AS and BPD

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been reading about BPD lately and am noticing it fits in a lot with AS... though there are some differences... anyone have a comorbid or ways of distinguishing? i feel like i identify with it a lot except for idealizing/demoralizing people and i don't have anger management issues other than getting overly defensive about stuff... ie-criticism.

I was misdiagnosed as BPD. I've heard from quite a few women especially that were dx'd with a personality disorder instead of AS. It never felt like I "fit" with BPD, most notably the fact that its a nurture thing. You aren't born that way, it happens because you're born more sensitive and then live in an environment that is insensitive. Essentially neglectful or abusive in some way, at the very least emotionally.

Though I have had issues in childhood, I do not consider any of it to be traumatic. I've always felt this way even before certain events happened. (sexual and verbal abuse) And my primary caregiver was NOT abusive in any way, she was wonderful.

So in those ways I always felt that the BPD thing wasn't a great fit for me. I've had therapist just shake their head and say, "Yes, but you were traumatized as a child." Um. No. No I wasn't. Sorry but you're way off base there. I may have been abused, but I should know if I've ALWAYS felt this way.

Bi-Polar Disorder or Borderline Personality Disorder?


M.

I was going to ask the same thing.

My husband has Bipolar II and most likely AS

borderline.

think the closest thing for me about it with AS is that i do get obsessed with people... but it's in a kind of different way. and i'm usually fine by myself
9unlike what BPD is supposed to be)... but what i read about it only describes it by describing how other people describe the BPD person... which a lot of people would probably say about me.

PD = generally always the abbreviation of personalty disorder.

Seeing how a psychiatrist readily wanted to diagnose me as having a BPD, the appearance of some autistic symptoms can appear eerily similar to even a professional who doesn't seem to know that autism with speech exists. I also noticed the same thing when being together with those with a BPD.

On the other hand, knowing females with BPD, my ASD symptoms have different causes that are unrelated to theirs.

Though if an autistic person had depression, anxiety and other such psychological additional disorders, I expect that the line may become blurry. Or if the autistic person had both ASD and BPD, one might easily slip the attention of diagnosticians.

I don't associate PD with personality disorder; in fact, that makes me think of Police Department. It's a valid question; the acronym is used in reference to both conditions... my most recent doctor was considering Bipolar-II/Mixed State but it doesn't fit well or respond accordingly.


M.

Not at all.

AS is an impairment in reciprocal social interaction, plus a narrow and circumscribed interest.

BPD is a "dramatic" disorder of personality, of the likes of narcissistic, histrionic, etcetera.

The symptoms between the two are entirely different.

I do not disagree with you, however, I've had a BPD label chucked at me by a psychiatrist, so clearly it's not as clear-cut as your simple yet accurate synopsis indicates it ought to be.

Personally I suspect some (perhaps unintended and unacknowledged) sexism comes into it. A.S. is associated with males (along with maths/transport/computer interests), whereas being 'dramatic' is associated with females.

Where no other sensible diagnosis will fit, it's often possible to construe BPD because of the vagueness of the diagnostic cluster; many of the behaviours described are not uncommon in people who are depressed, alienated, and/or disaffected. Because people with BPD are construed as being manipulative, lacking in insight and cognitively disordered, it's easy to dismiss evidence of symptoms contrary to BPD as being the result of unreliable cognition and/or reporting on the part of the patient. Anything the patient says or does can be explained as either the result of dysfunctional cognition or a deliberate attempt at manipulation.

Because the DSM IV-TR concentrates on diagnosis via behaviour clusters, in at least some cases, it is possible to construe the presence of a condition based on a behaviour-cluster that essentially ignores the condition supposedly being diagnosed. For instance a person with few relationships, none of which are intense, and which all lack instability can be diagnosed with BPD. This is a rather silly situation and explains why two very obviously different conditions might be diagnostically confused by an unwary psychiatrist.

As it is currently being applied, the BPD diagnosis in the DSM is vague, nebulous and fails to ensure that individuals who clearly do not fit the synopsis description of the condition also do not meet the diagnostic criteria threshold.

I certainly agree with your assessment regarding the clarity of the difference between the disorders on the level of considering them as entities rather than looking at the 'symptoms cluster' criteria (for BPD), but in practice this differentiation can fade into diagnostic insignificance because of the diagnostic criteria (in the DSM IV-TR) for BPD and its application by practitioners.

Keep in mind, too, that there's a quite real possibility that autistic people are abused enough at high rates to make it probable that a lot of us (from abuse) acquire personality traits that psychiatry would associate with borderline personality. Keep in mind, also, that many professionals see a woman who is self-injuring and automatically think 'borderline' whether the rest of the traits apply or not.

Also, many professionals use the label punitively on women they don't happen to like, which can be women who are autistic. People considered to be borderline often are stereotyped as manipulative, and many autistic traits can be misconstrued as manipulative in the wrong circumstances. For instance, taking things literally can be seen as deliberate attempts to avoid the real point of the conversation. I once talked to an autistic person who had taken something literally, and then a professional used a word that meant 'manipulative' in some contexts but had other meanings, and the autistic person took that literally as well, and the professional decided that the person was very manipulative now.

I also don't think autistic traits have ever been fully teased out from autistic traits in autistic-hostile environements. And those hostile environments, in other people, can certainly create traits associated with the term 'borderline'. I know a number of autistic people who've been diagnosed with both at once for similar reasons.

And... Daniel, I notice in general with your posts, that your answers are technically correct from the point of view of professionals, and often from the among the strictest or most conservative points of view of professionals, and extremely abstract in nature. The problem is that you're too often talking about how, in theory, things work. And the real world is much more complicated and messy than you sometimes make it out to be.

The real world is composed of people, who are complex and messy beings to begin with, and we live in large, complex and messy societies that influence our behavior and attitudes (yes, even autistic people's). There is no such thing as 'autism' or 'borderline' as divorced from the real lives of actual human beings. Those two words are used to describe clusters of traits that as often as not are based on outward guesses as to our behavior and its reasons, not necessarily the actual realities. And all those traits occur on people, those messy creatures who can't be easily classified.

The DSM refers to some outward behaviors used to diagnose someone as borderline. However, if you get into the actual lives of people who have experienced it, there is a lot more detail and depth than something like the DSM or even your average textbook can possibly cover. And there is some degree of overlap between the actual lived experience as a person considered to have BPD, and the lived experiences of many people who're autistic.

Even in the context of DSM, there's some discussion of traits that could easily be seen in an autistic person. Emphasis my own in these quotes (and used only in quotes where only part of it seems to apply to what I'm saying):

(Note that I don't think pets are objects and think that's a really bizarre notion on the part of the DSM authors.)

So basically, in all those quotes, there's a lot of references to trouble with change in routines and unstructured situations, and to finding objects and animals easier to handle than human beings.

I didn't quote the parts about interpersonal relationships and fear of abandonment, but many autistic people develop such things due to prolonged bullying, or due to a phenomenon like "I never had a friend until now, and I'm terrified this one will go away, it seems too good to be true." The black and white thinking about social situations is very common in the thinking of children (people are often seen as all good or all bad), and in people with less social experience or social delays... well... that can happen there too, and you see it all the time in the autistic community. (Good grief I wish there was less of it.) And a lot of the feelings of worthlessness and emptiness are common in autistic people with very bad self-esteem, and they may do the same things in response to it.

So I can easily see how they'd be mistaken for each other potentially. Just because things are on two totally different chapters of the DSM doesn't mean that the two can't be confused by some people.

I was misdiagnosed because of my black and white thinking and self-injuring. And I told the psychologist that I watch people and try to copy their behaviour because I don't know how I'm supposed to behave. This was interpreted to be a sign of BPD.
I have never had any turbulent relationships or fear of abandonment, but I guess my other symptoms were enough to meet the diagnostic criteria?

Misdiagnosis is always going to be there, no matter the condition in question.

Of note, PDDs aren't a differential diagnosis of BPD, and such points to a similar manifestation; Schizophrenia is common with Asperger's as they can manifest similar in appearance in some cases.

There won't be the telltale lack of nonverbal and verbal cues that regulate interaction (whether social or mechanical), and the inability in putting thoughts to words in relation to something that's unexpected in a clinical setting.

BPD lists a cluster of personality traits, all of which can be there in anyone; self-harm for example. When one has a certain number of these traits at a certain age of onset, they have such.

Asperger's has a list of symptoms that are unrelated to personality, which will always be there [since birth].

Also, the affective, cognition, and behaviour part you listed, manifests in a different way to AS when there's a loss of structure.

Manifestation is everything.

anbuend wrote:

I would think that is mostly male professionals. Also I find it hard to believe that many professionals would impose a psychiatric label punitively on women, merely because they didn't happen to like them, because that would be unethical and unprofessional. Though a few may.

Well, no and yes. Yes if you know about the disorders, but no if you just read down the criteria of BPD and know nothing of ASDs.

BPD criteria and ASDs:

Unstable (=short-timed) relationships can be a perceived result of ASDs because one can't talk always/can't use the phone/isn't interested in friendships. Inappropriate distances - the best example is a non-verbal classic boy who will jump onto everyone's lab, and I personally first talked to nobody about what I thought and then realised I should and talked to everybody about everything, which was highly inappropriate. I also liked some people but preferred not to talk to them.

Self-mutilating behaviours can appear in meltdowns.

Identify disturbance can be read into the autistic lack of understanding of social interaction that for other people is a tool of definition of self. Also, autistic people do not often react socially according to their character because of limited understanding and skill of how to behave in a social situation.

Idealisation and demonisation is something I know a very autistic guy with AS does. He's right, everyone's wrong and he knows the truth and if he says all children are ugly and horrible things, then it's like that. Also, this criteria can appear to be fulfilled if a person misunderstands the motives of others due to their ASD and thus becomes wary who has good and bad motives.

Meltdowns and overloads usually appear without reasons other people can explain and are thus affective instabilities to others. Same goes for aggressive behaviour (if meltdowns are aggressive and explosive).

The lack of understanding when someone likes you, when they dislike you and misunderstanding in this context can be explained by a (subconscious) fear of abandonment.

The confusion about 'what is' that is sometimes taken as a replacement for full-blown paranoia, delusions or dissociation is easily met by an autistic if they mess up with routines and become unable to function (or experience anxiety?) and also by that

The only things I can't explain are impulsive actions and the chronic feeling of worthlessness. (Though these are kind of like the most important features, even if it's not mentioned in the criteria themselves I think.)

But 5 are needed, not 9. I hope I got them all right from memory.

What is not mentioned in the criteria of BPD but are easily associated from others PDs are a shallow affect and inappropriate non-verbal regulation. I think they say that 'it's not unusual that a person with a PD has features of the other PDs'.

So, it works if the professional doesn't believe overloads, repetitive behaviours, routines etc. exist, knows nothing about PDDs and believe certain aspects of PDs can manifest as early as the age of 2-3 years.

Try not to look at the criteria too much; they can be interpreted in so many ways if they aren't applied with the expanded text.

For example, a person with AS can have short duration and "chaotic" relationships, but this is usually due to a lack of social and emotional reciprocation, rather than emotional disturbances that are reciprocated in a normal manner. Plus, a person with AS will have immense difficulties in starting such, whereas the person with BPD won't [as they aren't impaired in social interaction].

I've seen someone with such (cousin), and she is so far from Asperger's in manifestation, that the two couldn't be confused. Granted, this is only a single anecdote.

All right, I now think that you mean what I mean.

That the criteria are ambiguous and can make both disorders look eerily similar depending on interpretation.

But taking a real person with BPD and a real person with any ASD, the differences are easily noticeable and are immense in nature.