Join Dr. Regan for the second in this series on autism misdiagnosis. This episode focuses on how often and why autism may be misdiagnosed as a personality disorder. Although there are 10 personality disorders outlined in the DSM-5, Dr. Regan focuses on two in this episode: borderline personality and narcissistic personality. Netherlands study of over 1000 autistic individuals Italian study: misdiagnosis Norway case study Borderline Personality Disorder misdiagnosis Recognizing dysregulation on the autism spectrum: podcast episode Dr. Regan's Resources New Course for Clinicians - Interventions in Autism: Helping Clients Stay Centered, Connect with Others, and Engage in Life New Course for Clinicians: ASD Differential Diagnoses and Associated Characteristics Book: Understanding Autism in Adults and Aging Adults, 2nd ed Audiobook Book: Understanding Autistic Behaviors Autism in the Adult website homepage Website Resources for Clinicians Read the episode transcript -- 1 00:00:07,070 -- 00:00:08,390 Hello everyone. 2 00:00:08,400 -- 00:00:12,770 This is Dr Theresa Regan joining you for the podcast, 3 00:00:12,780 -- 00:00:14,560 autism in the adult. 4 00:00:15,800 -- 00:00:18,180 I am a neuropsychologist. 5 00:00:18,190 -- 00:00:24,480 I specialize in understanding how the brain impacts personality emotions, 6 00:00:24,480 -- 00:00:26,720 behavior and thinking skills. 7 00:00:26,730 -- 00:00:38,440 I'm a certified autism specialist and the director of an adult diagnostic autism clinic in central Illinois and I'm the parent of a child on the spectrum. 8 00:00:39,400 -- 00:00:49,180 You are joining us for the second episode of a series we're doing on misdiagnosis for those who are on the autism spectrum. 9 00:00:50,210 -- 00:00:53,070 If you did not listen to the first episode, 10 00:00:53,070 -- 00:00:54,890 I really encourage you to do that. 12 00:00:55,670 -- 00:01:04,100 There are foundational things that I think will really be illuminating and that I'm not going to be repeating in this episode. 13 00:01:05,230 -- 00:01:06,550 For today's episode, 14 00:01:06,550 -- 00:01:15,940 we're going to focus about when the misdiagnosis has to do with the category of personality disorders. 15 00:01:17,120 -- 00:01:17,340 Now, 16 00:01:17,340 -- 00:01:34,990 personality disorders originally really focused on the impact of the environment and early life experiences and parenting and the development of the personality structure. 17 00:01:35,650 -- 00:01:55,910 And when I was in graduate school back in the 90s there was a focus on the fact that there were some studies coming out suggesting that some of the personality disorder categories actually had some influence in genetics. 18 00:01:55,910 -- 00:02:06,170 So this was through adoptive studies and looking at the personality traits of adopted Children as compared to their biological parents. 19 00:02:07,020 -- 00:02:31,810 So that at the time was actually news because the personality theories that dominated the literature had a lot to do with parenting and that personality was a learned experientially based um long term way of interacting with the world. 20 00:02:32,890 -- 00:02:42,420 Now today a lot of the literature explaining that personality disorders are likely caused by multifactorial issues. 21 00:02:42,430 -- 00:02:49,460 So issues of biochemistry and genetics and experience are more prominent. 22 00:02:49,470 -- 00:03:10,390 So the original foundations of personality disorders being in that theory about early life experiences and of course autism being in the category of physically based in the neurology of the individual and really impacted by the genetic code. 23 00:03:11,350 -- 00:03:15,850 There are three clusters of personality disorders, 24 00:03:15,850 -- 00:03:17,060 cluster a, b, and c. 25 00:03:17,670 -- 00:03:25,220 And there are a total of 10 conditions listed in the current diagnostic manual. 26 00:03:25,230 -- 00:03:35,380 So what will the scope of our discussion today be about as regards personality disorders and autism? 27 00:03:36,320 -- 00:03:47,230 What will not happen in this episode is that you will not be able to distinguish autism from personality disorders at the end of the episode, 28 00:03:47,240 -- 00:03:50,990 that's really not in the scope of what we can focus on. 29 00:03:51,260 -- 00:03:58,390 And it takes an expert clinician with many years of training and study to do that well. 30 00:03:58,400 -- 00:04:05,400 But what we are going to focus on is why this happens and how often it seems to happen. 31 00:04:05,410 -- 00:04:09,950 So why does this misdiagnosis occur? 32 00:04:09,960 -- 00:04:14,180 And and how many people does that impact? 33 00:04:15,910 -- 00:04:17,270 As you probably know, 34 00:04:17,270 -- 00:04:22,200 a lot of the literature about autism focuses on early childhood and development. 35 00:04:23,230 -- 00:04:29,790 And more of the literature is beginning to focus on autism across the lifespan. 36 00:04:30,820 -- 00:04:45,170 And there are some articles out there about autism and misdiagnosis And what you'll see when you look for them is that these are often scattered internationally. 37 00:04:45,170 -- 00:04:45,360 So, 38 00:04:45,360 -- 00:04:54,790 the first article that I want to talk about actually was published last year 2021 and it came from the Netherlands. 39 00:04:54,790 -- 00:04:59,070 And I have a link in the show notes if you'd like to read more about it. 40 00:05:00,930 -- 00:05:01,550 So, 41 00:05:01,550 -- 00:05:07,810 this article was based in their national health system. 42 00:05:07,820 -- 00:05:12,940 They have a database of individuals who are on the autism spectrum. 43 00:05:12,950 -- 00:05:19,490 And then they contacted individuals to ask them about their diagnostic history. 44 00:05:20,790 -- 00:05:27,370 They surveyed a 1019 adults in this way, 45 00:05:27,950 -- 00:05:33,550 and it was very nearly an even split between males and females. 46 00:05:35,360 -- 00:05:51,020 And what they found was that about 50% of the 1019 adults reported that they had previous mental health diagnoses prior to being diagnosed with autism, 47 00:05:52,810 -- 00:06:00,900 They report that 63% of the females and 37% of the males had a previous diagnosis. 48 00:06:02,940 -- 00:06:07,810 Females had more previous diagnoses than males. 49 00:06:07,820 -- 00:06:16,220 So they had a larger number of diagnoses on their list in the mental health area. 50 00:06:17,770 -- 00:06:28,000 And this suggests that men in their sample were more likely to be diagnosed correctly the first time rather than carrying incorrect mental health diagnoses. 51 00:06:30,320 -- 00:06:30,810 Now, 52 00:06:30,810 -- 00:06:36,500 the top categories in their list of frequently misdiagnosed 53 00:06:36,510 -- 00:06:42,270 conditions for the autistic were mood disorders. 54 00:06:42,280 -- 00:06:45,260 And it didn't specifically say, 55 00:06:45,260 -- 00:06:48,980 I'm assuming this may include depression and bipolar. 57 00:06:50,190 -- 00:06:53,670 and then the second category was personality disorder. 58 00:06:53,670 -- 00:06:53,930 So, 59 00:06:53,930 -- 00:07:05,170 26% of the total sample had a history of mood disorder diagnosis and 20% had a history of personality disorders. 60 00:07:07,080 -- 00:07:11,140 They also asked the individuals who did have previous diagnoses. 61 00:07:11,140 -- 00:07:17,090 So that was 512 people out of the 1019, 62 00:07:17,100 -- 00:07:25,260 if any of their previous diagnoses were then removed from their list once autism was diagnosed. 63 00:07:25,270 -- 00:07:29,910 So this is really getting at that phenomenon of misdiagnosis, 64 00:07:29,910 -- 00:07:30,420 where, 65 00:07:30,430 -- 00:07:30,680 oh, 66 00:07:30,680 -- 00:07:36,760 now that we know that what we're actually looking at here is autism. 67 00:07:36,770 -- 00:07:38,770 What diagnoses, 68 00:07:38,780 -- 00:07:39,540 if any, 69 00:07:39,550 -- 00:07:41,490 might we removed from the list 70 00:07:41,490 -- 00:07:50,240 ...these were misdiagnoses. Of the 512 participants who did have a previous diagnosis, 71 00:07:50,250 -- 00:07:59,700 382 reported that one or more of the diagnoses were removed once autism was diagnosed. 72 00:08:00,550 -- 00:08:07,630 So that's 75% of the participants who did have a history of diagnosis. 73 00:08:08,680 -- 00:08:15,930 And the authors also report this as 38% of the total sample of 1,019. 74 00:08:15,940 -- 00:08:19,560 I'm not sure that this is as meaningful because of course, 75 00:08:19,560 -- 00:08:25,940 people who did not have a prior diagnosis would not report that a diagnosis was removed. 76 00:08:25,950 -- 00:08:26,590 So, 77 00:08:26,590 -- 00:08:26,960 to me, 78 00:08:26,960 -- 00:08:35,470 it makes the most sense to to show that half the people had at least one previous mental health diagnoses. 79 00:08:36,400 -- 00:08:38,330 And of these participants, 80 00:08:38,340 -- 00:08:44,600 75% reported that at least one of the diagnoses were removed, 81 00:08:44,610 -- 00:08:44,880 then, 82 00:08:44,880 -- 00:08:59,570 once autism was diagnosed. And personality disorders were the most frequent of the diagnoses that were removed and that's the category that we'll be speaking about today, 83 00:09:01,830 -- 00:09:05,300 I'm gonna look at two other articles before we keep going. 84 00:09:06,970 -- 00:09:20,300 Uh there is an article that came out of Italy in March of 2022 and it had a much smaller sample size that was only 161 individuals and only 47 were females. 85 00:09:20,300 -- 00:09:23,580 So I don't feel like it's quite as representative. 86 00:09:23,590 -- 00:09:27,550 Probably not something that we can generalize as much from. 87 00:09:28,670 -- 00:09:35,030 But one thing that was interesting that they found was that the age, 88 00:09:35,040 -- 00:09:44,440 the median age of first evaluation by a mental health professional for these individuals was age 13. 89 00:09:45,320 -- 00:09:55,380 And then there was a gap of averaging about 11 years before any autism evaluation was even performed or considered. 90 00:09:55,380 -- 00:09:55,970 So, 91 00:09:55,980 -- 00:10:13,800 these individuals had presented with some distress or having some struggle 11 years prior to the consideration of autism in that diagnostic arena for the differential. In their sample, 92 00:10:13,810 -- 00:10:21,060 a third of participants had never received a psychiatric diagnosis prior to autism diagnosis. 93 00:10:21,060 -- 00:10:26,260 So two thirds of their sample did have a history of mental health diagnoses. 94 00:10:27,940 -- 00:10:38,360 The next article we're going to focus on is about borderline personality disorder, and I did want to focus on that for today's episode. 95 00:10:38,370 -- 00:10:41,690 In addition to narcissistic personality. 96 00:10:41,700 -- 00:10:42,230 Now, 97 00:10:42,230 -- 00:10:51,570 these are the two personality disorders that I see most often in my clinic as misdiagnoses for the autism spectrum, 98 00:10:51,770 -- 00:10:58,990 But really I have seen all 10 of them listed incorrectly for the autistic in the past, 99 00:11:00,000 -- 00:11:06,050 but let's take a look at borderline personality and talk about why 100 00:11:06,060 -- 00:11:12,930 there may be a misdiagnosis of this condition. 101 00:11:14,380 -- 00:11:30,480 So the concept of borderline personality refers to a constellation of characteristics and one of the prime characteristics has to do with difficulty connecting appropriately in relationships. 102 00:11:31,780 -- 00:11:39,800 So it says a pattern of unstable and intense interpersonal relationships characterized by extremes. 103 00:11:41,320 -- 00:12:01,450 Um and also these efforts to avoid abandonment and relationships. What we can see for the autistic is that often there is this desire to connect with the supportive other ... that I do want to be connected. 104 00:12:01,450 -- 00:12:03,330 I want to be in a relationship. 105 00:12:03,340 -- 00:12:04,870 And of course, 106 00:12:04,870 -- 00:12:07,990 there can be difficulties in that connection, 107 00:12:07,990 -- 00:12:13,760 particularly when they're trying to maintain this relationship over time. 108 00:12:14,040 -- 00:12:14,400 Now, 109 00:12:14,400 -- 00:12:20,930 that is not to say that the autistic individual doesn't have close relationships, 110 00:12:20,940 -- 00:12:29,180 but there may be some history of dissatisfaction with the ability to connect or feeling like the relationships didn't work out, 111 00:12:29,190 -- 00:12:32,370 Maybe the person isn't quite sure why or what happened. 112 00:12:32,380 -- 00:12:42,380 So this area of difficulty maintaining relationships may overlap in someone's concept... 113 00:12:42,390 -- 00:12:49,080 and if you did listen to the first episode of the series, 114 00:12:49,090 -- 00:12:57,000 it's kind of like looking at what's right in front of you without seeing the big autistic picture. 115 00:12:57,000 -- 00:13:07,910 You can see that if someone is trying to interact with a client who has a history of relationships that have not been maintained over time, 116 00:13:07,920 -- 00:13:24,680 that there can be perhaps the question of whether borderline should be in the differential... in addition to that there can be this element in borderline of chronic feelings of emptiness and also just identity disturbance. 117 00:13:24,680 -- 00:13:37,310 Like I don't really know who I am or I feel like I'm different people when I'm with various groups or I have an unstable self image or sense of self. 118 00:13:37,320 -- 00:13:47,780 So for the autistic that can be present in the sense that it can be difficult to um delve into the internal world. 119 00:13:47,790 -- 00:13:49,600 Like what am I feeling? 120 00:13:49,600 -- 00:13:49,990 What, 121 00:13:50,000 -- 00:13:52,390 what is going on inside of me? 122 00:13:52,390 -- 00:13:54,680 How do people perceive me? 123 00:13:54,690 -- 00:13:57,400 What is their evaluation of me? 124 00:13:57,410 -- 00:13:59,700 How would people describe me? 125 00:13:59,700 -- 00:14:14,100 What's going on in the core of myself scanning the internal for what's going on in my internal world and the world of the other person that I'm with. 126 00:14:14,110 -- 00:14:18,190 That's part of a neurologic ability called Theory of Mind, 127 00:14:18,200 -- 00:14:31,920 where we can scan and have this um exploration of what's inside me and then we can have a theory of what's in the mind of the other. 128 00:14:32,910 -- 00:14:33,290 So, 129 00:14:33,290 -- 00:14:35,100 you can see again, 130 00:14:35,100 -- 00:14:49,930 if you are a clinician or diagnostician and you hear these explanations of having difficulty uh knowing who you are or feeling like you're different people in various groups. 131 00:14:49,940 -- 00:14:51,280 This of course, 132 00:14:51,280 -- 00:14:54,750 can have to do with the masking and autism. 133 00:14:55,260 -- 00:15:04,110 You can see how that one piece may trigger someone to think about a borderline personality. 134 00:15:05,790 -- 00:15:12,370 There also is this characteristic lability of mood and emotions. 135 00:15:12,370 -- 00:15:13,540 So by that, 136 00:15:13,540 -- 00:15:19,380 I just mean that this kind of roller coaster of intense emotions. 137 00:15:19,390 -- 00:15:25,970 Um so it talks about um difficulty controlling anger, 138 00:15:25,970 -- 00:15:27,950 frequent displays of temper, 139 00:15:27,950 -- 00:15:29,320 constant anger, 140 00:15:29,330 -- 00:15:39,430 recurrent physical fights for the individual on the spectrum who has dis regulation that looks external realized. 141 00:15:39,440 -- 00:15:40,000 So, 142 00:15:40,000 -- 00:15:45,320 if you've listened to the dysegulation series, and I'll put a link in the show notes, 143 00:15:45,330 -- 00:15:47,110 you'll know that for that... 144 00:15:47,120 -- 00:15:56,320 Everyone on the autism spectrum will have difficulty feeling centered with their emotions and behavior. 145 00:15:56,320 -- 00:15:58,680 And that is called dysregulation. 146 00:15:59,130 -- 00:16:04,410 And that's neurologically based for the autistic... and for some people, 147 00:16:04,420 -- 00:16:07,130 this regulation is very quiet. 148 00:16:07,140 -- 00:16:11,190 It's this shutting down. 149 00:16:11,200 -- 00:16:16,940 It could be a disassociative episode which can also occur in borderline. 150 00:16:17,520 -- 00:16:21,280 It can be a very quiet withdrawal. 151 00:16:21,290 -- 00:16:22,810 I'm going to my room, 152 00:16:22,810 -- 00:16:24,550 I'm quitting this relationship, 153 00:16:24,550 -- 00:16:26,250 I can't make it to work. 154 00:16:26,260 -- 00:16:32,000 Um but it can also be this externalized reaction, 155 00:16:32,010 -- 00:16:34,470 this explosive reaction, 156 00:16:34,480 -- 00:16:35,520 a meltdown, 157 00:16:35,520 -- 00:16:36,130 a crying 158 00:16:36,130 -- 00:16:37,650 spell... shaking. 159 00:16:38,220 -- 00:16:42,720 And for people who have that externalized reaction, 160 00:16:42,730 -- 00:16:49,200 this can look like borderline to a clinician who's not looking at the big neurologic picture. 161 00:16:50,730 -- 00:16:51,630 And finally, 162 00:16:51,630 -- 00:17:02,180 one of the aspects of borderline personality can be this recurrent self harm behavior or impulsive, 163 00:17:02,190 -- 00:17:04,470 self damaging behavior. 164 00:17:04,480 -- 00:17:22,050 You can get elements of that on the autism spectrum in the sense of ... it would not be unusual for clients to in the midst of their dysregulation to do things like hitting themselves or biting themselves, 165 00:17:22,050 -- 00:17:23,340 cutting themselves, 166 00:17:23,340 -- 00:17:24,490 banging their head. 167 00:17:24,500 -- 00:17:25,490 Um, 168 00:17:25,500 -- 00:17:27,070 and that is part of, 169 00:17:27,080 -- 00:17:29,810 of dysregulation for the autistic. 170 00:17:29,820 -- 00:17:30,570 Um, 171 00:17:30,580 -- 00:17:38,900 and so there are certainly differences in borderline personality as compared to autism, 172 00:17:38,940 -- 00:17:43,020 in this dynamic of when dysregulation occurs. 173 00:17:43,190 -- 00:17:43,560 Uh, 174 00:17:43,560 -- 00:17:49,500 and also what you don't see in the borderline is the broader neurologic picture. 175 00:17:49,510 -- 00:17:50,300 So, 176 00:17:50,300 -- 00:17:52,270 these sensory elements, 177 00:17:52,270 -- 00:17:54,610 these stereotyped behaviors. 178 00:17:54,620 -- 00:17:55,480 Again, 179 00:17:55,480 -- 00:18:01,400 we're not going to end on a note where people know how to distinguish the two conditions, 180 00:18:01,400 -- 00:18:05,150 but I do want you to have a sense of why this occurs. 181 00:18:05,150 -- 00:18:17,480 Why does this mistake happen where someone looks at pieces of an individual and their history and comes up with borderline instead of autism. 182 00:18:18,480 -- 00:18:32,040 This article that I do want to share is actually a case study of a gentleman who had been diagnosed with borderline personality and then was correctly diagnosed with autism. 183 00:18:32,050 -- 00:18:34,620 And the link is in the show notes, 184 00:18:34,630 -- 00:18:46,900 this article was published in Norway In February of 2022 and I'll just read you some elements that I think are important. 185 00:18:48,780 -- 00:18:57,950 The patient received treatment for borderline personality disorder without any observable improvement in his difficulties for several years. 186 00:18:59,320 -- 00:19:00,290 And that's end, 187 00:19:00,290 -- 00:19:00,870 quote. 188 00:19:02,470 -- 00:19:12,920 The authors note that the case highlights the need for mental health professionals to have the quote knowledge necessary to recognize and diagnose autism. 189 00:19:12,990 -- 00:19:14,250 End quote, 190 00:19:14,300 -- 00:19:21,990 they suggest that the evaluation for autism may be warranted in patients with non suicidal self injury. 191 00:19:22,000 -- 00:19:24,680 So that's the cutting the banging, 192 00:19:24,690 -- 00:19:35,030 those kinds of things that we talked about and assumed personality disorder who are not benefiting from the treatments that have been used. 193 00:19:35,980 -- 00:19:37,340 So essentially, 195 00:19:38,720 -- 00:19:48,490 they're suggesting that if there's a patient that has been diagnosed with a personality disorder but is not benefiting from the treatment. 197 00:19:49,650 -- 00:19:51,500 and staff feel like, 198 00:19:51,510 -- 00:19:51,940 gosh, 199 00:19:51,940 -- 00:19:56,690 I just feel like we're missing something...that might be a good trigger. 200 00:19:56,700 -- 00:20:02,290 I would say any time borderline personality is on the table, 201 00:20:02,300 -- 00:20:10,290 autism should specifically be in the differential because of some of these features that can look similar. 202 00:20:10,300 -- 00:20:13,280 And if you want to know more about differentials, 203 00:20:13,290 -- 00:20:27,300 go ahead and listen to the first episode in our series. With regard to the young adult that they were describing in the article. 204 00:20:28,690 -- 00:20:29,580 Um, 205 00:20:29,590 -- 00:20:38,210 they could see that there were characteristics of several different personality disorder conditions. 206 00:20:38,220 -- 00:20:39,040 Um, 207 00:20:39,040 -- 00:20:45,250 but nothing that really hit the spot with any one personality disorder. 208 00:20:45,260 -- 00:20:45,900 Uh, 209 00:20:45,910 -- 00:20:47,600 so they looked at schizoid, 210 00:20:47,600 -- 00:20:50,350 avoidant. dependent, and borderline, 211 00:20:52,060 -- 00:20:57,110 but there were not sufficient symptoms to meet criteria for any of those. 212 00:20:57,120 -- 00:20:58,970 And it was noted that, 213 00:20:58,980 -- 00:20:59,340 quote, 214 00:20:59,340 -- 00:21:05,900 his difficulties with regard to social engagement were pervasive rather than transient. 215 00:21:05,910 -- 00:21:25,110 So what they're trying to say is that really they did an in depth assessment for autism and they saw that really he was not able to navigate neurologically the theory of mind issues and the nonverbals, and 216 00:21:25,120 -- 00:21:28,100 social reciprocity and conversation. 217 00:21:28,100 -- 00:21:36,890 So they concluded that his social difficulties really were not the result of his intense personality, 218 00:21:36,890 -- 00:21:48,430 but more the result of a neurologic wiring that it was different and he was not able to navigate social interactions in that context. 219 00:21:50,920 -- 00:22:03,090 They also state he did not display a pattern of attachment and rejection in interpersonal relationships, and his non suicidal self injury. 220 00:22:03,100 -- 00:22:09,890 (And for him this was cutting) rarely occurred as a response to an interpersonal conflict. 221 00:22:09,900 -- 00:22:18,380 So they're also just trying to point out that although he had dysregulation, and he had self harm in that context, 222 00:22:18,390 -- 00:22:19,390 it didn't have... 223 00:22:19,400 -- 00:22:25,700 it wasn't triggered by the same kinds of things that a borderline personality might be triggered by. 224 00:22:27,680 -- 00:22:28,080 Now, 225 00:22:28,080 -- 00:22:29,500 in my own clinic, 226 00:22:29,510 -- 00:22:36,290 what I see is that in addition to the borderline personality as a common misdiagnosis, 227 00:22:36,300 -- 00:22:46,280 I also frequently see narcissism or narcissistic personality disorder uh as a misdiagnosis as well. 228 00:22:47,240 -- 00:22:52,550 So where does this misdiagnosis stem from? 229 00:22:53,800 -- 00:22:54,330 Well, 230 00:22:54,330 -- 00:22:59,930 if you listened to the episode two sessions ago, 231 00:22:59,940 -- 00:23:03,030 it was called why pattern is important. 232 00:23:03,040 -- 00:23:10,920 And in our episode today we are making some generalizations about how the autistic neurology, 233 00:23:10,920 -- 00:23:13,300 when it has a certain pattern, 234 00:23:13,310 -- 00:23:18,340 it can lend itself to misdiagnosis of certain conditions. 235 00:23:18,580 -- 00:23:36,700 So what we've done so far is we've talked about how some people on the spectrum have a pattern of neurology that fits within that autism schema and that also could look in some aspects like a borderline personality. 236 00:23:37,330 -- 00:23:49,780 Now here we're looking at a different pattern and how some aspects of the autism neurology may be heightened in an individual in a way that looks like narcissism. 237 00:23:51,430 -- 00:24:11,470 So one of the reasons for that can be that if you have an individual on the spectrum who uh is very passionate about topics and they have a great value for fact and rightness and correctness. 238 00:24:11,480 -- 00:24:12,380 Um, 239 00:24:12,380 -- 00:24:20,150 and they love um certain pieces of information so that their special interest, 240 00:24:20,150 -- 00:24:24,780 maybe politics or religion or the environment and ... boy, 241 00:24:24,780 -- 00:24:27,110 they deep dive into this. 242 00:24:27,110 -- 00:24:37,850 They love talking about this particular topic or handful of topics and being correct about the facts is also very important to them. 243 00:24:37,860 -- 00:24:43,700 And so they have this deep commitment to being right now. 244 00:24:43,700 -- 00:24:51,670 What they are less attuned to neurologically is understanding the internal of the other person. 245 00:24:51,680 -- 00:24:56,800 How does this conversation affect the personhood... 246 00:24:56,810 -- 00:24:57,750 The person, 247 00:24:57,750 -- 00:25:01,710 the internal person of this individual I'm speaking with. 248 00:25:01,710 -- 00:25:05,620 So they have less of a sense of do they feel criticized? 249 00:25:05,620 -- 00:25:29,490 How does that impact our relationship because to them we're talking because this topic is important and their whole reason sometimes for talking with you about it is to uh enlighten you or instruct you or help you understand what the right facts are. 250 00:25:30,010 -- 00:25:37,200 And some of the autistic individuals with this pattern may say, 251 00:25:37,210 -- 00:25:45,340 well I will shift my beliefs if someone proves that I'm wrong but I'm not wrong. 252 00:25:45,350 -- 00:25:46,360 Um, 253 00:25:46,370 -- 00:25:54,850 and so that quality of having difficulty with thinking in gray areas. 254 00:25:54,850 -- 00:26:00,410 So someone who may have that black and white thinking this is right and this is wrong. 255 00:26:00,630 -- 00:26:12,460 Someone who has difficulty shifting and giving um like they are committed to a thought or an idea or an opinion and it really does. 256 00:26:12,470 -- 00:26:14,740 Uh they're not wishy washy, 257 00:26:14,750 -- 00:26:15,310 you know, 258 00:26:15,310 -- 00:26:24,950 their strength is that they have this very strong commitment and so when they have that and they're gonna stick to it neurologically, 259 00:26:24,950 -- 00:26:32,340 and they don't have as much sense of what you need during a conversation as the other person. 260 00:26:32,350 -- 00:26:40,260 Uh then you can get the sense of narcissism and somebody may say they want to lecture me or talk to me, 261 00:26:40,260 -- 00:26:44,520 but they don't want my opinion or they don't want me to participate. 262 00:26:44,910 -- 00:26:50,670 Um and that could be a feeling that lends itself to this descriptor, 263 00:26:52,160 -- 00:26:55,850 another piece of this really... 264 00:26:55,860 -- 00:27:05,970 ... if you do have that black and white thinking that this is right and this is wrong and you do want to commit to be right. 265 00:27:05,980 -- 00:27:08,160 Um one of the things can, 266 00:27:08,170 -- 00:27:32,020 that can happen with that neurology is that there's a strong um commitment to being correct and if they are wrong or they fail something or they lose a competition that can be extremely difficult um with their emotional regulation because they want to be in the good category. 267 00:27:32,030 -- 00:27:34,570 And if the only thing left, 268 00:27:34,580 -- 00:27:37,970 once they make a mistake is the bad category, 269 00:27:37,980 -- 00:27:48,870 that's just so difficult for them to land there because their brain really doesn't show them any in between or any complexity that yeah, 270 00:27:48,870 -- 00:27:55,750 I'm this mix of good things and difficult things and I have achieved, 271 00:27:55,760 -- 00:27:56,910 um, 272 00:27:56,920 -- 00:27:58,600 correct things here, 273 00:27:58,600 -- 00:28:00,590 but I really missed the boat here. 274 00:28:00,600 -- 00:28:01,290 Um, 275 00:28:01,300 -- 00:28:09,870 so you can have this real resistance to losing or being wrong or falling short. 276 00:28:12,060 -- 00:28:17,370 There's another feature in the list of narcissistic personality, 277 00:28:17,380 -- 00:28:17,910 um, 278 00:28:17,920 -- 00:28:21,350 criteria and that is lacks empathy, 279 00:28:21,360 -- 00:28:26,800 is unwilling to recognize or identify with the feelings and needs of others. 280 00:28:26,810 -- 00:28:27,340 Now, 281 00:28:27,340 -- 00:28:28,750 for the autistic, 282 00:28:28,750 -- 00:28:31,260 that is really not the case. 283 00:28:31,260 -- 00:28:33,020 It's not that they're unwilling. 284 00:28:33,030 -- 00:28:36,810 And some people have a deep empathy for, 285 00:28:37,260 -- 00:28:38,260 um, 286 00:28:38,270 -- 00:28:38,850 you know, 287 00:28:38,850 -- 00:28:43,350 wanting every person to be good and to be doing well. 288 00:28:43,360 -- 00:28:43,940 Um, 289 00:28:43,950 -- 00:28:52,070 but sometimes in their mind you will be doing really well if you have the correct facts, 290 00:28:52,080 -- 00:28:58,700 so they may not be in tune with the internal emotions and relational needs of the other person. 291 00:28:58,710 -- 00:28:59,620 Um, 292 00:28:59,630 -- 00:29:04,850 but it's not that they're unwilling to recognize the feelings or needs of others. 293 00:29:07,070 -- 00:29:08,470 And as I mentioned, 294 00:29:08,470 -- 00:29:15,460 there are many other personality disorders that end up being misdiagnoses for autism. 295 00:29:16,960 -- 00:29:29,190 But hopefully this gives you a flavor of how someone might see the interaction style and behavioral pattern of someone presenting for, 296 00:29:29,190 -- 00:29:29,650 let's say, 297 00:29:29,650 -- 00:29:58,410 counseling or some type of assistance and they may look at that pattern of neurology that fits within the autism spectrum and make conclusions about personality and therefore assign a personality diagnosis when if they really knew what the autism flags were and could add that to the differential and specifically assess for autism. 298 00:29:58,410 -- 00:30:01,880 When considering these other personality structures, 299 00:30:01,890 -- 00:30:07,200 then we would get a much more beneficial diagnostic process. 300 00:30:07,470 -- 00:30:15,030 We don't want someone with another mental health condition to be mistakenly diagnosed as autistic and vice versa. 301 00:30:15,040 -- 00:30:28,550 So we want the diagnoses that are used to really empower you and people around you to improve your well being and to really get you to those goals that you want. 302 00:30:29,500 -- 00:30:36,950 Thank you for joining me today as we talked about personality disorders as misdiagnoses for autism. 303 00:30:36,960 -- 00:30:38,570 We reviewed borderline, 304 00:30:38,570 -- 00:30:54,310 we reviewed narcissism and we reviewed some of the research and publications that are emerging both on a statistical level and also with regard to case studies about why it's really impactful to the individual. 305 00:30:54,310 -- 00:30:56,660 To get these diagnoses correct. I hope you can join me for the next episode.

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