Asperger Syndrome vs. Borderline Personality Disorder

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That's interesting, I too have a friend with BPD and have sometimes wondered if there might not be some Aspie traits in there, due to her interests and the way she goes completely and utterly overboard with them each time (usually getting into financial trouble as a result). The identity thing, the interests being what they base their personality around at the time, is true, I hadn't thought of that.

Although to some degree, my interests too dictate how I behave to some degree, for example when I had an interest in politics I only read and wrote about political stuff online, and joined a local party and was quite active at the time, but as soon as the interest waned I lost all interest in even talking to the same people, which given that I only have a few social contacts, wasn't really good. I definitely don't have any of the abandonment issues and feelings of emptiness associated with BPD though.

Even as a small child my interests rather influenced my sense of self though, for example when I was into collecting rocks, I would go around announcing to all the parents in the playground that I was a rock now, the same for lorries and a Fisher Price cash till that I loved to play with - if someone else was playing with it in playgroup, I would just "be" the till myself and go around telling parents to pull the lever (my arm) and feed me coins etc.

Last edited by Noetic on 03 Dec 2012, 12:57 pm, edited 1 time in total.

They aren't the same, they are different disorders.

There are many ways to look at this particular bit of reality. Here's mine. It is simplified. The truth is that the brain is programmed in hardware...so there's no clear division between hardware and software.

Personality disorders (PD)...as a group...are maladaptive behaviors and ways of thinking and perceiving. They vary a lot, but commonly include low empathy, black and white thinking, shame, and problems with emotional control. This includes BPD. And, BPDs can develop social issues stemming from their behaviors and inability to understand normal thought processes. PD can include social butterflies who cut themselves and attempt suicide a lot. PD can also include zero-empathy workaholics who throw temper tantrums.

AS...is hardware. (Here, I am referring to autistic tendencies rather than diagnostic critera for the disorder.) It also varies a lot. Autistic tendencies commonly includes low empathy, black and white thinking, shame, and problems with emotional control. It is important to realize that AS commonly involves either low emotional arousal or high emotional arousal (highly sensitive personality). And AS can develop abandonment issues stemming from their difficulties nurturing social relationships. AS can include silent introverts who obsess about Star Trek. AS can also include zero-empathy workaholics who throw temper tantrums.

My belief (and at least one study echos this belief) is that undiagnosed AS (highly sensitive) is a strong risk factor for BPD. Basically, AS are more likely to resort to maladaptive behaviors and suffer more stress than NTs. I believe that low arousal AS are unlikely to develop BPD. For some reason, this seems (no real data) to be particularly true for women.

On a personal note, my wife spent many years believing that all of the problems in her life came about because everyone else in her world had AS. She was eventually diagnosed with BPD/NPD. (what with the violent rages, constant blame, abandonment issues...). Recently, she's realized that the recurrent speech issues, low empathy, ritualistic behavior, ... are indicative of at least some AS traits. And she's calmed down a lot.

So, yes, BPD/NPD/AS can look really similar. And yes, AS can lead to BPD.

Treatment?

In terms of treatment, AS and BPD both respond well to DBT and poorly to drugs. Being misdiagnosed with depression or bipolar is more problematic.

What could be better?

Well, being aware of one's AS traits really helps understanding - which helps decrease anxiety. So, therapists doing at least some tests for AS traits as part of any therapy with a BPD and incorporating those results into treatment would probably help a lot.

--Argyle

Now, the fact that BPD and AS have similar prevalances, but opposite male-female distributions is quite interesting - not proof of anything, but interesting.

I think you have some good points here.




I may be (and I hope I am) misunderstanding dialectical behavior therapy, but isn't it sort of like "tough love" .. something like undervaluing the patient's emotional displays as a way of demanding that they present in a less melodramatic fashion?

as I said, I hope this is a gross misunderstanding, but if it isn't, I don't see how an ASD patient would respond well to it.

...a gross misunderstanding.
...the core lessons of DBT are:
acceptance: accepting reality
mindfulness: living in and being aware of the moment
distress tolerance: learning to tolerate, eg, anxiety
social skills training: nonviolent communication, listening
emotion regulation: learning to calm down

...this is only mildly useful for your quiet emotionally withdrawn Aspie. But then, aside from some social skills training - whatcha gonna do? The people in their lives are the ones mostly needing training.

...but it is extremely useful for Aspies who are having trouble coping with anxiety and emotional control (meltdowns)...as mentioned by several people in our Aspie support group. In particular, very useful for Aspie women who spend their whole lives pretending to be normal, feeling horribly ashamed because they aren't, melting down from stress, and falling into anxiety-related depressions. Men do it too...but...possibly less often. Or, it may simply be that anxiety and meltdown-prone men tend to be completely ignored by society.

--Argyle

good. it came from an article about DBT that made it sounds like it consisted of a therapist basically berating their patient into emotional submission.



how is this taught?

Actually, I found a study that indicated that cluster A and C personality disorders are more likely for autistic people with and without ADHD, and that cluster B disorders are more common with ADHD alone.

BPD had the highest prevalence of all four cluster Bs in autistic people, however.

It was a small study, so I wouldn't assume it actually shows accurate percentages, but I think it did point to certain tendencies. I think a statement such as the one you made is overreaching, especially without reference to how many autistic people don't develop PDs at all, or which PDs are more likely to develop in autistic people.

DBT is typically taught by a combination of a CBT individual therapist and another therapist teaching a class on DBT skills. This arrangement works well for BPD, probably mostly because BPDs tend to paint their therapists black occasionally and stop talking to them and having 2 therapists means that one of them will usually still be painted white. The course also has the advantage of reducing shame by exposing the patient to other people suffering from the same challenges. I suspect that the DBT course alone would be pretty effective for an anxiety-prone AS. (The advantage there is that the DBT course is inherently cheap - because several people attend 1 therapist.)

@Verdandi
Oy, which study (if you can remember...)? (The Impact of ADHD and Autism Spectrum Disorders on Temperament, Character, and Personality Development?) I agree that that statement is overreaching and possibly deceptive. (particularly as clusters A and C are more prevalent) Something along the lines of...
Autism may be a strong risk factor for the development of maladaptive behaviors leading to various personality disorders, including BPD.

That said, I haven't found (and have looked for) a single study checking for AS traits in BPD-diagnosed women. I suspect (absolutely no data, just a reasonable guess) that AS traits have a high incidence in BPD-diagnosed women. This is mostly based on observations in BPDFamily, where I tended to notice that BPD women, as described by their partners, tended to fall into 2 roughly equal subgroups.
(a) Overly emotional, out-of-control, executive dysfunction, often suicidal, poor character.
(b) Violent rageaholics, zero empathy, strangely innocent, extremely honest, and obsessed by the notion that everyone around them was broken in some way.

Dunno. Seems suspicious to me. ...particularly after noticing that some of the women in our AS support group ended up in DBT...and that at least one female Aspie author of Aspie books was misdiagnosed...and that Penelope Trunk is apparently an Aspie with significant personality issues. (blogger) It is easy to see patterns where none exist, but...still suspicious.

--Argyle

I think a lot of autistic women get misdiagnosed with BPD. There are several on this forum.

I didn't mean to say you were being deceptive. Mostly just "incomplete."

I'll look up that study again and link it for you. I found it fairly interesting.

...yep.
...and I didn't think you'd implied that I was being deceptive - but, in my judgement - my earlier comment wasn't accurate and could tend to lead people to the conclusion that autism was mostly a risk factor for BPD. As far as I understood the paper in parenthesis, autism is a risk factor for practically any personality disorder - more type A and C and that, for type B personality disorders, BPD tends to be the most common. (I wonder about NPD connections also.) This is reasonable as increased stress+black and white thinking is a recipe for poor mental health.

...I'm not sure it is entirely misdiagnosis - it is perfectly possible to install Windows on a defective machine - having a messed up OS and messed up hardware isn't mutually exclusive. With my wife, for example, she fit the diagnostic criteria for BPD - so I'd tend to say she had it. She also has quite noticeable autistic traits. I'm guessing there are two checkboxes - one says (has BPD) and the other says (is AS). You can check any combination.

I suspect that women with less than 2 boxes checked tend to be diagnosed correctly. However, I suspect that women with both boxes checked tend to be lumped into the (has BPD) category. This isn't terrible - as (has BPD) is often fairly treatable. OTOH, this isn't great - as appropriate treatment should change a lot with an additional (has AS) diagnosis.

In particular, I believe that fewer therapists would have thrown my wife out of the office if they'd seen her communication issues as autistic rather than as mind games. And, frankly, my wife would have been more motivated if she'd accepted that many of her communication issues were related to her instead of being a function of how everyone she met was autistic and failing to understand her. Her progress has been noticeably more consistent since she realized she is at least moderately AS.

--Argyle

Aside from your wife, you are speaking hypothetically. Several women on this forum have reported being misdiagnosed with BPD before being correctly diagnosed with AS, autism, or PDD-NOS, so I would assume their reports are correct. I also fall into this category, and despite the BPD diagnosis, five other professionals now have disputed it and agreed with my AS diagnosis. Two of them diagnosed me with AS.



I suspect given the number of misdiagnoses I've read about that the "diagnosed correctly" is not as common as you might think.

The paper's I'd read seem to allow for co-morbidity between AS and BPD. OTOH, they seem to indicate that AS+BPD is less than 15% of the female AS population. So, probably less common than I'd guessed. I haven't been able to find any results for autism in the BPD population though.

...I'm perfectly willing to believe that misdiagnosis of women with (has AS) as (has BPD) is common. This might explain why, of the people in my wife's DBT group, she characterizes one as crazy and the other as AS. I'm somewhat dubious, as she also characterized 3 of our therapists, several of our doctors, my entire family (some truth there), and most of her friends (some truth there too...) .... as AS. I'm not saying she's altogether incorrect - she just seems unable to grasp the notion that autistic traits exist on a continuum.

--Argyle

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Last edited by Tali on 11 Feb 2013, 8:23 am, edited 1 time in total.

They are the exact opposite of one another. I think they can co-exist, however. There is the stereotype of the "emotional aspie."

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Last edited by katzefrau on 12 Feb 2013, 12:42 am, edited 1 time in total.

I apologise I do not know the right etiquette here. I have deleted my post in order to minimise disturbance.