Hierarchy of diagnosis of AS and Schizoid PD

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In the current diagnosis system, if someone has symptoms of AS and Schizoid PD, the diagnosis is AS.

But perhaps the opposite makes more sense? Or, at least, to put the two conditions in the same terms and choose the better diagnosis by the number of symptoms?

Why I say that:

Imagine 3 people:

Peter has a strong interest in some issue and tries to talk with everybody about that. He is usually rejected by other people (at school, other kids did not like him and they refuse to play with him because they thought that he was very weird) and sometimes feels very unhappy because that.

Mary has a strong interest in some issue and spends almost all time thinking and daydreaming about that. She hates when other people try to interact with her and force her to “go down to earth”. At school, other kids did not like her because she was always alone and refused to play with them. When she has to attend social meetings, she becomes very distressed with that.

Michael spends almost all time thinking and daydreaming (as a children, perhaps living imaginary adventures; at adult, usually about abstract, sometimes philosophical, issues). He hates when other people try to interact with him and force him to “go down to earth”. At school, other kids did not like him because he was always alone and refused to play with them. When he has to attend social meetings, he becomes very distressed with that.

At the current standard, Peter and Mary have AS and Michael probably SPD. But you do not think that Mary resembles much more Michael than Peter? (I admit that my words are choosen to produce this effect)

Like is defined today, the diagnosis of AS don’t make any distinction between people who don’t like to socialize and people who try to socialize in an awkward way and fail (in other words, between the “loners” and the “active but odd”) – probably, both will have A2, A3 and A4 criteria of the DSM diagnosis

Of course, rediagnosing the “Aspies-with-schizoid-symptoms” as “Schizoids” will have the opposite problem: to put the same label to people who really likes to be alone and to people who developed a desire to be alone as a reaction from previous bullying and rejection, but I think these problem will not be much relevant, because:

a) even today, probably there is “people with AS who really likes to be alone”, “people with AS who likes to be alone because previous rejection”, “people with SPD who really likes to be alone” and “people with SPD who likes to be alone because previous rejection”.

b) if the diagnosis is made at children (or looking to the childhood picture), I think it is possible to distinguish between the two.

Another reason for rediagnosing Aspies-with-schizoid-symptons as Schizoids is because the psychiatric diagnosis are made with some purpose: to decide what is the best intervention. Well, I think that the adequate intervention for Aspies-with-schizoid-symptons is the more or less the same that for Schizoids: basically, a “leave him alone!” approach, and, in school age, perhaps to try to put them in small classes, and with many schizoids in the same class (for two reasons: to reduce bullying; and because sometimes schizoids like to have ONE friend).

In contrast, for Aspies-without-schizoids-symptoms, perhaps things like classes of “communication” or “social skills”, watching juvenile “soap operas” etc. (the kind of things that Tony Attwood recommends when he gives lectures to associations of parents of aspies) could be useful (for an Aspie-with-schizoid-symptons, probably this kind of thing is useless: he will consider these as “brainwashing” and will refuse to pay attention).

However, I don’t have any habilitation at psychiatry (and not formally dx with anything), then is very possible that what I am proposing is totally stupid.

What do you think?

The only difference between Mary and Michael is that "Mary has a strong interest in some issue", whereas Michael does not have a strong interest.

The criteria for Schizoid Personality Disorder does not include marked impairment in communication as it does for AS.

In her fascinating book Loners: The life path of unusual children, Routledge, 1995, ( http://www.amazon.com/Loners-Life-Path- ... 0415066654 ) Sula Wolff describes a group of solitary children who were unable to fit in with the social and educational demands of school, and were given a diagnostic label of Schizoid Personality of Childhood. She compares them with children with AS, autism and schizoid/schizotypal personality disorder and concludes that the majority of her schizoid children would be more accurately described as having a mild form of AS with some schizotypal traits.

If you know the book "The Stranger" by Camus, the schizoid would be Meursault, whereas the aspie would be the Autodidact.

I read that book, and my impression is that she thinks (or thought) that the better diagnosis is not the current diagnosis of AS (or the current at 1995), but a new label that she named "Schizoid/Asperger" (and classified as a personality disorder, instead of a development disorder). And I think that she thinks that "her" children have traits identical to the adults with Schizoid and/or Schizotypical PD.

Some years lates, in "Beyond Asperger's Syndrome" (an essay with many copies on-line), apparently she thinks that "schizoid" is a better label than "asperger" (for the children that she studied):

http://4np.net/~sum1/psyforum/swolff-beyond_as.pdf

I think there's some overlap between the two. The big differences, when you run across an asocial person, will be that with SPD-only you are unlikely to find special interests, oddities of speech, repetitive movement, a need for routines, sensory overload, or unusually concrete thinking.

Most Aspies are not schizoid and most schizoids are not Aspie--but I think that in both categories you will find more people than in the general population who fit both descriptions. Schizoid PD is something developmental and environmental and is genetic to the same (surprisingly large) degree that personality is genetic; Asperger's is almost entirely genetic.

mm I think the anhedonia is a big difference. It speaks to lack of special interests or enthusiasms. There's a childlike thing in autism, whereas schizoids strike me as 'old' cynical and word weary, even when young.

I think that there's not enough study done on either yet to determine a solid, infallible diagnoses either way. But then again, soft sciences are pretty much in their infancy vs. hard sciences. For example, I don't think there's that much work on adult AS (as far as I can tell), but infant and juvenile stages are getting all the research.

Check back in a decade or 2, we'll know more by then.

See-saw syndrome?

I was Dx SPD as a teen. I was certainly noticeably different before that, but no one had yet learned of Hans Asperger and his work.

I like being a loner now, but I consider my self non social, rather than antisocial. I see people all too clearly, and I choose not to have dealings with them.

When by myself I have only to answer to me.

My belief is Aspergers was a correct dx for me. Comorbidity of other disorders interests my curiosity. I see many traits of other seperate psychiatric disorders in my personality, however I would not recieve a 2nd disorder dx.

Disorders I associate my personality/moods are; ADHD/NVLD(Not sure which), OCD, GAD and Schizotypal disorder. Always had a melancholy mood since childhood, but would not categorise it as depression.

I believe all these traits are extensions of my autism. This is my experience with Aspergers/autism and will not impose it on others.

TPE2 says,
In contrast, for Aspies-without-schizoids-symptoms, perhaps things like classes of “communication” or “social skills”, watching juvenile “soap operas” etc. (the kind of things that Tony Attwood recommends when he gives lectures to associations of parents of aspies) could be useful (for an Aspie-with-schizoid-symptons, probably this kind of thing is useless: he will consider these as “brainwashing” and will refuse to pay attention).

Interesting observation you have made! I have met some aspies who are anti-psychology and Tony Attwood to an extreme, almost demonising the art of psychology. Wonder if they have SPD traits in their personality?

I was diagnosed with "personality disorder NOS" (don't you love "NOS"? It's like they're admitting they don't know what they're doing) before AS. Basically, I got this old chestnut...

Neuropsychologist: Do you have many friends?
Me: No.
Neuropsych: Does that bother you?
Me: No.
Neuropsych: ...really?
Me: ...I seriously don't see the point in having friends or in interacting with people.
Neuropsych: Is it because you're anxious around people?
Me: It's because they have nothing to offer me.

But I don't think I fit enough of the diagnositic criteria to make schizoid work. I'm curious about how many other people got jerked around with a misdiagnosis...

Or... if this was actually a misdiagnosis.

All the DSM says is:

I suspect that, in practice, "only having pleasure in few activities" (SPD) or "having a strong interest in a restricted topic" (AS) can be very similar (this is only a suspiction: I don't personaly know nobody dxed with AS or SPD, then I can't see de difference in loco).

yeah, I spose they can seem the same. I have only known one schizoid but I've known him for 35 years. He had a few speccy interests: WWII & nazism, porn to some extent (I think they call it erotomania or something like that in schizoids) although not very interested in actual physcial sex, prolly more of a voyeur thing, um other interests were music maybe, books of certain genres, history/war/mythology....yeah I guess they correspond to aspie perseverations, but schizoids tend to know when to keep it quiet or shut up about it, I mean they don't go on and on about their special interests, in fact they're probably quite guarded about them if they're likely to be perceived as unusual, since they're more cluey than aspies about concealing 'difference'. He was extremely articulate and could read people like a book, these are things you don't find in aspies. I'd call it social 'poise'.

The anhedonia is definitley there, it's like amazing sloth. There's an inertia an inability to act or take action possibly because he doesn't think we wants or needs anything even to the extent of food. He'd rather starve (and often did) than go into a shop to buy food, he doesn't cook except maybe boiled eggs. The kitchen was the least used room of the house. It's funny he used to speak fondly of going back to the womb, where everything is done for you and you don't need to do anything (this was before we knew he was a schizoid) - there's also a gross selfishness there, but I think aspie self absorption can also seem like selfishness. That's uh a few things I can observe about schizoids. I wonder if I'm rambling off topic though, I've forgotten what the specific topic was.

Sometimes, I am a bit like that. 10 years ago, I was unemplyed I used to stay in bed at 12:00 AM, 1:00 PM, 2:00 PM... Sometimes I was full of hungry but was lazy enough to get up of bed, thinking "If I get up and go eat, it was good. But, before eating, I have to take bath, dress... much work".

In these times, one day, at 3:00 PM a friend of mine make me phone call and I said to her "I get up from bed because of your call" and she answered "T., don't tell these to anybody!" .

I usually go to the computer with projects of writing something, or make a program (I am a kind of "hobbyist" computer programer), or participate in some colective on-line project, or..., but usually I endend reading random articles at net, and thinking "One day - perhaps tomorrow - I have to beggin that thing that I am thinking".

And, in my work, is not rare that, in one day, I do about half of the things that I had planned to do that day (perhpas it was because this that I was unemployed during more than 3 years - possibly, my potential employers were smart enough to discover my personality before hiring me).

i guess the key difference is the superior social and language skills, here's a schizoid forum if you want to try and establish what the differences are. just from knowing one for so long, I know i'm not one. AS gets mentioned at this site, there is some confusion between the two conditions over there too.

Aspies would be social if they could be, they end up being loners because the social world excludes them, whereas schizoids just prefer to be alone, it's voluntary.

http://www.schizoids.net/forum/index.php