ASD and Borderline Personality Disorder?

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I don't think BPD mirroring is really about putting on a mask to fool others. It's more that they just don't know how to "be themselves". Mirroring is more for themselves than for others. To others it can seem weird or even creepy.

The distinction between Autism, Bi-Polar Disorder, Schizophrenia, OCD, ADHD and Borderline Personality Disorder is not clear-cut.

There's a significant overlap in symptoms and genetic correlation between each of these "disorders". Co-morbidity is also very common.

Personally, I lean towards the notion that Autism, Bi-Polar Disorder, Schizophrenia, OCD, ADHD and Borderline Personality Disorder are not individual conditions but as different expressions of the same spectrum.

I would also argue that these are not disorders, but normal variations within human behavior that have been pathologized for no other reason but the rather eccentric and unusual behavior of people within, which makes them more difficult to manipulate and control.

OCPD overlaps quite a lot with ASD. In fact, I'd argue that if someone has OCPD along with schizoid personality disorder, they'd be indistinguishable from ASD. (Not that all ASD people would meet criteria for either of those conditions, though. I don't.)

From what I understand, the treatment for OCPD would pretty much be exactly the same as the treatment for the 'insistence on routine/rituals' component of ASD. So if that's the aspect that's causing you the most trouble, you'll probably find their treatment helpful.

Borderline personality is an actual diagnosis and can be valuable for guiding appropriate treatment and for increasing understanding. However, unfortunately, some psychs use it as a label for a patient they dislike, or diagnose anyone who self-injures as borderline, and neither of those practices are particularly helpful for the patient in question.

I think that some of what is generally considered to constitute autism is a stress response and looks like stress responses in other conditions. I'm not sure how much fundamental overlap between conditions would remain if that weren't there, maybe some but I think that is the cause of quite a bit of overlap.

The general behavior and emotional state of stressed individuals with Autism is very similar to :

• * Depression in "neurotypical" people.
• * The "dysphoric" state of schizophrenics.
• * The "depressive phase" of Bipolar people.
• * Unfocused people with ADHD.

The general behavior and emotional state of happy individuals with Autism is very similar to :

• * Euphoria in "neurotypical" people.
• * The "psychotic" state of schizophrenics.
• * The "manic phase" of Bipolar people.
• * "Hyperfocused" people with ADHD.

The main differences in each of these cases are the frequency of and triggers for the behavior and emotional states related to respectively depression and euphoria. Depending on how your brains are wired, different triggers impact whether you're either stressed, euphoric or none of the above (apathic).

And then there's also Schizotypal personality disorder. Schizotypal personality disorder typically co-occurs with the schizoid, paranoid, avoidant, and borderline personality disorders. Major depressive disorder, dysthymia, social phobia and obsessive-compulsive disorder are also common.

Each of these co-occurances is also not uncommon in people with Autism either. It's not a coincidence that my best friend is Schizotypal. We're extremely similar, except for his psychotic fits (which are alien to me) and his risk-seeking behavior being far more extreme than mine.

I don't find autism much similar to the several other disorders discussed in this thread.
It seems more like similarity of limited language to describe behaviors or cognition than real similarity of the behaviors or cognition.

I disagree. OCD manifests and is experienced in a very different way than ASD rigidity or obsessions....even stereotyped behaviors, a d it involves specific circuitry. I do not believe comorbidity is the same as overlap. Comorbitity means they often occure together while overlap implies there is poor distinction between the disorders in question.

Can you elaborate on that?!

And what about neurotic behavior in people with ADHD or perfectionists? How would you say that relates to either rigidity/obsessions in people with ASD or the manifestation/experience of OCD?



IMO much of what is called "comorbidity" is actually just overlap.

IMO, Schizophrenia, Schizotypal personality disorder, Bi-polar disorder, ADHD, OCD, Asperger's Syndrome and classic Autism are all just labels given to (often subtle) variations within the same spectrum, of which the Autistic spectrum is only a segment.

Can't speak for Chronos, but from my understanding, part of the definition of OCD is that they don't actually want to do these compulsive things but feel like something terrible will happen if they don't do it. Doing the compulsion doesn't make them happy, just alleviates the anxiety for a little while.

In contrast, ASD obsessions and rigidity are usually a lot more pleasant for the person. If you're prevented from doing the thing, anxiety can result, but generally instead of just relieving anxiety, doing the particular action feels comfortable and enjoyable. For example it can be soothing and relaxing to do a familiar routine.

Of course, ASD people can have more OCD-style obsessions and compulsions, too. If they're severe enough, that would warrant a dual diagnosis.

I can't speak for all people with ASD, but my emotional state at any given moment in time is largely an expression of the comfort I'm experiencing at that moment.

Whether or not my ASD "obsessions" (I prefer the term "passions") give me joy, largely depends on the outcome of the activity :
* If I'm reading, I only experience true joy when the book is better than I expected
* If I'm watching a movie, I only experience true joy when the movie is better than I expected
* If I'm programming or designing, I only experience true joy when my creation is better than I expected
* ...

When the outcome is as expected, my emotions tend to range from mild discomfort to mild comfort, depending on other criteria. And when the outcome is worse than expected, I can actually become frustrated from engaging in the very "obsessions" / "passions" that are supposed to give me joy.

In contrast, I can experience a major stress relief from obeying the most erratic, irrational impulses and experience peak stress levels when ignoring those same impulses if those impulses are beyond a certain threshold of pervasiveness.

The classic term for this state of mind is "neurosis". Neurosis can be described as hard-to-ignore impulses that generate a state of comfort when obliged and a state of discomfort when ignored. It is a common trait of people with OCD, ADHD, Schizotypal Disorder, Bi-Polar Disorder, Borderline Personality Disorder and pretty much any other outlier of the neurospectrum.

So, really, I honestly don't see any significant difference between an OCD cleaning frenzy, an ADHD hyperfocus or an ASD obsession. In my opnion, these are just three very slightly different variations of how people use their neurosis (which is generally regarded as a negative trait) in a way that benefits them.

I have both autism and bpd! My main autistic traits are sensory sensitivities (all noises are equally loud to me, certain frequencies make me burst into tears, I have an unusually strong sense of taste/smell, if one side of my body is touched I have to touch the other), poor proprioception (walking into walls/doorframes, dropping things, tripping, trying to sit and "missing"), singular passions (mainly religion), poor eye contact, staring, flat affect, can't regulate voice volume, having to script interactions, difficulty interpreting others motives, I was overly literal/guillible as a kid, associational thinking, speaking in non-sequitors, and I stim like a m**********r, including rocking, flapping, finger tapping, repeating phrases, and self-harm stims when I'm upset like hitting myself or biting my hands.

My BPD traits are feeling like I have no sense of self, like I'm not a real person, like the world isn't real, like if I'm not exactly what others expect me to be they'll get mad and yell and abandon me and I'll be poor and die, like I have to be taken care of and act exactly the way others want me to to maximize the amount of love they'll give me, thinking a lot about how love is conditional, extreme mood swings (I'll go from content to suicidally depressed to rageful and back to happy in the space of a couple hours, with the actual change from one emotion to the next happening in a matter of minutes), frequent suicidal ideations especially when upset or feeling unloved, and poor impulse control.

I don't lash out but internalize the BPD syndromes (mostly) so fortunately it's not as obvious as my autism, but still. Here is a link to the DSM-V definition of BPD (scroll to pg 6)- I would say if you aren't experiencing any of the emotional side of the disorder, than you probably don't have it? I really don't think self-harm alone, especially in the context of an autistic meltdown, is enough to diagnose with BPD. Definitely something to bring up with your doctor!

I'd would second this. As my psychiatrist told me, there is a strong correlation with borderline PD and trauma (sexual abuse, etc), but cannot be proven decisively because one can't ethically perform the experiments.

I think a fair few of psychiatrist automatically jump to borderline diagnosis for women because of the pervasive sexual abuse that happens to girls and young women in our society. A psychiatrist may diagnose one with borderline PD even if no abuse is mentioned, believing (erroneously) that the patient is too traumatized to talk about the abuse. If there is no abuse in the past, I think it'd be fair to mention that to the Dr who diagnoses borderline PD.

It seems to me that Borderline Personality Disorder typically has one of two causes :
* Abuse (often of sexual nature) by parents or other family members during early childhood
* Physical and/or mental torture and social isolation by peers during teenage years

While I doubt the former is any more common among individuals with Autism than individuals without Autism, individuals with Autism are among the most common victims of the latter.

So for those in that particular category, a dual diagnosis of Autism + BPD does make sense.

The obsessions a person with OCD experiences are not obsessions in the typical sense of the word (which usually entails profound interest in something). Are intrusive thoughts which the individual finds disturbing (it's usually very counter to the person's character), or intense, irrational fears, and they tend to fall into specific categories which are consistent across cultures. Common "obsessions" are....

1. Unwanted intrusive imagery of a sexual or violent nature.
2. The fear that the person will act on these thoughts.
3. The fear that an unrelated action will bring harm or injury to someone.
4. A sense that something is contaminated or dirty, whether it actually is or not.
5. A sense that something was done improperly or is "unbalanced", even if it is known that this is not the case.
6. Fear of divine punishment, whether the person is religious not.

In most instances, the person knows these things are illogical or irrational, but such knowledge is not enough to abate the obsessions. To relieve themselves of these things, the person often performs "compulsions" which can be small little nothings to elaborate rituals. Common compulsions are...

1. Hand washing. Usually done to relieve the sense of contamination of one's hands. However the person might have to do this some certain number of times in a certain manner. For example, they might count to some number or move their hands under the water in a certain way, and they might have to dry their hands a certain way, and if any part of this is not completed "properly" they will feel compelled to start over. A person with OCD might wash their hands more than 100 times per day in extreme cases.

2. Checking. This is done when the intrusive thought or fear was that the person forgot to lock a door or turn a stove off, and is often coupled with a sense of incorrectness. The person might go back and unlock and relock the door, or test the knob, until they get the sense that it was done the "right" way, even if they do remember locking it the first time.

3. Touching. A person with OCD might have to touch something a certain way a certain number of times to balance things or to rid themselves of the feeling that something bad will happen if they don't. For example, if the person touches the left side of a doorway, they might also have to touch the right side of the door way. Maybe they have to touch the left and right side three times.

4. Avoidance. Some people with OCD will indeed avoid stepping on cracks on the sidewalk because they have the sense that if they do, it will indeed break their mother's back, even though they know it actually won't.

So you see, the name is actually very misleading. It should really be called "Intrusive Compulsive Disorder", or "Intrusive Ritualistic Disorder".

It's vastly different from interest based obsessions, because it doesn't really entail actual obsessions at all, and it's different from schizophrenia because it doesn't entail delusions. The person with OCD KNOWS their "obsessions" and compulsions are irrational, and just can't shake the sensation they cause.

OCD is though to arise due to white matter abnormalities that disrupt the communication between the frontal lobe, and more primitive parts of the brain such as the basal ganglia, the same part of the brain involved in Tourette's Syndrome, and Parkinson's Disorder. A person with verbal Tourette's will say the thing they least want to say, and a person with OCD will think of the thing they least want to think of. To that end, the intrusive thoughts with OCD are sometimes called "thought ticks". Even so, actual comorbidity of these conditions is not very common because they arise from different regions of the basal ganglia.

Schizophrenia on the other hand, which there are now thought to be around 8 different types, in some forms at least, can entail gross structural changes that are easily identifiable on an MRI.

I think this idea of overlap and spectruming will fall away the more we learn about the actual pathologies of these disorders.

Some of my obsessive Autistic traits are :

1. Buying up to several boxes of antiquarian books (at the same time) for my collection
2. Buying up to several dozen DVDs (at the same time) for my collection
3. Programming for +10 hours straight
4. Watching movies for +10 hours straight

Some of my OCD traits are :

1. Pushing the door of the fridge or freezer about three times to ensure it's closed.
2. Opening / closing the car the least two times to ensure it's closed.
3. Opening the toilet seat with my foot to avoid having to touch the seat with my hands.
4. Being frequently reminded of a handful of books in my collection that I harmed, in some cases more than a decade ago.

---

On an average day, my mind is constantly occupied by a backlog of activities that need to be done, ranging from (1) activities that I constantly need to remind myself of in order not to forget to (2) activities that I don't want to do but that I can't stop my mind from focusing my attention on.

This latter category (activities I can't stop my mind from focusing) usually involves my Autistic obsessions, but it is often as unwanted and annoying as a common OCD trait, as it prevents me from both engaging in and focusing on activities of the first category (activities that I constantly need to remind myself of).



I have that only in specific cases, like when my hands have been fully or partially covered by a fatty/oily substance.
No matter how often I wash them, I never get the sensation of oiliness from my hands.



I have that consistently only with a fridge or freezer and the car door, which probably results from failing to close the fridge and car door properly in the past.

I have it inconsistently with eg. other doors, items in my backpack or items in my pockets.

I can't speak for others, but in my case ritualistic checking routines tend to prevent the need from re-checking. For example, it helps to just count the number of items in my pockets whenever I leave the house to ensure nothing that should be in my pockets is left out.



In my case, there's no different between checking and touching. When I close the fridge and don't tap the door at least two times extra after closing it, I generally feel uncomfortable.

I used to touch my books or DVDs as well to check whether they were placed perfectly, but I stopped doing that a while ago.



I did that as a child. I stopped doing that as an adult.



Based on your detailed descriptions of OCD, I would argue that have very mild (but nevertheless real) OCD along with my ADD and my Autism.

Based on your detailed descriptions of OCD, I don't think the name OCD is poorly chosen, as the C in OCD ("compulsiveness") pretty much covers its key trait.

Based on your detailed descriptions of OCD, I would still argue that the line between OCD and Autistic obsessions is a very thin line, as my Autistic obsessions often come to me in a way no less compulsive and unwanted than the OCD desire to check a door or wash one's hand.



IMO the idea of overlap will gradually be replaced by a spectrum description, as a spectrum is a much better way to describe the often subtle differences between behavior and cognitive styles in different diagnoses.

This sounds remarkably like what Aspies (particularly girls) do to "pass as normal".
Watch and copy. I've done it all my life and I've been told that it's partly because Aspie girls often have identity issues and need to do this to fit in.
However, I now believe I'm a "quiet borderline" so maybe it's to do with that.