AS with a mood disorder or schizotypal personality disorder?

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As you may be able to tell from my profile, I have been posting on WrongPlanet for years under the impression that I have Asperger's syndrome. It's not surprising that I have this impression - I've been diagnosed with AS by a psychologist, a psychiatrist, and an entire school system. Yet, after all this, I am beginning to doubt that the diagnosis is correct. Specifically, I wonder if I have schizotypal personality disorder instead.

We are all familiar with Asperger's here, but schizotypal personality disorder deserves an explanation. SPD is a tenacious personality disorder that falls in the middle of what is called the schizophrenia spectrum. SPD patients are socially self-isolating, prone to odd beliefs, paranoid, and socially awkward, but rarely frankly psychotic like their cousins, the true schizophrenics. It can be difficult to tell an AS and SPD patient apart, but the two diagnoses preclude each other - under the DMS-IV and the DMS-V, you can't have both.

These are the diagnostic criteria for SPD. Five positive findings equal a diagnosis:
Ideas of reference - The belief that ordinary events have special personal significance. Even though I know how idiotic it is, I am extremely superstitious in this regard. When I hear that the pope (I have a thing about the pope) has given a statement, my first thought is, "hey! That's about me!" (my second thought is, "am I going crazy? That has nothing to do with me!") I also secretly and shamefully believe in astrology, which is essentially the belief that the movements of the planets are significant to the individual. Don't try to talk me out of this stuff, either - the rational MissPickwickian who's studying to be a neuroscientist already agrees with you, and the delusional part of her brain never will.
Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms - I don't know exactly what qualifies as an "odd belief," but I do change my religion - and thus my entire life - a lot. As I said, I am extremely superstitious. I often do things in 20s because I think that the number 20 has protective properties (don't ask me where I got that one).
Unusual perceptual experiences, including bodily illusions - I have this bad when I'm off my Abilify. Spiritual visions, weird smells, someone calling my name, the headachy, penetrative sensation of having someone read my mind...it's all there.
Odd thinking and over-elaborate speech - My speech is stilted and I often get stuck on a single topic. People often don't understand or don't care what I'm saying.
Inappropriate or constricted affect (externally displayed emotion or mood) - I've been told that my emotional responses are extravagant and fakey. They always match my real emotions, but they look weird because I learned them from cartoons.
Behavior or appearance that is odd, eccentric, or peculiar - How do you think I got that AS diagnosis in the first place?
Lack of close friends other than first-degree relatives - Eh, sort of. I have a lot of friends on Facebook, but things tend to break down when people meet me in person.
Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears - I am paranoid and it just kills me. I always think people are out to get me for being gay, even to the point of planning kidnappings. The meds help, but I'm still suspicious of most people I meet. I think people talk about me behind my back and sometimes read my mind. Back in school I accused some poor girl of "manipulating me into a panic attack through osmosis." As for social anxiety, I see some people as "safe" and some people as "unsafe"; the differentiation has a nutty but consistent internal logic that I won't discuss here for fear of being considered bigoted. Even if an unsafe person proves themselves friendly, I still feel profoundly uncomfortable with them.

All of that was pretty hard for me to admit; I like to keep it all secret.

It sounds like I have SPD, certainly, but there is a problem: I had infantile-onset social delays and sensory processing disorder. I didn't play peek-a-boo or respond to being tickled, and I sought out the cold to the point of putting myself in danger (crawling out into the snow in just a diaper and such). I had toilet training and fine motor delays as well. That would seem to indicate autism. Also, SPD people rarely self-diagnose or even think there is a problem.

My old therapist said that my symptoms could be explained with two main diagnoses, AS and psychotic major depressive disorder (PMDD), as well as three adjunct diagnoses, OCD, ADHD, and panic disorder. That's a mouthful, and I want a second opinion.

Is your psuedo-psychosis/psychosis/delusions precipitated by anything? For example, do they occur spontaneously or do they tend to happen as a response to stressful or depressing situations?

How long do they last and do you ever completely lose sight of the fact that they are delusions?

Thanks for the questions - questions are helpful.

My delusions increase enough to cause problems when I'm scared about my schoolwork or I don't take my medicine (an antidepressant/antipsychotic combination - neither component works alone). Completely whacked-out thoughts about kidnapping and the Vatican are more easily gotten rid of than the creeping sense of "people in general can't be trusted."



Delusions last until someone or some chemical intervines. I am constantly trying to get rid of irrational thoughts; I only slip in my vigilance for one five-minute period roughly once a month, but during those five-minute periods I do really wild things. In the past, I have e-mailed my friends in a panic saying that I feared my own homicidal intention toward my oppressors and screamed at strangers to get them to stop reading my mind. After an attack, I become perfectly lucid and apologize to everyone, but the damage to my social standing is often done.

I always know that my hallucinations are hallucinations.

Sometimes I wonder about temporal lobe epilepsy, but then wouldn't psychotropic drugs make my attacks worse rather than better?

The first three symptoms don't seem to be consistent with Asperger's. It's my understanding that we tend to be logical thinkers, and belief in the supernatural and superstition is not something I would say would be common in the Aspie population.

Maybe the delusions are a coping mechanism that your brain uses to try to escape or deal with stressful situations.

For example, maybe you get the sensation that the Pope is talking about you because you are stressed and your brain is trying to run from reality because it can't cope with it. Maybe it turns to a belief that there is something bigger for you in life, telling you you have a purpose to be here and serve some divine function, rather than accepting you are ordinary Jane who has a million homework assignments and howevermany finals and life is not happy at the moment.

In otherwords, the brain can't deal with the reality so tries to make it into something else.

If you think that might be the case, I would highly avoid stressful situations, even if it means changing majors or leaving school or taking a reduced courseload.

In schizophrenia anyway, there are physical changes in the brain, and so they try to treat the disorder as soon as possible to prevent the changes from becoming permanent or at least getting worse.

I think stress plays a big role in some forms of psychosis.

If I understand correctly, she believes in these things in a sense other than someone who truly believes in them. I think what she meant was she KNOWS they aren't true but can't shake the feeling that they are.

But yes, it is not consistent with AS, if only by definition. Neurologically the two might be compatible to co-existence.

Maybe people with AS are more likely to develope psychosis due to inabilities to cope with stress, and those with Schizoptypal Personality Disorder are really just those with AS who developed it.

I probably do. When I got out of the mental ward as a teen, my diagnoses was AS and "mood disorder", they never specified which, I supposedly just had a "mood disorder" but then the doctors and staff there were idots and had no understanding of AS at all. Whenever I take a phycological disorder test online for fun it always comes back "schizopal" so I wonder. I also wonder if schizopal is just an discription of AS before AS was known about. I am severely paranoid but I think it stims from being bullied and harassed all the time as a child. I had severe mood swings even as a toddler. My mum wanted to change my name to Stormy becuase she thought it suited my personalty better; I would have let her if she just shortnend it to Storm. She often says that as a child, I was worse behaviorly than all three of my older brothers put together but was better than all three of them put together as a teen with the exception of my mood swings.

Well if memory serves me correct, schizotypal disorders do not cause eye contact problems. Autistics, including those with AS, have eye contact issues. That is, someone with AS will have problems maintaining eye contact. A schizophrenic can actually make too much eye contact. Not sure if that is also true of schizotypals, but I know they don't have problems maintaining eye contact..

Also, most schizo disorders don't kick in until the person is in their early 20's. So they are fine as kids and young teens.

I was diagnosed with Depression, when I was in my early 20s.

Listen to your therapist. I'm not a therapist but I think that he/she might be right.
I have AS and major depression, and know that when my depression gets really bad I can become delusional and paranoid. I've done many things you've mentioned, like screaming at strangers (in my case, I thought they were police informants making false reports about me).

I tend to agree. The OP's symptoms sound not at all like AS to me.

There is nothing in ASD that protects against psychosis (and in fact plenty of evidence that older people with ASD are more prone to ASD), so it is perfectly possible to have both, or multiple, diagnoses.

these pages are interesting and might help you decide, on the forum its got threads about AS and STPD
http://schizotypal.freeforums.org/portal.php
http://schizotypaldisorder.webs.com/

I was thinking I might have this but after reading more on it I dont think I have, its tricky as I have bits of all group a and c personality disorders, but they are also traits which are consistant with aspergers so it makes it hard to tell.

My major problem is definatley social phobia more than anything else and really limits my quality of life, the hard thing is finding the root cause- PD's or psychosis or ASD all can cause social phobia. Im sure someone with STPD (or any PD) could stim and have special interests too with out haveing ASD or they could have both AS and PD.

Its definately hard to find out who one is and whats wrong and get understanding and help, especially as psych's say such differing things.