AS and BPD

Post Reply New Topic

I like the term healed rather than cured. Cured implies someone else doing the work. Healed comes from the self. Others can help (and books too ), but it doesn't happen without active participation.

I'm also reminded of the Serenity Prayer...

Serenity to accept what I cannot change

Courage to change what I can

Wisdom to know the difference.


Wisdom in this case contributed to by the knowledge of others. Though, still, even with a label, there's a process of figuring out what things one can change and wants to change, and what things are parts of one that aren't going to change.

To add to that (for those few whose countries go by the ICD):

In the ICD-10 there's also the differential diagnoses F.60.5 anankastic personality disorder, F.94.1 reactive attachment disorder of childhood and F94.2 disinhibited attachment disorder of childhood.

That's again, the differential diagnosis according to what they think is going to "present" similarly, mostly according to what patterns of traits seem to overlap even in the diagnostic criteria themselves.

They don't mention the many things that are mistaken for each other, outside of the diagnostic criteria and the most basic knowledge about how something works.

As in, basically, when they write the diagnostic criteria they write about what general traits they view most people with a condition as having in common.

But every condition (or pseudo-condition, given psychiatry's fondness for creating false categories) also has many traits that aren't listed in the diagnostic criteria, and often not even in the long description. Those less-official traits can resemble each other too, and even greatly influence which thing a person is diagnosed as. But they aren't taken into account in the 'differential diagnosis' section, at all.

Because of this, there's no way at all to definitively say "These things are the differential diagnosis of that thing" in anywhere near so rigid a manner. Remember again that the real world of what people might look like, and the grossly oversimplified world of the DSM, are two very different things. Even the people who wrote the DSM were aware of this and warned people against using it in this sort of overly rigid and out-of-context way.

For instance, something they don't mention in that list of differential diagnoses, is bipolar. Why would autism be mistaken for that? Well, many autistic people can stay up all night perseverating, on one topic, for several days at a time, neglecting self-care in the process. And periods of extreme activity such as that can be mistaken for mania or hypomania. In contrast, after the extreme periods of perseveration are over, the person may become overloaded, physically sluggish, and exhausted, even catatonic. This can be mistaken for depression. Additionally, there's some evidence that bipolar (or something that gets diagnosed as that) runs in the same families as autism does.

That sort of thing got me a misdiagnosis of bipolar at one point, a "rule out bipolar affective disorder" at another point, and a schizoaffective (bipolar type) diagnosis at another point. My family has a history of people being diagnosed with bipolar. I had a movement disorder that could manifest both in difficulty starting, and difficulty stopping, actions. At the most extreme, this meant running around the room in an apparent frenzy at some times (sometimes until I literally dropped from exhaustion, gave myself asthma attacks, etc), and not moving at all at others. (But these things were not mood-correlated. This is a relatively standard pattern for certain movement disorders that can be associated with autism.) And I had the perseveration/shutdown cycle I described above. And I stimmed which some people mistook for having manic energy, same for being unable to control the speed of my voice, and/or requiring extreme momentum to continue speaking since it was so hard to speak, and thus sometimes talking very fast when able to speak (other times being unable to speak at all). Plus when put on certain medications (stimulants and anti-depressants) I either moved around a lot and stimmed more, or experienced something more readily approximating the experience of psychotic mania (but they did not bother to realize that these were brought on by meds, even if the correlation was exact and the problem went away when I stopped the meds).

But you won't see bipolar listed as a differential diagnosis, even though nearly all the things I just described stemmed from autism-related traits, and can be easily mistaken for bipolar traits. Combine that with the fact they often run in the same families, and you can see how easy it is to make that mistake. It would be grossly unfair as well as untrue to claim that because bipolar is not listed as a differential diagnosis, then autism somehow isn't commonly mistaken with it, or is never mistaken with it.

I've even known several people who were autistic who went for years of therapy, prior to diagnosis, where they were being convinced their traits were the result of childhood abuse. Sometimes these people had PTSD and sometimes they didn't, but all were diagnosed with it. They were told that their hypersensitivities were actually PTSD-related hypervigilance, that their social problems were the social problems created at times by PTSD, that their aversion to touch was a sign they were sexually abused, etc. But you won't find PTSD as a differential diagnosis in the DSM even though it's often used like one.

BPD is usually described in terms of relationship problems. How hard is it to see (no matter what the DSM says, or what category they claim it belongs to) that anything that causes relationship problems can be mistaken for autism? The root causes don't matter in terms of that. People don't truly see root causes when they see someone's behavior, they just see the behavior.

Isn't differential diagnosis not just for things that might look similiar, but things that one shouldn't diagnose both? Like, isn't that where they say for one of the two disorders that if they meet the diagnostic criteria for one disorder, you shouldn't diagnosis with the other?

Because, if so, that's quite different than thinking the two diagnoses might look alike. Mental health professionals are well aware that bipolar and Borderline Personality Disorder can look a lot a like, but there's no prohibition against diagnosing both, because they are, despite looking a like, quite different at the core, and one can have both.

My understanding is that 'differential diagnosis' (in psychiatry) is the entire process of looking for the likely reasons for someone's behavior, and that includes knowing what things look similar to each other and can be confused for each other.

It definitely does not mean a person can't have both. For instance, Daniel mentions schizophrenia among the list of differential diagnoses for autistic people. But the DSM has actual guidelines for when to diagnose schizophrenia in an autistic person. That means that it is possible to diagnose both, under the psych system's rules.

I don't understand why you refer back to Daniel's list, yet you define it as something clearly different than how he used it.

That's okay. I think I'll say out of this conversation from here on out. Unless perhaps it gets back to the topic of BPD and I feel I have something to add on that.

If you "sense" something, it's through the senses and what you have extrapolated from them. I strongly believe that any apparently inexplicable phenomenon can be explained through careful observation, correlation, and thought. If you have a strong intuitive sense of others, it is coming to you naturally and not supernaturally. Saying you've "never yet been wrong about a person" is an extraordinary claim, and I'll take it to be hyperbole or selective recall. For example, if you've concluded someone is annoying, you will interpret future actions from them as annoying to fit into your cognitive framework; it's really subjective.

I thought he and I were talking about two different facets of the same thing, or the same thing stated two slightly different ways.

And I'm not sure why you would have to stay out of the discussion.

To lighten the mood and the reading, here's a funny I found when looking up BPD:-

Also Known As:
Emotional dysregulation disorder; many other new names for this condition have been proposed. One pundit suggested calling it "Teenagers."

Yaya I'm a middle aged teenager!! !

As far as the mood not being lightened, I seem to have gotten into a social situation in this thread that is way out of my depth (so far that I didn't see anything wrong until just now), but have no clue how to rectify the situation.

Yeah, one can have Schizophrenia and Asperger's/Autism "officially as long as the former clearly proceeded the latter in onset. In reality, if someone with an ASD experiences hallucinations and/or delusions for a month, they can be hit with the Schizophrenia label.

Concerning Bipolar: I have a cousin with such too, and the core of the disorder cannot be mistaken for an ASD from this single anecdote. When she was manic, which lasted for months; she'd never sleep; she'd be bounding with energy; she'd do many less than virtuous things--all of which had normal social reciprocation; she'd lavish in attention and conflict. I remember at a wedding, she came down and sat next to me, and she started talking for a minute or two, and then she quickly left when she realized I was ignoring her; she went and spoke to someone who responded to her in a normal way (not to mention that she became drunk in short order). When she's "down", which lasts for months, she's clinically depressed, with the scars on her wrists to prove it. She was effectively "normal" to me in social ability, with "normal" reciprocal interaction with its verbal and nonverbal cues.

The Schizophrenia Spectrum Disorders can appear as an ASD due to the negative symptoms; like the poverty of speech, flat effect, social withdrawal, etcetera. But they tend to speak in a less than logical way than someone with an ASD, and they also don't lack the nonverbal cues; the impairment in social reciprocation isn't as severe either.

Yeah, I'm interested in compareing it to BP. I don't get manic often, but I am obcessed with things no matter my mood. Someone suggested a couple days ago I was hypomanic now, I don't know... any good info out there?

But I thought you already did




I thought it (whatever "it" was) was handled quite well, so much so that I didn't notice anything but logical discussion.

***********************

I don't have to. I choose to. I don't have enough to contribute to make the attempt at trying to follow in order to contribute worth my while.

Yes, but they don't look at the "core". That's the point I was trying to make. They look for things through their own filters. (And bipolar doesn't require mania anymore, just hypomania.) It's not just an anecdote, every single trait that got me diagnosed as bipolar was a trait that is in fact associated directly with being autistic, in one form or another.

What I was trying to get you to realize, is that confusing one condition for another has to do with the whole person. Not just the parts of that person that are directly related to the diagnostic criteria as set forth in the DSM-IV. But still parts of the person that are related to the condition they actually have. The anecdote was just an illustration of that.

You then proceed to give an anecdote that you think counteracts what I said, but all you were saying was that they were not the same condition. I know that. That's not my point. The point is that two conditions can be easily confused with each other and frequently confused with each other, and that can happen as a result of characteristics that you don't consider to be "core features" but are actually associated with the condition the person really has, not just with individual personality or something.

You talk about sleeplessness. Many autistic people have circadian rhythm sleep disorders (and this has been tied directly to core neurological features of autism) that manifest in random sleep, and random sleep can appear the same as diminished sleep, especially if it's so random that the person does not sleep for three days, but then spends the three days after that in bed all the time, etc. The sleep balances out but can result in surprisingly long periods of sleeplessness.

So if they are looking for signs of bipolar, the sleeplessness will be considered mania, the excessive sleeping will be considered depression. They will not necessarily see that this is a circadian rhythm disorder associated with autism.

IT DOESN'T MATTER that this is not what you call a "core feature" of autism. They don't go around looking at people's "core features", they go around looking at people's behavior and then interpreting it in certain ways. I am not saying autism and bipolar are the same, I am saying how they can be mistaken for each other using only features associated with autism, but not necessarily or always ones that are in the diagnostic criteria. Yes, autistic people will have other social problems, but when they're looking at it as bipolar they're not going to see them the same way.

And keep in mind there is such a thing as rapid-cycling bipolar, so not sleeping for a few days is sufficient to convince people that you've been manic for a few days. You talk about anecdotes -- just because in your sister mania lasted for months doesn't mean it lasts for months in every bipolar person. (In fact, some bipolar people are never manic, please keep that in mind too.)

And the rest of what you're saying... do you understand that I am talking about how two things can be confused for each other? Do you understand that I am not saying that these two things are the same, so attempting to tell me essentially "real bipolar people are different from autistic people" is missing the point?

Autistic people routinely have characteristics, that if someone is more familiar with bipolar, can get them confused with a person who has bipolar, especially rapid-cycling bipolar.

There's circadian rhythm sleep disorders, as I've just discussed. This has been tied in autistic people to genes that regulate the body's sense of time.

There's hyperactivity, and hypoactivity, which are both common in autistic people.

There's difficulty starting and stopping actions, which can occur in autistic people without the additional movement disorder, but which are amplified in autistic people with the movement disorder. The extreme versions of these can look like catatonic excitement and catatonic stupor, to people who don't realize what they're looking at, and those in turn can be mistaken for extremely severe mania and depression.

The stereotyped movements and difficulty sitting still can be mistaken for the excessive energy in mania or hypomania. And the difficulty moving or extremely slowed movements. can be mistaken for the sluggishness of depression.

The family history of bipolar in families with autistic people (which has been commonly shown, I believe) can lead professionals to see that family history and think "bipolar" and interpret people's actions within that lens.

Remember, professionals view us through lenses, not through reality. They don't see into the "core" of traits for any condition, I can't emphasize this often enough because it seems to be what's getting you tripped up on this. Most of your points don't even matter because they are not points that professionals are taking into account. All the differential diagnosis things read like the points you're making, but since bipolar isn't listed, they aren't going to be looking for autism when they see someone who they think looks bipolar. And if they do see the social traits, that might just make them lean towards schizoaffective instead, thinking they're "negative symptoms" of schizophrenia.

So what I am showing, is that these traits, whether or not they are considered "core" to autism, are more common in autistic people, and that autistic people who have these traits and more, can easily be considered bipolar by people who aren't looking for autism and therefore aren't likely to see autism.

I'm not the only person this has happened to, I just used myself as one example among many in which the traits of autism (whether considered "core" or not, they're still all associated with autism and that's all that matters) could be considered bipolar by someone not looking hard enough.

I have both AS and BPD.

I'm different in that I have more of an ability to look at things logically than most Borderlines but black/white thinking aside I have most of the criteria.