Bipolar and AS

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My therapist said adults with AS are often diagnosed as bipolar first and when they were kids ADHD. I'm currently diagnosed as bipolar and I would like to know more about this.

My bipolar cycles so fast the moods do not last long enough for typical bipolar, instead of moods lasting months they last for hours or even minutes, is this an AS thing?

I'm also diagnosed schizophrenic, but the only symptom that appears is delusions (not hallucinations) that come along with the mood swings, which my therapist suggested could be a bad meltdown because I also get severe sensory overload, do meltdowns come with delusions?

The combination autism and bipolar is highly controversial, some say it's very common, others that autistic ppl don't have a higher risk than the general population and often get miss-dx with bipolar because of moodswjgs that often occur in autistic symptoms because of meltdowns and problems to regulate emotions correctly. You'll also find studies who suggest both, depending on the study,

Same problem with autism and schizophrenia.
So I guess they suggest schizoaffective disorder?

If I were you, I would go to an autism specialist to make sure that you really have the comorbidities. Especially if your only schizophrenic symptom is supposed to be delusions and your bipolar pattern is supposed to be "rapid cycling". Of course it's possible to have both, but in my opinion it's good to look into if this combination is correct because of high overlap.

I am having similar confusion and contradicting view points of therapists.

I have a lot of trouble regulating my emotions. In a the space of a few hours I can have many extreme emotions that I generally can not relate to any real-life events. My sensory overload, restlessness, energy, irritability, concentration and level of depression goes up and down relentlessly in a day.

I recently spent a month as an inpatient after beginning Lexapro, which made my levels of agitation, anger and energy skyrocket and swing all over the place even worse than usual.

Raziel, you mention emotional regulation issues in ASD, but I am having trouble finding any specific information/personal account of this. The various therapists that I see have varied interpretations of what my emotional dysregulation is. In particular, psychiatrists (who I have very little contact with, and appear to know little about ASD), push for a borderline personality disorder diagnosis. But I don't feel that this is right, when I read about it I don't really relate to any of it other than the rollercoaster emotions. Sure, I have emotional regulation issues obviously, but it is VERY rare for me to be triggered by real life events (except for sensory issues). And I don't really feel emotions like guilt, abandonment, feeling bad about myself... the more socially directed emotions at all.

Ultradian cycling Bipolar II has also been raised (by a therapist that I have worked with for years, who diagnosed me with ASD). In particular we have been discussing Mixed States (which I appeared to have whilst on Lexapro). As well I have a history of severe depression lasting months at a time, and months of well-above average functioning/mood. I've never had any luck on any antidepressant (no or worsening effect).

I believe I would meet the criteria for Ultradian cycling Bipolar II, but I'm hesitant to have a full assessment done if all of this can be better explained (or is an expected part of) my ASD.

Hey alexi,

I'm always a big shocked that so few mental health professionals know that, that emotion dysregulation is a common symptom of autism. Borderline PD and Bipolar disorder are by far not the only disorders were problems regulating emotions can occur. It is also very common in low function autistics where many can't control their emotions and also self harm is common. In high functioning autistics (Aspergers included) approx. 10% self harm. Actually borderline personality disorders is a very common miss-dx. for high-functioning autistic ppl. But like in your case there is a certain overlap, but also differences. So there is quite a difference between autistic emotion dysregulation and borderline. In borderline the instability is more severe and also going along with reckless behaviour that isn't typical for autistic ppl., like having sex with a lot of different partners, gambling and so on. Also the drug abuse among ppl with borderline is much higher than in autistic ppl. and ppl. with borderline usually have a very good sense for the emotions of others, they detect usually very fast when something is wrong with the other person.


Here some links:

ASD, a psychiatric disorder, or both? Psychiatric diagnoses in adolescents with high-functioning ASD.

"[...] Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. [...] Approximately 60% of prior psychiatric diagnoses were not supported on the Autism Comorbidity Interview; the lowest diagnostic concordance was for prior bipolar disorder and obsessive-compulsive disorder diagnoses. Although 51% of children met Autism Comorbidity Interview criteria for at least one psychiatric disorder, rates of prior diagnoses were much higher, with 77% having at least one prior psychiatric diagnosis and 60% having two or more. Although many participants met criteria for comorbid psychiatric disorders, the majority of previous psychiatric diagnoses were not supported when autism-related manifestations were systematically taken into account. [...]"

http://www.ncbi.nlm.nih.gov/pubmed/22642847


The role of emotion regulation in autism spectrum disorder.

"[...] Autism spectrum disorder (ASD) is associated with amplified emotional responses and poor emotional control, but little is known about the underlying mechanisms.[...]"

http://www.ncbi.nlm.nih.gov/pubmed/23800481


Emotion Dysregulation and the Core Features of Autism Spectrum Disorder.

"[...] Compared to typically developing controls, children and adolescents with ASD showed more emotion dysregulation and had significantly greater symptom severity on all scales. Within ASD participants, emotion dysregulation was related to all core features of the disorder, but the strongest association was with repetitive behaviors. [...]"

http://www.ncbi.nlm.nih.gov/pubmed/24362795


Also Wikipedia has an article about emotional dysregulation:
http://en.wikipedia.org/wiki/Emotional_dysregulation


I was also once miss-dx with the suspicion of having borderline PD tendencies (yes it was seriously both, a suspicion and tendencies), but it didn't fit quite. I was highly paranoid back than towards psychiatrists because the locked ward I was put in for a week, against my will, was traumatic for me. I'm having claustrophobia actually. I'm still paranoid towards that psychiatry, but now I would never go there again if I don't have to. I'm also a bit the paranoid type when someone is trying to force me to things. But besides that, I'm usually not paranoid. I'm dx with schizotypal PD at the moment and I'm having quite a few symptoms, but here I've also a bit the problem with the overlap towards autism. Maybe it's correct and I've a bit of both. It's just that there a quite a few symptoms who are overlapping that I'm not sure.

Thank you so much Raziel, that is great info. I am always surprised to see so little discussion here about everyone's daily quality of life. There is so much to discuss beyond shutdowns and meltdowns. I don't even know how to explain the more or less constant level of distress.

Thanks again, I'll get reading so that I can hopefully better communicate to the professionals what is actually going on.

hello. I have the aspergers/schizoaffective diagnosis as well.
Over the years I have gotten better at distinguishing which disorder causes which symptoms.
I do have "mini episodes" which are usually more just angry outbursts but I think these are more due to the aspergers/adhd symptoms.
The schizoaffective/bipolar symptoms are somewhat rapid cycling too, but last longer than the shorter angry outbursts. Both types of symptoms have responded well to medication though.
Without medication my schizoaffective/bipolar symptoms can sometimes last for months, but I get mini episodes as well, if that makes since. There seems to be a bit of an overlap but I think the aspergers/adhd symptoms are mostly consistant while the schizo/bipolar symptoms fluctuate.
My personality is a lot friendlier when I am medicated.

I was diagnosed with Aspergers 1st and then Cyclothymia 2nd. It was cyclothymia instead of bi-polar because except for a few times, I never dipped down into crushing depression or jumped up into full-blown mania. The cycles would last 1-2 weeks with maybe a week at most of normalness inbetween.

I'm on a mood stabilizer now and it's wonderful. Occasionally I'll have highs and lows lasting for a few hours, but they're uncommon and random. It's wonderful being stable.

Hey alexi,

You are welcome
I know how important good knowledge for personal understanding can be, but my personal experience meeting many mental health professionals in the last years is that it doesn't help much in most cases, telling them what other experts wrote, because they feel like you don't take them serious as mental health professionals and for NTs the social rank and respecting authority is very important. Just very few mental health professionals really come along with autistic ppl. Tony Atwood once said in an interview that someone with aspergers should go to a mental health professional who has worked together with at least 100 autistic ppl. IF there is a psychiatrist in my city who has worked together with that many, it's one who works in the child psychiatry in my city and I can't go there because I'm not a child anymore. So there is no way for me if I don't want to travel to another city each time and even then it gets difficult. Most psychiatrists who aren't specialised in autism don't know much about it and also not about it's complexity and miss it often. Autism is actually a highly complex disorder, probably that complex like schizophrenia who is also a highly complex disorder where many different symptoms can occour.

My personal opinion is that autistics have trouble talking about their quality of life and so on because of a high level of alexithymia and as a result a poor insight into the own emotional life. I've also trouble expressing my own difficulties I have in evereyday life and many mental health professionals complained about it, but none of them told me how to communicate differently so I could never solve those issues and they were expecting from me that I would know that naturally how else to communicate.

My personal opinion is that in autistics the emotion disregulation has to do with alexithymia from early on and in borderline PD with an unstable self image, not knowing where to belong to, often resulting out of negative experiences in the past, but that's just a personal guess.

This is EXACTLY what I experience, glad to know there are others like this. Now I have not had this to an extreme since I've been on medication, but sometimes I get really anxious and depressed. And I am diagnosed schizoaffective, and also anxiety nos, my therapy team highly suspecting AS and wanting to give me therapy according to it.

Oh and about borderline... I think they were suspecting it in me because the whole story is I was referred to DBT group therapy by my caseworker, but after a couple of individual sessions, the therapist suspected an ASD and went further down that road because she felt I would not do well in a group.

Angnix, I have also been referred to a DBT program. They have acknowledged that my ER issues are not stemming from Borderline Personality Disorder (which is what the program is usually used for) but that the program should be very useful anyway for anyone with ER problems.

I learn best in very structured ways, so the way the program runs is very appealing to me. The psychologist running the course has told me that they are concerned that I won't be able to handle that it is group based, but to be honest I'm more concerned about how I will handle sitting still and being in flourescent lighting for such long periods. Sitting still is SO hard for me.

I have done a bit of research and it seems that there are good results for people with ASDs doing DBT. I hope so... I really need something to cling to for hope of a better life.

Raziel, I have also thought that Alexithymia must be playing a role. My psychologist has been telling me that I use words like feeling "bad" or "overwhelmed" without any real way to describe what those feelings actually mean. I have recently started using an app to try to record my mood and am finding it SO difficult because I'm looking at words that they have put on opposite poles such as "tired" and "energised" and thinking "well, I feel both of those right now, how can that be right?". I don't feel like I have the right words to describe what I feel, so expecting others to understand is unrealistic. I feel like my feelings are confused in a similar way to my senses (eg. I may not if my body is saying I'm hungry or I'm feeling sick).

A woman I know in private, working in the psychiatry once told me that every patient being for a long time in the psychiatry probably gets sooner or later at least once a borderline PD suspicion. I personally find that a bit bizarre.

I also asked her, why do many young teenage girls are diagnosed with BPD and that I don't quite believe it that it's that common. She just answered: "well, what else should we diagnose someone who is young and female?"

In my country the health insurances usually just pays for DBT if you are diagnosed with BPD, because this therapy got especially invented for ppl with BPD. So if a psychiatrist knows that DBT helps the patient and that the patient maybe just has some borderline tendencies, he/she will still diagnose BPD in many cases, because there is no other way to get the patient into DBT. A friend of mine went into DBT and after several weeks they noticed that he is not BPD, so they kicked him out, but of course he was mad about it, because this therapy actually helped him.

Well, they said they were going to do some sort of individualized DBT on me, because I have bad emotional regulation problems. The funny thing is that I'm trying to teach this stuff to my husband who has "borderline traits" (personality disorder NOS) and my husband thinks he's diagnosed with multiple personalities and I don't correct him because that's funny.