have so much overlap.

I found these two pdfs - they're a two-part paper on complex PTSD and implications for people with autism spectrum disorders

Part I: http://www.oadd.org/docs/41008_JoDD_16- ... 0_king.pdf

Part II: http://www.oadd.org/docs/41009_JoDD_17- ... ulnier.pdf

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15 May 2013, 7:44 pm

Tyri0n wrote:

The criteria for autism only looks at observed behaviors. It does not look at other things, like cause. Cause is not in the DSM criteria.

You're right that the DSM does not go into anything about causes for autism -- that's why I mentioned that it's idiopathic, because "idiopathic" means that something doesn't have a known cause. The DSM does mention causes for PTSD, though, and that is what sets it apart from autism.

A competent clinician (not saying anything about how many of those exist) would look for the identifiable causes of atypical behavior instead of deciding automatically that the behavior is idiopathic and an inborn part of someone's neuro-cognitive makeup....it's part of the process of differential diagnosis. Using differential diagnosis, if atypical behaviors are caused by trauma, they should be called Complex PTSD rather than Autism.

Tyri0n wrote:

And they expect people to talk about their trauma fluently and comfortably in the psychiatrist's office and also to remember it perfectly. And to realize that it is relevant without being asked.

Those are really huge problems, for sure.

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15 May 2013, 11:57 pm

I was actually diagnosed as having a form of PTSD. I very well might; they are not mutually exclusive.

I think that if my shrink had known that I liked to line up my toys, freaked out around loud noises, was picky about who I would talk to, had eye contact issues, and (according to my mother) skipped the separation anxiety phase of development BEFORE I experienced any major trauma (as far as I know), that diagnosis would not have been made. Well, it may have been, but not on its own. At the time, I knew next to nothing about the high-functioning end of the spectrum and didn't think to mention any of that.

Where trauma and autistic traits co-exist, how do you even know for sure what is the source of this or that symptom? What is anxiety because of sensory integration problems vs. because of lingering sensory issues related to the trauma? I don't think anyone can say for sure, maybe not even the people living through the symptoms. I am not sure to what degree such a distinction really matters.

Last edited by velocirapture on 16 May 2013, 12:19 am, edited 1 time in total.

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16 May 2013, 12:08 am

velocirapture wrote:

I was actually diagnosed as having a form of PTSD.

I think that if my shrink had known that I liked to line up my toys, freaked out around loud noises, was picky about who I would talk to, had eye contact issues, and (according to my mother) skipped the separation anxiety phase of development BEFORE I experienced any major trauma (as far as I know), that diagnosis would not have been made. At the time, I knew next to nothing about the high-functioning end of the spectrum and didn't think to mention any of that.

Where trauma and autistic traits co-exist, how do you even know for sure what is the source of this or that symptom? What is anxiety because of sensory integration problems vs. because of lingering sensory issues related to the trauma? I don't think anyone can say for sure, maybe not even the people living through the symptoms. I am not sure to what degree such a distinction really matters.

Yep, like you, diagnosed with both Asperger's and C-PTSD. Probably will never know one way or the other if I am autistic or not. They are just too damn similar!! Down to the motor coordination/sensory integration and disturbances in the capacity for empathy!!

My mother says one of my early autistic symptoms was extreme separation anxiety, which predated the trauma (BPD at a young age, hahaha). Is this really not correct?

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16 May 2013, 12:25 am

Tyri0n wrote:

velocirapture wrote:

There is more than one type of disordered attachment. There is a certain point in development where separation anxiety is normal. Whether you are disordered because you lack separation anxiety or because you have it at the wrong point of development/after that phase is supposed to have ended does not matter as much as the failure to fall within that window of normalcy. At least, that is how I understand it. I have no degree in childhood development and may be incorrect.

Since abusers often target children on the spectrum because they are easier to victimize, I would suspect many people have both ASD and PTSD. Moreover, there is a genetic factor present in both that can be exacerbated by some of the same environmental factors. I wonder what the statistics would look like if anybody took the time to gather them--they are probably quite sad.

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16 May 2013, 12:55 am

velocirapture wrote:

Tyri0n wrote:

velocirapture wrote:

One of the studies Verandi linked had some statistics. Estimating that 20-something % have some form of PTSD (often the acute kind, though).

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16 May 2013, 3:58 am

The criteria for suspecting child abuse are also consistent with PSTD and Autism which is why so many families with autism spectrum conditions end up in child protection difficulties.

This is why it is essential for any clinician to take a history prior to diagnosing an ASC to establish that the behaviours are present in early childhood thus ruling out other causes of the behaviours.

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16 May 2013, 8:22 am

zemanski wrote:

The criteria for suspecting child abuse are also consistent with PSTD and Autism which is why so many families with autism spectrum conditions end up in child protection difficulties.

So that would explain why my mother got a visit from a very rude social worker once despite being a near perfect mother when I was 12! She was only there about 20 minutes but I couldn't figure out why anyone could possibly consider my mother or father abusive.

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16 May 2013, 10:50 am

zemanski wrote:

What happens if a parent blatantly lies in order to cover up abuse by the other parent and other types of abuse by both of them? My mother told my diagnostician that I had "no friends" as a young child and no interest in social interaction. I contacted some individuals who were adults then and found out that was not the case. When I got older, I didn't have friends because I was forcibly isolated. But, while I often had conflicts with other children and other behavior problems, other children frequently enjoyed following my creative games, according to these people. I developed ODD/Antisocial traits at around age 8 but did not have so many beforehand.

Interesting -- some of the creative games I remember making up as a child factored strongly into my answers on the Rorshach ink blot test and, in conjunction with other tests and my own recollections, indicated sexual abuse and trauma.

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16 May 2013, 11:08 am

I also wonder if extreme sensory issues very early on can alter development, even without overt abuse or emotional trauma. My mother tells me a screamed and cried all the time, seemingly for no reason, for the first two years of my life. Apparently I was extraordinarily terrified of loud sound and music and was an extremely fussy eater to the point it worried my mom. My mom could not take me to a restaurant for the first three years of my life. I could not even be carried into a restaurant without screaming like bloody murder. Of course I almost completely outgrew the sensory problems by the age of 10 or so. At the age of 3-4 I had a particular stuffed animal that I would "talk to" all the time and carry with me at all times. I would scream bloody murder if it was taken away.

The only thing I still have is audio processing disorder. I have trouble understanding people on the phone if it's a bad signal and I can't hear people talking when going out to bars and such or in a crowded social environment where everyone is talking at once. It's kind of a socially crippling disorder in itself in a world where people often insist on being as noisy and obnoxious as possible in public environments like bars and clubs and such. Do people with PTSD ever develop audio processing disorder? Is audio processing disorder a sensory integration issue?

Last edited by marshall on 16 May 2013, 11:17 am, edited 1 time in total.

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16 May 2013, 11:11 am

marshall wrote:

I also wonder if extreme sensory issues very early on can alter development, even without overt abuse or emotional trauma. My mother tells me a screamed and cried all the time, seemingly for no reason, for the first two years of my life. Apparently I was extraordinarily terrified of loud sound and music and was an extremely fussy eater to the point it worried my mom. Of course I almost completely outgrew the sensory problems by the age of 10 or so. I still have audio processing disorder where I have trouble understanding people on the phone if it's a bad signal and I can't hear people talking when going out to bars and such or in a crowded social environment where everyone is talking at once. It's kind of a socially crippling disorder in itself in a world where people often insist on being as noisy and obnoxious as possible in public environments like clubs and such. Do people with PTSD ever develop audio processing disorder? Is audio processing disorder a sensory integration issue?

The link I included mentioned gaps between receptive and expressive language. I guess that could factor in. I had similar hearing issues to you but mostly outgrew them. What's interesting is that all my siblings did, too, except the younger ones who were raised in a completely different environment.

I still have trouble hearing in loud clubs. Which can be an advantage if it forces girls to get closer and talk into your ear. :lol:

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