On the relationship between AS and personality disorders

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From the personality disorder thread:

First, there is a kind of misunderstanding here that runs rampant not only on this forum, but in neuropychological "laymen" of every stripe, and even in many doctors.

Neuropsychological diagnoses merely represent trends in human thought/behavior. The hard and fast walls between two diagnoses as described above--"You either have Asperger's OR schizoid"--are ultimately arbitrary and reflect reality only in a limited way. If the difference between Asperger's and schizoid is that one does not desire relationships and the other does, what does this say about the nature of these diagnoses? That they're extraordinarily similar. What about people who aren't easily categorized in terms of whether or not they desire relationships? It's not a binary issue--there are a million shades of gray between the two options that describe the difference between Asperger's and schizoid. What about those people? Should we establish yet another diagnosis for them?

In other words, if Asperger's and schizoid have 99 traits in common and 1 by which we differentiate them, why should we be surprised when a "test" for one gives a positive result for a person who's been diagnosed with the other? The only way a negative result would be given is if the test hinged on the one trait that differentiates the diagnoses.

This is why the DSM is moving away from the splitting/differentiating of diagnoses, the endless building of more boxes, and toward a "spectrum" approach. They've begun to realize that, if they keep going the "build more boxes" route, eventually they'll have to build a box for every single one of us--none of us are exactly the same, the "condition" of our brains is ultimately different. It's much more practical to erect a few "spectrums" that simply describe our general degree of severity in terms of a few broad trends, and leave it to our doctors to address our individual issues and determine which plan of treatment is best on that basis.

Another issue is the lack of understanding in regard to the relationship between HFA/Asperger's and personality disorder. Very important ideas coming up next, ones that I would really like to see the members of this site really become familiar with:

"Personality disorders" are a set of diagnoses that were established in order to categorize the ways in which the ADULT personality can "go wrong".

Asperger's is a diagnosis that was established in order to identify neurological problems in CHILDREN.

These two "sets" of diagnoses were arrived at from very different point of view, and to a certain degree even represent different ideologies. But it should be easy to understand how these conditions relate to each other--children with neurological problems often grow into adults "gone wrong". The Asperger's child, unless they go a long way in adapting themselves to the world, will grow up into some personality disorder. If you look beyond the "logical introvert who wouldn't hurt a fly", politically correct characterization of Asperger's to more classic descriptions (like the one given by Hans Asperger himself) you will see that Asperger children are miniature narcissists and borderlines just as often as they're miniature schizoids/schizotypals (which are the PDs that come closest to the "politically correct" harmless logical introvert).

There are several problems here.

Number one, people started asking, "Can adults have Asperger's?" The answer is clearly "yes", but by embracing the "Asperger's at any age" thinking we've obscured the original purpose of the diagnosis--that is, to identify problems in children. Once you're an adult, you (technically) should move into the territory of personality disorders.

A "sub-problem" here is that, thanks to Freudian thinking, personality disorders (when they were originally conceived) were thought to be psychogenic conditions. People tend to think that Asperger's and, say, BPD are mutually exclusive because one is an inborn, "organic" condition while BPD is psychogenic, or the result of some kind of psychological trauma. What they aren't taking into consideration is the great likelihood of a child with Asperger's enduring precisely the type of psychological trauma that leads to BPD. Another thing they're not taking into consideration is the way we tend to grossly overestimate psychogenic effects on the personality. When someone is a narcissist, we tend to write it off to some instance of emotional trauma they experienced when they were a child. They ignore the fact that egocentricity is largely an "organic" condition--that neurological insult causes the distinction between self and environment to dissipate. Furthermore, they ignore the fact that "psychogenic" trauma results in organic dysfunction. If a child is tortured/neglected such that they develop reactive attachment disorder, it doesn't just mean that their psyche has been damaged--it means that their white matter hasn't developed properly. There is ultimately no distinction between mind and brain. They're the same thing, even if we haven't absolutely nailed down the mechanisms behind their relationship.

Part of the genius of Asperger was recognizing that traits previously considered to be of purely "psychological" genesis in adults could be found in children who, as far as he could tell, had not been exposed to the type of psychological trauma thought to be at the heart of the adult, "psychogenic" conditions. The "discovery" of autistic psychopathy helped us take a huge step in understanding away from the classic Freudian point of view, and toward the modern understanding of neuropsychological dysfunction (in which the distinction between "function" and "organ" has been blurred dramatically).

When you read the DSM, keep in mind that the boundaries erected in it are ultimately arbitrary. In the real world, there is continuity between the diagnoses, or "trends", that it describes.

There's increasing evidence of organic causes to personality disorders.

Also, as it was pointed out to me in another thread, there are more distinctions between those typically diagnosed with AS and those diagnosed with SPD. I mean, I think that there's probably a lot of overlap in NLD, AS, and SPD diagnoses, but they each may describe otherwise distinct things.

While the ASD diagnoses were written for children, many were not diagnosed as children. It strikes me as a kind of black and white thinking (as you complained about the other day) to suggest that ASD diagnoses should be reserved for children and adults should be diagnosed with personality disorders. Consider also that many adults could have been diagnosed as children, or would have been if the diagnosis had existed at the time. It's not as if autistic children grow up to be personality disordered adults, so why would an undiagnosed child grow up to be a personality disordered adult? This is where an overly strict interpretation of the criteria goes wrong.

All that aside, I do agree with you that the separations are arbitrary. In the PD thread, it would surprise me if a lot of us here didn't score very high on Schizoid because the similarities are definitely present.

It's not that I feel that this should be the way things are done. I'm just trying to give a better understanding of how these diagnoses were developed.

What about introverts and extroverts? How do they fit in?
It's not a matter of there being one degree of difference between Asperger's Syndrome and Schizoid Personality Disorder. Personality disorders might not even exist, anyway. Why? Because personalities go through phases. Someone might want friends one week, then want to escape them all and be totally alone the next, only to find they are lonely and want more friends a month later. It changes.
Neurology is a different thing, entirely. You don't just "change" it. There's only so much you can do to alter it. It's just not the same as personality. Let's say you have a neurological disorder and you choose to deal with it by approaching people and talking about it, demanding they accept you for who you are. That's one type of personality. Then, there's another someone with the same Neurological disorder, instead of going around talking to people about it, they go into their house and turn on the television. When anyone asks, they say they are happy being alone. It's another example of coping, a different style of coping.
So, you can see, there are huge fundamental differences between the personality and the neurology. Personality merely implies how you cope with what you have been given while neurology is what you have been given, no ifs, ands or buts.

That's fair - I misunderstood. I think my point stands - just not aimed at you, obviously.

Again, they're merely neuropsychological trends.



These types of "changes in personality" are part of the description of some personality disorders. You're not looking at the big picture of what constitutes a "personality". If someone's personality tends to change, then the proper way to describe them from a clinical point of view is that their personality is unstable, tends to change, etc.--not that they go through different personalities, or whatever you're describing.



Saying two people have "the same neurological disorder"--do you mean that, for instance, they both have Asperger's, or that their brains are the same? "Neurological disorders" like Asperger's are extraordinarily heterogeneous, so of course two different people with Asperger's can employ different "coping styles".

There is not a "huge fundamental difference" between neurology and personality, aside from the perspective from which they're described. They are the same thing, only viewed from different perspectives

I'm sorry, but it seems that you didn't understand my post, and have some muddy ideas regarding neuropsychology. Not sure how to bridge the gap here.

Then most people have unstable personalities. People's coping styles tend to change depending on circumstance. For example, someone with a stable personality resorts to drinking when going through a tough divorce or a death in the family. Someone with a gentle personality becomes aggressive when surrounded by hostile people. How do you explain the change in personality that occurs due to circumstances surrounding the individual? What about the "born again" personality type? Someone with dysfunctional coping styles all of a sudden becomes "born again" and vows to give their life to Christ so they may become productive citizens. This kind of personality conversion occurs most often in prisons. These are examples of stable personality types changing to another stable personality type, for better or worse. Personality metamorphosis is a distinct possibility and has been noted in certain individuals.
Wouldn't it be cool if you could transplant personalities


Neurology and personality are two different things, or everyone with a neurological disorder would appear exactly the same. Personality explains the differences between individuals with neurological conditions.
You could say that depressive episodes are linked to personality, though, since the coping style changes whenever somebody is depressed.
You do realize personality involves coping styles, don't you?

Whatever a person happens to be doing at any point in time does not determine their "personality".



It's clear that you don't understand heterogeneity, and how the concept applies to conditions like Asperger's/autism. This is subverting your ability to understand me.

Asperger's is not a single condition. It is a trend. It is a set of generalities. Until you understand this, you're not going to understand this thread.

Which begs the question, isn't it likely that BOTH approaches have limitations? Each is an attempt to narrow scope. Reductionism is good for studying the parts but often fails to grasp the interactions between the parts that ultimately make up the whole.

By "trend" you mean you think it's trendy to get an AS diagnosis?
I am speaking form the perspective that AS is part of the Autistic spectrum and is, therefore, distinct from personality. First of all, you need to see personality for what it is, ways in which an individual copes with life, and leave it at that. It's best to approach matters in a simplistic way.
Second of all, Freud was a very confused individual.

No. I mean that Asperger's is a generality. It's not a "single" condition, but a description of traits that many different conditions share. It's a general tendency.

Compare it to cancer. There are lots of ways you can have cancer, lots of "types" of cancer. The concept of "cancer" is just a generality, or a trend. It's something that all of the specific cancers have in common.



This is a position of limited utility.



All behavior has a neurological basis. The truth, unfortunately, is complicated.



Yes, I agree, and implied as much in my original post.

Last edited by Poke on 26 Mar 2011, 7:30 pm, edited 1 time in total.

Poke, this was a really interesting and thought-provoking posting.

I believe that you are correct here. People place too much emphasis on a particular diagnosis, when the reality is that multiple overlapping categories are more appropriate. I personally have a number of "official" diagnoses, and a couple more unofficial ones. I spent a great deal of my life trying to understand the origin of these conditions. I did associate some traits with childhood trauma. Yet, I came to realize that there was a fundamental difference between me and other people. I realized this before I discovered AS. I realized that in some way that my mind functioned differently from other people. I think that the classical model of psychology, in which behaviors are always due to trauma, does people a huge disservice. What is even worse is the attitude that people with psychological problems are lazy or too weak to solve their problems.

I came to my conclusions from a different viewpoint. My most serious problem is depression. I have spent many years involved with groups whose primary focus is depression. One thing that you get from such groups is the feeling that depression is something which really can come out of nothing. It is just really puzzling, from a psychoanalytic or behavioral viewpoint. I think that the only reason that people began to understand that depression was not purely a psychological problem was because of the discovery of antidepressants. This lead to the "chemical imbalance" theory of depression. I think that this theory is a good first step, but it does not really explain anything. I suspect that the true answers lie in a deeper understanding of neurology.

I really think that psychology is just beginning to enter the scientific age. I see this coming from various directions. ASD shows that some people are different from childhood, even where there is no trauma to cause a difference. Depression research shows the significant effect of biochemistry. Modern imaging methods show that some brains function differently from others.

I hope that I haven't taken your thread too far from its origins. I just think that the topic is a part of a much bigger one. Personality disorders are a facet of neurological differences, but there are so many other facets to be examined.

My examples show that personality is dependent upon circumstance, not neurology alone. What about actors? The "acting" personality is an example at how adaptable someone can be, regardless of neurology. Adaptation is part of the personality and it s a learned coping skill that has it's origins in what people are capable of acquiring.
So many types of personalities can be altered or "improved upon" at will, depending on circumstance.
A good example of this would be the employee who gets a memo from his boss that reads "either treat the customers better or go find another job." Suddenly, we see a milieu of sugary skills emerge. These skills could, in fact, be temporary and could disappear by the end of the day only to reemerge the next time the employee is called again to work, but how do you explain their emergence at all if personality is so dependent on neurological mechanisms?

But all cancer is essentially cells dividing uncontrollably. This is what differentiates it from AIDS. malaria, or rickets.

Autism appears to have neurological origins that are sufficiently different than other conditions that a separate diagnostic category is justified. I think part of the problem is that since personality disorders catalog external behaviors, two different neurological conditions could conceivably manifest behavioral symptoms sufficiently similar to result in the same psychiatric diagnoses. But the differences in the underlying neurology would suggest different treatments and prognoses.

I have an autistic neurology. It may have lead to behavioral traits similar to some personality disorders. But attempting to treat those traits without understanding and treating the neurology seems short sighted.

Your thinking on these matters seems clear. All behavior, every mental state, every human personality "trait" has an "organic" basis of some sort, whether it's the basic structure of the brain, how that structure functions, the chemicals that interact with it, etc. I find that people are generally rather reluctant to admit this, for a variety of reasons, often relating to religious or political belief.



It's going to be an uphill battle, for sure, with the amount of misunderstanding out there.

The brain would need to exist for these behaviors to happen, but two brain scans can be remarkably similar, yet the two people they belong to can be as different as night and day. In fact, one could be an NT while the other an Aspie!
So, the question becomes, how do you explain the differences? It's more complicated than it being a single thing.

Last edited by ooOoOoOAnaOoOoOoo on 26 Mar 2011, 7:47 pm, edited 1 time in total.