It's confirmed: I must get undiagnosed: how?

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It was kind of scary how she introduced the results by saying: "Your empathy test came back very low under [affective] empathy." And that's because "you are very pissed off, very pissed off."

Well, yea, deep seated anger is a horrible thing to deal with because it cuts you off from everyone and if you act on it it's even worse. I mean, depression isolates you bad enough because you're constantly surrounded with people that just don't get it, but anger on top of it pushes people away even more.

My cognitive empathy is "above average," and my theory of mind is normal. Is there a name for this type of split with low affective empathy, high cognitive empathy, and normal theory of mind?

BPD and especially Complex PTSD are highly overlapping.

I was also once missdiagnosed with Borderline, because I met some criteria, but I had PTSD at this time. Now my PTSD is a lot better and I don't show these symptoms anymore and that's the main difference between PTSD and BPD in general. Someone with "classic" BPD will continue to behave this way, no matter if the person has a trauma or not.

But I still think DBT can help you, especially when you have Compelx PTSD.

So, does she think you don't have Asperger or how does it looks like?

It depends on what is meant by affective empathy. I don't think it necessarily means you're a sociopath or anything. I think there's a big difference between 1.) feeling emotionally indifferent due to anger, alienation, or feeling empty/distant with people, and 2.) having a true machiavellian mindset. If it was the latter you wouldn't feel ambivalent or confused about what you want.

I also think it's possible to have above average cognitive empathy and still be on the autism spectrum. This goes against research that posits theory-of-mind deficits are at the root of autism spectrum disorders, but it seems there are enough counter-examples (including myself) to contradict this hypothesis. Of course there are endless arguments on the topic both in the professional sphere and among diagnosed people. Its just my personal opinion that the two aren't mutually exclusive, but possibly the very definition of the autism spectrum is imprecise. It might actually just describe a cluster of generally overlapping conditions, yet the broad category can include individuals who are so different as to have a very small overlap.

She thinks I meet the DSM IV criteria for Asperger's but thinks, like I do, that it is not appropriate due to the circumstances. Also, I wouldn't put it past my parents to have lied about my childhood autistic tendencies in order to shift blame away. For example, my mother told the doctor that "as a child, [Tyri0n] did not have any friends and always tried to run away from other children." Come to think of it, this was definitely not the case. I remember having age-appropriate friends--although my best friend was a 14-year-old girl--up until age 8, after which I was forcibly isolated due to external circumstances. I even remember arranging highly imaginative play games that other children loved.

Finally, should I push for the BPD diagnosis just because it's better known and there are more support resources out there for it? Someone on the BPD forums said this was the case, but I'm not sure. What about U.S. insurance? I looked on my company's website and couldn't even find this info.

Unless something has changed in your life as a result of environmental influence that is the opposite empathy profile from border line personality disorder. Deficit in cognitive empathy and extreme affective empathy is the profile for border line personality disorder.

This is an excellent discussion, and the more I read of it, the more I suspect my spouse may have some of the genetic components of Border Line Personality Disorder, as my spouse has extreme affective empathy and some difficulty it seems with properly picking up on the intentions of others, per exaggeration of intent at times in inaccurate cognitive empathy. I see that a lot in the Autism Community outside of these walls of Wrong Planet.

I don't see it in you all. I see the opposite. That is based on my observance of thousands of conversations in the last couple of years.

Essentially people with borderline personality get "unhinged" more easily than those that do not experience high levels of affective empathy. Obviously, this is a source of paranoid ideation as well, that is almost opposite from what one would expect from a systemizer.

You evidence yourself in your writing as an extreme analytical problem solver removing emotion from the equation. That is not common among people with Border Line Personality Disorder.

http://en.wikipedia.org/wiki/Empathy#Bo ... y_disorder

While the neurodiversity movement, overall, has attempted to steal away the empathy problems associated with Autism, it is the core issue identified both by Kanner and Hans Asperger per Kanner and his "disturbances of affective contact with others" and the term "autistic psychopathy" coined by Hans Aspergers.

The DSMIV workgroup committee chose not to include deficits in social-emotional reciprocity as a mandatory requirement so there are likely many people diagnosed on the spectrum currently with no empathy problems of note, since 1994.

That decision was anti-thesis to both Kanner and Hans Asperger's observations. Kanner's hypothesis at the time was viewed as coming as an environmental influence from "cold detached" parents, but now considered one of primary genetic origin with environmental factors associated. Hans Asperger did not offer environmental influence as a substantial contributing factor.

To be clear per the modern definition "psychopathy" it is not a deficit of affective contact alone, it is one element of many that come together on a checklist of behaviors designed by Hare, and most widely accepted and followed per his design.

If you experience guilt or remorse you would not likely meet that check list. However, the empathy profile you describe is shared both by some people currently diagnosed on the spectrum and some people assessed with psychopathy and/or anti-social personality disorder.

This is part of the reason that Christopher Gillberg places psychopathy, per modern day definition on a wide spectrum of difficulties with social instinct he describes as "the Autisms".

The propensity toward extreme affective empathy appears to be of biological origin as does lower levels of affective empathy influenced by factors such as hormones and structural differences in the brain. Environment plays a substantial role.

People who originally start out with extreme affective empathy can end up burning out and feeling almost nothing per affective empathy.

If that is your story, it could have more likely started with biological origin per the profile of excess in affective empathy associated with BPD, however it you have accurate cognitive empathy it still would not meet the empathy profile for BPD.

Many people have extreme empathy of biological origin and do not fit anywhere close to the profile of BPD, but perhaps their cognitive empathy is well developed too.

This is a similar analogy with those with low affective empathy not meeting any diagnostic or assessed condition associated with deficit in affective empathy.

Almost every person who fights in combat in the military fits that category, as it is not a place where a person with extreme affective empathy is as likely to survive per the heightened "natural instinct" of aversion in harming other life, which often comes with that attribute of extreme affective empathy.

However, those people who stay within the social norm of behavior in real life are not assessed as anti-social or psychopaths. That is where cognitive empathy comes into play per hero or villain.

There is not that much difference that sets a psychopath and hero apart. It appears to be conscientious intent in cognitive empathy rather than level of affective empathy. Environment, particularly environment in early childhood and if one does feel protected by their parents and loved, most specifically in maternal connection, can make all the difference in the world.

Interesting too, and thought provoking I think, is that those individuals who experience low affective empathy for others may similarly experience low affective empathy for themselves in "ego", per the hero laying down his life for others.

The evolutionary benefit for the species as a whole is clear, I think.

Culture provides a shell of protection for humans that was one of wild animals eating humans for hundreds of thousands of years, where the "warrior gene", in laying down one's life for others, to protect those who nurture was likely vital for species survival.

The irony that can be found in human nature per differing environmental influence is extremely interesting to me. Also per the hero turning villain or the reverse. Impacted, of course, by environmental influence.

Most ironic in psychiatry is the influence of the systemizer, and the fact if by coincidence in accessibility to diagnosis or biology, 4 out of 11 of the parents in Kanner's case studies were comprised of psychiatrists.

There are many "budding" psychiatrists on this website. That is no suprise to me, nor would it likely be to Hans Asperger, as he was a certified pediatrican but effectively a psychiatrist as well.

There isn't nearly as much "budding" psychiatrist material in the broader neurodiversity movement outside of these walls but a great deal of shared affective empathy at times without accurate cognitive empathy which is very similar to what is called Theory of Mind.

It is almost impossible to debate a point with a person who has difficulty with cognitive empathy, for others.

It is often about the affective empathy of anger, which can be much different than personal frustration. which can also result in anger, but not necessarily an emotion to be shared with others to bond.

I am only systemizing my points here based on the cognitive empathy I have developed by analyzing the behavior of others, without getting too emotionally involved in arguments.

My analysis here is certainly far from complete per my limited experience in life, that continues to grow as long as I do not set walls between myself and others.

And to be clear, this analysis is based on thousands of conversations and not directed negatively at any person in particular.

The article linked below talks about the hero/villain connection and links to another very interesting article about this irony in biology and fortune of environmental circumstance.

http://www.psychologytoday.com/blog/lit ... e-altrusim

Deficits in theory of mind on the spectrum are closely associated with co-morbid intellectual disability and some learning disorders associated with language.

Theory of mind and Cognitive empathy requires abilities in language; emotional contagion and/or affective empathy does not necessarily require language.

Children with substantial language difficulties are assessed as having greater difficulty with cognitive empathy and often cannot be tested in theory of mind tests, because of this limiting factor.

Research has been almost entirely focused on this subgroup of children on the spectrum in the research that has been done in the past. Newer research shows those without verbal language impairments and/or intellectual disability, do not have the same degree of cognitive empathy impairment, if any.

This of course is based on the criteria per DSMIV, that does not require a mandatory criterion element of impairment in social-emotional reciprocity.

It is also worth noting that impairment in affective empathy has been measured among people on the spectrum in brain scans per structural difference and process in the brain among people on the spectrum with Alexithymia, attributed to alexithymia per biological origin, rather than autism and biological origin.

However, again, the current loosely described DSMIV criteria could certainly play a role in why "only" eighty-five percent of people on the spectrum experience this currently assessed co-morbid condition of Alexithymia as it is almost impossible to experience that condition in substantial degree and not have a significant impairment in the current optional criterion element of clinically assessed impairment in social-emotional reciprocity that becomes a mandatory one in DSM5 criteria.

With BPD the level of cognitive empathy depends your current emotional state. If you're upset or engaged in a fight you might be inaccurate due to projection, splitting, or just plain exaggeration. If you're calm you're likely to be more accurate than average. This is how you could do better than average on a test yet still have problems in real life situations. I can relate to this but I'm also definitely a systematizer as well.

I don't feel comfortable with hugging, smiling all the time, or other social "touchy feely stuff", and I get bored quickly with small talk or discussions of details of other people's lives that I really could care less about. That is one type of affective empathy I'd classify as being "low" on. Yet I definitely have strong feelings of sympathy and concern for others, probably higher than average. I also have good cognitive empathy when I'm calm and composed. I have strong psychological intuition, yet most people would never know because I'm not very social and not a confident talker. This is all more complicated than meets the eye. It seems like there are two kinds of affective empathy, social affective empathy (which I am low on), and sympathy (which I am high on), and these are both distinct from cognitive empathy (which I am high on when calm but low on when upset).

Sorry Tyrion for derailing this thread. I'm just a bit obsessed with this stuff at the moment.

All cognition is subject to derision through the impact of stress hormones and the "fight or flight" response, including cognitive empathy. It is part of the reason that those individuals less reactive to the "emotional contagion" of affective empathy can remain calm and make logical decisions.

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

It is the small talk that "most" people benefit from in social emotional contagion in bonding with each other, that is biological in origin per social instinct and affected by environmental influence.

I am not good at describing emotion in words so I defer to Wiki to provide a "well rehearsed" definition of Sympathy linked here, on which I will provide my opinion below:

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



As one can see from the definition above Sympathy is the concern for the well being of another person that does not require a sharing of emotional contagion or what some describe as the component required for "affective empathy"; however, it can include that feeling.

A person can understand the needs of another person through cognitive empathy without sharing their emotions and still express concern over their well-being.

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

Compassion is the communal passion in desire to effect change to help others. It too does not require the sharing of emotional contagion per that component of affective empathy.

People that experience the intense sharing of other people's pain through personal distress often are handicapped in providing either sympathy or compassion to others, as they cannot bear the emotional contagion of the pain of others. A level of autonomy is suggested as required to demonstrate empathy for others.

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

There is extremely limited research done on individuals with Asperger's syndrome, but in the research linked below per a group of individuals studied as adults with Asperger's syndrome, there are identified deficits in empathic concern and increased personal distress over the emotional contagion of others. Once there is understanding through cognitive empathy that there is a problem that is not previously noticed levels of empathic concern (sympathy) for other people is increased.

It is suggested in this research that it is the personal distress of experiencing too much emotional contagion in sharing pain with others that is a "handicap" in demonstrating empathic concern (sympathy) for others.

http://en.wikipedia.org/wiki/Empathy#Co ... ve_empathy



As one can also note, it is the suppression of affective empathy per emotional contagion in personal distress, that leads to difficulties in the demonstration of empathy with others as well, in avoiding potential emotional conflict and/or actual suppression of emotions for those that are able to do that.

There is also the potential for eventual emotional burnout for those either not able to suppress the feelings or avoid the environment that produces the feelings, similar to care provider burnout.

I hope my communication is clear, but the entire article on empathy from Wiki has become a work of art, of sorts, in helping people that have difficulty describing emotion in words, or problems with empathy to understand empathy better, in logic and language.

From Wikipedia:

"Rogers' research, following the distinction between cognitive empathy and affective empathy, suggests that people with Asperger syndrome have less ability to ascertain others' feelings (in terms of theory of mind), but demonstrate equal empathy when they are aware of others' states of mind (in terms of affect)."

I've been part of this research!
By Isabel Dziobek in Germany. I got diagnosed from her with HFA back than, but on the "cut-off". So I still fall into the ASD spectrum, but in a very mild way.

I'm not 100% sure if it was really this research, but it was the same time and the same topic, just in Germany. Isabel Dziobek researches in ASD, especially in the differences in empathy of autistic people.

Last edited by Raziel on 08 May 2013, 4:40 pm, edited 1 time in total.

Good point, but it also should be mentioned that whatever trauma occurred at a very early age, such as physical brutality toward a toddler from the father or someone else, is always factored into the context of the particular mother-child dynamic and in this sense surely reinforces whatever dysfunction is occurring there.

To Tyrion and others, my own understanding is that BPD is a bonding disorder which occurs at a very early age, almost preverbal, where the child becomes stuck at a certain stage of development in that he has partially began to separate from the mother and individuate but cannot complete the process because the mother psychologically will not let him go (and yet at a subliminal level is also pushing him away)....so, in order to survive, he cannot allow himself to want to go (individuate himself from 'her') though the developmental urge or life force is that he does want to....This is the primary underlying conflict. .a classic and very terrible developmental double-bind. The reason it is called borderline is that such a condition can (under extreme stress) revert back to psychosis.

Again, the underlying dynamic is that the person with what is called BPD has begun individuation but cannot complete the process. He wants to (psychologically) get away from the primary caretaker but also does not want to, so the original push-pull of that particular kind of child-parent situation cannot be resolved. In the adolescent or adult the inner state of fluctuation has kind of stabilized into a way of coping, but is very fragile and can break down to some degree, though not necessarily revert to overt psychosis, depending upon various external contexts.

This is very sad, but the anger of such a person is probably anger at the primary caretaker (or whoever at the moment represents this to him), because, in order to completely individuate and become a whole person, he needs to leave without getting what he needs rather than after getting what he needs, which is very sad, so in this sense the anger is a diversion for feeling the sorrow.

Is there a way out? Of course, but, as I have written before, such a quest is the quest of the hero because it is not easy and so requires a deep focus and dedication in the face of all kinds of obstacles. Whether a person gets this or that kind of diagnosis and therapy or not, there will be a way out if he is deeply dedicated and desires with his whole being to become free.

Little Bee, are you suggesting that an over nurturing mother is the cause of BPD? Perhaps I am misreading your statement.

Research shows that it is the neglect not over nurture of children that is associated with BPD. At one point in time it was considered a purely environmental disorder, but it is now understood that genetics plays a significant role in the disorder, which could also mean that the mother might be more likely to experience an associated condition as well.

http://bpd.about.com/od/causesofbpd/a/CausesBPD.htm

Interesting too, is similar studies done with primates separated from the nurture of early life raised in an environment of "lack of nurture" develop some characteristics of behavior that are "Autistic like" in "behavioral impairment".

It appears that genetics can make the difference too, as to how resilient a person may be to these type of environmental effects of nurture and nature.

That is very interesting that you were part of the research.

The mix of nature, nurture, and empathy is very complex. It is difficult to understand considering it is most often measured by self report and observable behavior, where observation or words are often not adequate to measure or fully describe the phenomenon of empathy and the experience of it.

The testing I did we saw little movie clips and had to tell how they fell and why they behaved that way. I was under the MRT the entire time. There were also a whole bunch of other tests, like the degree of alexithymia, some other social question tests and EQ and so on. The testings alone took 7 hours and also an ASD diagnosis and they also talked to my mom to confirm the diagnosis.

Dziobek found out years ago in her research (I think she did more than one about it) that autistics have difficulties identifying emotions, but care about others in the same degree neurotypicals do.

To BPD: Some autistics told me that people with BPD got attached to them. I made the same experience and found that very interesting. I talked with a friend of mine about it (she broke up the contact) why it is that way? She told me that I don't use double meaning and she is afraid that people are not honest with her and with me she doesn't have that. We talked a lot about the similarities and differences of BPD and ASD, but I never understood totally BPD. It seems to be very complex somehow.