Aspergers, differential diagnosis?

Post Reply New Topic

Asperger's Syndrome(AS), Social Phobia(Social Phobia = Social Anxiety Disorder = SAD), Avoidant Personality Disorder(AvPD) and Schizoid Personality Disorder(SchPD) have many similarities. This website points to some subtle differences between AvPD and SAD.

If you should summarize the main difference(s) between any of these four(AS/SAD/AvPD/SchPD) with only two sentences, what would they be?

AvPD vs SchPD
Internet tells me that those diagnosed with AvPD differ from those with SchPD, because they want to have relationships with others but are prevented by their social inadequacies. Persons diagnosed with SchPD, on the other hand, usually prefer social isolation. AvPDs are excessively preoccupied with being criticized or rejected in social situations, while SchPDs are indifferent to praise or critisism in any situation.

AvPD vs SAD
Internet also tells me that unlike SADs, who are aware of the irrationality of their anxiety yet are unable to control it, people with AvPD are unaware of or reject the idea that their fears are excessive and believe with full conviction that they are inadequate, unlovable, broken, etc. AvPDs are reluctant to initiate new activities in fear of being criticized. SADs are not as sensitive to perceived criticism as people with AvPD. Some theorize these are the same conditions only with a severity difference.

AvPD vs AS
AvPDs are often resistant to therapy, and if they do agree to group therapy, they will be reluctant to self disclose (however, I'm unsure if the opposite is true for those with AS). People with AS lack the ability to interpret non-verbal social ques. AvPDs are beyond just aware of others social ques when they are interacting with others, they are actually hypervigillant.

SchPD vs AS
SchPDs are often resistant to therapy, and if they do agree to group therapy, they will be reluctant to self disclose (however, I'm unsure if the opposite is true for those with AS). SchPDs personality can be defined to be bland, humorless and dull, with no interest to converse or interact with another person. All these traits are things you won't find in someone with AS.

SchPD vs SAD
A phobia/anxiety, of any sort, is an irrational fear. Those with SchPD would not feel fear; they would simply feel indifference.

AS vs all
People with AS have strong tendencies to be very literal in their understanding of spoken or written language. An unusually intense interest or restricted, repetitive, and stereotyped patterns of behaviour, interests and activities. Enthusiasm and a propensity for obsessive research ensure that Aspies develope a deep base of knowledge in subjects of interest, but it takes up a lot of the family’s financial resources, space or time. Tendency to give monologues about special interests. Often focus on details of a conversation, and are impaired in achieving local coherence. Difficulties in areas like planning, time management, wise setting of priorities, and with multi-tasking. People with AS have difficulties with transitions or changes and prefer sameness. Often wear similar clothing day after day regardless of fashion. Rigid adherence to rules where flexibility is desirable. Asperger's typically appears first in childhood, while all the others usually appears in adolescence / young adulthood. People with AS often have
eccentric behavior in childhood.

You can have AS and AvPD/SAD at the same time, but you can not have AS and SchPD at the same time(DSM-IV says AS takes precedence, ICD-10 says SchPD takes precedence).


Thats all I have for now, I hope you can help shed some light on the differences. I will update this first post if I find some satisfactory answers.

I've started to wonder if someone with Asperger's could fit into all of the above based on the diagnostic criteria, thats why I'm trying to find the subtle differences between these very similar diagnosis.

Edit: I researched similarities, and came across this little nice picture;

( source )
As you can see, SchPD and AvPD are close to eachother on the interpersonal circumplex model. I wonder where AS and SAD would be on this model, thus far I have not been able to track that down.

Edit2: I found an image that displays SAD fairly well;
[img][800:350]http://img801.imageshack.us/img801/716/interpersonalsubsad.png[/img]
( source )
You can clearly see SAD and AvPD are almost on the exact same spot. Some even theorize they are the same thing. However, there is a slight difference, as you can see from my above versus-section.

If you have any corrections, additions (or admirations ), please comment.

I am no psychologist, though I do have a few theories about differences...
Firstly, AS involves much more that just social inadequacies/differences. With Asperger's Syndrome, one also sees repetitive behaviors, narrow interests, a different learning style, usually some sort of hyper or hypo sensitives...
A phobia, of any sort, is an irrational fear. Those with Schizoid Personality Disorder would not feel fear; they would simply feel indifference. Therefore, it is unlikely that someone would have both Social Anxiety Disorder and Schizoid Personality Disorder.
The difference between AS and AvPD, it seems, is that one with AS may not natural recognize that they are socially inept--they may need to be told--while one with AvPD avoids others because of this awareness. I speculate, however, that Aspies who are highly self-aware may develop AvPD out of rejection and obsessive pondering.
Interestingly enough, Wikipedia states that SAD and AvPD are often co-morids to each other: those with SAD may develop AvPD from their avoidance, and those with AvPD who hyper-fixate on their perceived inadequacy may develop SAD.
The diagnostic manual for SchPD specifically mentions that any pervasive developmental disordering, including AS, mood disorders, such as depression, and psychotic disorders, such as schizophrenia, must be ruled out before the diagnosis is given. Therefore, under the DSM, one cannot have both AS and SchPD.
It seems possible that one can have AS, AvPD, and SAD, although the symptoms of AvPD would likely be attributed to Asperger's instead of being considered a co-morbid to it.
This is just from a bit of searching and speculation, those. Best of luck in finding the answers you seek.

I found some extra information and updated the first post(edit and edit2).

I personally think you can't put all the aspects into a neat chart. Are cold and friendly opposite ends of a spetrum? I know very friendly people who have a cold hearted reason for being friendly and socially adept. Heck, drug addicts are some of the most charming "warm" people, same way with con artists. Where is "asocial"? The difference between people who know they are socially awkward and those who "need to be told", well, after they are told enough times, then they "know".

People are not equations, charts can't simplify things. Every person is different, part of the problem of the medical and mental health community is that they don't want to account for each individual, they want to tick off boxes and come up with a label, and labels can follow people forever, sometimes ruining their lives.

Updated with "AS vs all" instead of "AS vs SAD", cause the latter are not really a point in differentiating since SAD has been compared to all the others.

[Moved from Bipolar, Tourettes, Schizophrenia, and other Psychological Conditions to GAD on OP's request]

Well it seems Schizoid PD and Avoident PD are very, very different.......so I don't get why that chart has them so close together and I would disagree that either are necessarily cold or heartless. Other then that though they seem pretty different so I don't see how they could be the same disorder.

One seems more like indifference to other people and one seems more like avoiding things and/or people out of anxiousness, those are pretty different.

This is interesting.

When I was sent to see a psychologist in the airforce, she mentioned avoidant and schzoid PD's and aspergers as possible causes of my issues. Apparently she also thinks they quite similar. The interview was more about me being able to function in the military and not going into these issues in depth.

Thanks for the information. It seem that I have traits of Avoidant PD and Dependent PD on top of my ASD (PDD-NOS, to be exact). If I had to pick one of the lettered labels it'd be "K Trusting".

I wonder how those diagnosed with Schizoid PD look like in real life. I don't even know if I've ever met one. I'm pretty sure that given the diversity of people diagnosed with an ASD, many of them have traits of different personality disorders like the ones you are after. This is why there are so many misdiagnoses. You have to have reliable information about one's childhood but often in adulthood it is simply not possible.

I believe that fundamentally all PDs must have a developmental basis, not only PDDs (the spectrum), but some traits appear only later in life.

As you wrote, there are other diagnostic criteria for ASDs that differentiate them form PDs: sensory issues (DSM V, ADOS, ADI-R), restricted interests, repetitive, stereotyped behavior, clumsiness in some cases, perhaps uneven skills.

I don't like the label I was given (the unrecognized and vague PDD-NOS), but I've come to terms with it, as what really important is that you get the help you need in the form of therapy, counseling, or even mentoring. Perpetual doubt of your diagnosis is something that is quite common in our community, but you have to put it to rest at a point, imho. Until then, good luck with your quest!

I don't know if anyone else sees this, but there is a flaw in the diagnostic model of personality disorders. These qualities are only expressed some of the time by most people; where is the disorder? There is a hierarchy in NT world of personality types that do influence and affect each other. If someone is in a position of authority they can be said to be "assured" but their true personality is one of submissive tendencies. Why is this model not accounting for relational differences. I can only imagine disorder actually reflects a fixed, disease-state of the mind? I am wondering how that would guide psychotherapy. I've always thought personalities were ever-changing due to circumstances. Even as the years pass we change who we are because that quality is in flux anyway; being based on aggregates reflective of a perceived whole entity.

Hmmm....