DIFFERENCES|COMORBIDITY: Borderline PD and Aspergers/autism spectrum disorder

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[_cbj]

I've read quite a lot about BPD and Asperger's (autism spectrum disorder).  

Each come in many flavours, of course.  It seems to me that a kind of low-functioning borderline-type BPD can be functionally identical to a kind of Asperger's (including the 'superficially charming' bit - aspies can act superbly well for a short time)  

If any difference remains, it's that Asperger's happens closer to the metal. Whereas BPD is a defense; input has to be processed before giving the same result.  Brain scans would readily tell them apart.

I was diagnosed Asperger's ten years ago but after an intensely weird relationship with an undiagnosed BPD / bipolar girl (high-functioning impulsive-type) and reading 'Lost in The Mirror' I realized with a jolt that my subjective PoV is pure bpd.  On the other hand, I have the physical symptoms of Asperger's: pale, smooth skin and geeky awkwardness.

Apart from those, everything -- I mean every tiny detail (although PLEASE try to prove me wrong) -- can explained by either condition, although the mechanisms are totally different.  It's truly fascinating.  I'm probably both, I guess.  By the way, given the choice, I would pick BPD.  It's fixable, albeit painfully.  And I've spent ten years drifting, believing myself hopeless.  Plus bpds have a better chance getting girls.  I'm not being flippant.  Sex is a really big thing, mental health-wise.

I have an appointment with a psychiatrist to get rediagnosed.  He doesn't know what's in store for him.  It could be difficult persuading him that it's an interesting subject.  The brain scans are probably out due to cost, so I hope to devise some simple tricks to distinguish between the loci of the abnormality (i.e., the cortex versus the amygdala.  Or wherever.  I'm no neuroscientist, and the questions are unanswered precisely in any case).  I have no idea what this might entail, but I recall reading about a simple test that betrays Asperger's where you ask the patient to guess the colour of playing cards, and if their guesses form a regular pattern it's a big clue.  Also I recall the brilliant 'bicycle gearing' discussion in Philip K. Dick's "A Scanner Darkly" that illuminated the difference between cognitive and perceptual deterioration.  Both of which may be irrelevant here except for inspiration.   All I know is that once higher level brain functions are involved, as in bpd, you can trick them.

[ddz]

The difference is in the self-view, as I understand from the literature (and to a lesser extent, from my perceptions) has to do with the reasons behind the behavior. It seems to me that the autism comes from an area of innocence, that is, the person with that condition has no desire, and no need, to control or hurt anyone else; he just wants to do what he wants to do, and any hurt inflicted is irrelevant.  By contrast, it seems to me that BPs are coming from a place of hurt and defensiveness, and that hurt of their own may cause them to hurt others; they may not do it with full awareness of what they are doing (and may rationalize it), but they nonetheless do it intentionally.

As for which is preferable (if such a choice were possible and had to be made), while it may be true as someone said that BP is theoretically fixable, I think that person is in quite a bit of pain, and we all know -- from experience and from the literature -- that such "fixing" is rare.

As for the asperger/autism, it is probably never truly "fixable"  (if you read the literature the constantly made conclusion is that anyone who appears to get better was simply misdiagnosed) it can be ameliorated with PT, OT, speech therapy and some or any of the various autism programs out there.  Be relentless in pursuing your options, don't take a simple no for an answer -- a lot of times schools will try to avoid the costly provision of services, and need to be reminded of their obligations -- sometimes nagged a bit (or a lot).

As for the internal feelings of Autism/asperger's and BPs, it seems to me that while the "higher-functioning" people on the a/a spectrum may be uncomfortable sometimes with who they are, they are not coming from the same place of pain as the BPs.  If you want to read an encouraging book, read any of those by Temple Grandin, an asperger's woman who is a professor at Northern Colorado University, focusing on animal care.  Your son is fortunate to have a mother who is dedicated to helping him get better; that said, be very careful -- this is a realm filled with charlatans who prey on desperate parents.

And one more thing to keep in mind:  autism/asperger and BP also have in common that they are more a collection of behaviors than a specific condition -- it may be possible that the earlier diagnoses were correct and your son is not in the a/a spectrum.  In any event, in my experience, an autistic son raised with love will be an essentially happy person, with hope for the future, and will give back joy and love.  That's my view, anyway. 

[ian]

My Dad was married to a pretty extreme pwBPD. At first he thought it was Asperger's.

I have actually known somebody with Asperger's -  that guy was about as un BPD as you can possibly be.

The differences:

1. Apserger's and autistic people don't get or misunderstand social cues.  pwBPD are hyper aware of cues but don't understand communication because they twist intent to suite what they are feeling, usually in a negative or self-inflicting way.

2. Asperger's people may not understand societal norms or why people do things, whereas BPs understand and exploit the dynamics but lack the empathy

3. Because of differences in social awareness pwBPD are much more able to appear outwardly normal or charming, have fairly complex interpersonal interactions (provided no intimacy). They also very capable of cunning and manipulation. In comparison, people with Autism spectrum disorders just seem to be clueless or not in touch with social realities.

4.Asperger's also is much different in terms emotional responses and self harm. They tend to not be all that self-destructive, impulsive or dysphoric from what I understand. Asperger's is not consider to be a shame-based disorder.

It is possible that both might be hypersensitive to their environment but Asperger's is like noticing too many random details, whereas BPD is noticing and overreading or even distorting subtle social and emotional details.

I think they are VERY different.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Skip]

Aspergers is one of five Autism Spectrum Disorders (ASD).  Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). The term "spectrum" refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have. Some children are mildly impaired by their symptoms, but others are severely disabled.  The five Autism Spectrum Disorders are Autistic disorder (classic autism), Asperger's disorder (Asperger syndrome),Pervasive developmental disorder not otherwise specified (PDD-NOS), Rett's disorder (Rett syndrome), and Childhood disintegrative disorder (CDD).

ASD are regarded by some experts as an inborn personality disorder sand most adults with ASD are probably clinically perceived as having a personality disorder.

In a small study (84 ASD patients), Rydén and Bejerot demostrated this.  Many of their Autism Spectrum Disorder patients displayed symptoms of other mental disorders.  They speculate that, in practice, psychiatrists diagnose/misdiagnose these patients as having a psychotic disorder, an obsessive compulsive disorder, a personality disorder or a pervasive developmental disorder and the treatment will vary as a result.

Comorbid with ASD------- Bipolar disorder Major depressive disorder Psychosis Social phobia ObsessiveCompulsive Panic disorder Gen Anxiety Disorder PTSD Bulimia Anorexia Borderline PD More info

------- 4% 49% 9% 17% 23% 9% 6% 2% 0% 13% 14%

When asking differential questions about multiple personality disorders, it is important to understand why you are asking the question and how you intend to use the information. Without this perspective and focus, the data may be overwhelming, confusing and misleading.  For example...

~ if your child is not responding to therapy, it makes sense to look more carefully into the possibility that the wrong illness was diagnosed or whether there are comorbid (multiple) personality disorders at play. Bipolar and Major Depressive Disorder, for example, are far more responsive to pharmaceutical therapy than Borderline Personality or Aspergers Syndrome.

~ If you are trying to get along better with your wife, it's not as important to precisely analyze the comorbidity as it is to recognize and fully understand the problem behaviors and how to constructively deal with them.  

~ If you are recovering from a failed relationship, the important thing is often to understand which behaviors were pathologic/developmental (mental illness) and which were just the normal run of the mill problems common to failing/failed relationships - there is often a bias to assign too much to the "pathology" and not enough to common relationship problems, or the issues we created by our own behaviors.

It's important to know that the distinctions are not all that neat and tidy. In a 2008 study, comorbidity of BPD with another personality disorder was very high at 74% (77% for men, 72% for women).  In the study, the comorbidity of BPD with mood disorders was also very high at 75% as was anxiety disorders at 74%. This is one reason why there is controversy around the DSM classifications of Personality Disorders - there is so much overlap it is confusing even to professionals - personality disorders are real, but they are not easily or neatly defined.
More info

Some helpful hints for sorting through this.

• General and Specific There are definitions for "personality disorder" as a category and then there are definitions for the subcategories (i.e., borderline, narcissistic, antisocial, etc.).  Start with the broader definition first.  Keep in mind that to be a personality disorder, symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder - - the history of symptoms can be traced back to adolescence or at least early adulthood - - the symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. Symptoms are seen in at least two of the following areas: thoughts (ways of looking at the world, thinking about self or others, and interacting), emotions (appropriateness, intensity, and range of emotional functioning), interpersonal functioning (relationships and interpersonal skills), or impulse control

• Spectrum Disorders  An extremely important aspect of understanding mental disorders is understanding that there is a spectrum of severity. A spectrum is comprised of relatively "severe" mental disorders as well as relatively "mild and nonclinical deficits".  Some people with BPD traits cannot work, are hospitalized or incarcerated, and even kill themselves.  On the other hand, some fall below the threshold for clinical diagnosis and are simply very immature and self centered and difficult in intimate relationships.

• Comorbidity Borderline patients often present for evaluation or treatment with one or more comorbid axis I disorders (e.g.,depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa). It is not unusual for symptoms of these other disorders to mask the underlying borderline psychopathology, impeding accurate diagnosis and making treatment planning difficult. In some cases, it isn’t until treatment for other disorders fails that BPD is diagnosed.  Complicating this, additional axis I disorders may also develop over time.  Because of the frequency with which these clinically difficult situations occur, a substantial amount of research concerning the axis I comorbidity of borderline personality disorder has been conducted. A lot is based on small sample sizes so the numbers vary.  Be careful to look at the sample in any study -- comorbidity rates can differ significantly depending on whether the study population is treatment seeking individuals or random individuals in the community.  Also be aware that comorbidity rates  are generally lower in less severe cases of borderline personality disorder.

• Multi-axial Diagnosis  In the DSM-IV-TR system, technically, an individual should be diagnosed on all five different domains, or "axes." The clinician looks across a large number of afflictions and tries to find the best fit.  Using a single axis approach, which we often do as laymen, can be misleading -- looking at 1 or 2 metal illness and saying "that's it" -- if you look at 20 of these things, you may find yourself saying "thats it" a lot.     A note in the DSM-IV-TR states that appropriate use of the diagnostic criteria is said to require extensive clinical training, and its contents “cannot simply be applied in a cookbook fashion”.

• Don't become an Amateur Psychologist or Neurosurgeon  While awareness is a very good thing, if one suspects a mental disorder in the family it is best to see a mental health professional for an informed opinion and for some direction - even more so if you are emotionally distressed yourself and not at the top of your game. 

I hope this helps keep it in perspective.  

Skippy


DIFFERENCES|COMORBIDITY: Overview of Comorbidity

Additional discussions...

Personality Disorders
Borderline and Paranoid Personality Disorder
Borderline and Schzoid/Schizotypal Personality Disorder
Borderline and Antisocial Personality Disorder
Borderline and Histrionic Personality Disorder
Borderline and Narcissistic Personality Disorder
Borderline and Avoidant Personality Disorder
Borderline and Dependent Personality Disorder
Borderline and Obsessive Compulsive Personality Disorder
Borderline and Depressive Personality Disorder
Borderline and Passive Aggressive Personality Disorder
Borderline and Sadistic Personality Disorder
Borderline and Self Defeating Personality Disorder

Other
Borderline PD and Alcohol Dependence
Borderline PD and Aspergers
Borderline PD and Attention Deficit Hyperactivity Disorder
Borderline PD and BiPolar Disorder
Borderline PD and Dissociative Identity Disorder
Borderline PD and P.T.S.D.
Borderline PD and Reactive Attachment Disorder (RAD)

[nevergiveup]

I know some kids with aspergers. I see the similarities, but my take on it is people with aspergers don't understand even the basics of emotions and as such they would never be able to manipulate another's emotions the way a BP can?

[rockwood]

My 16 year old has Asperger's.  My husband of 22 months is BPD.  My son would NEVER speak to anyone the way my husband does.  My son is extremely logical when he argues (I never "win").  My husband typically makes no sense.  I'm afraid of what my husband may say because he hurts me with lies and accusations.  The only thing my son will ever hurt me with is the TRUTH! My son keeps me on my toes!

(By the way, Asperger's is a form of autism.  It is not a personality disorder.)

Living with both in such close proximity makes it clear that there is little similarity.

One thing I've wondered about is the gender difference.  Roughly 2/3 of borderlines are supposed to be female.  Roughly 2/3 of Aspies are supposed to be male.

[m_in_pain]

I'm "on the spectrum," meaning Aspergers.  "High functioning" in some ways, but that's another story.  I'm not a spokesperson for everyone with the diagnosis, and hate to risk appearing to pose as such by jumping in here. 

Ian's description seemed right-on to me.  I'd like to comment on his points, in the order he used.  (Yep, that's mechanical, but humor me, sometimes that just works.  )

1. Asperger's and autistic people don't get or misunderstand social cues

We can often learn.  I'm incredibly motivated to learn.  Yes, it's a bit like color-by-number.  My system of working out social cues seems frighteningly analytical and dry - almost robotic - to people with whom I've dared to share parts of it.  But it doesn't mean I don't care about people or their feelings.  I'd argue that the amount of work I put into it is evidence I might just care _more_ than do normal-os who seem to have the social cues in their blood.  And at times my system picks up on things that normal-os have missed.


2. Asperger's people may not understand societal norms or why people do things, whereas BPs understand and exploit the dynamics but lack the empathy

My take (gross generalization here, and my 'study sample is in no way scientifically valid) is that we Aspies are much more open about not understanding.  I personally have no qualms in asking until I understand, or in challenging someone's assertion that things "just have to" be done a certain way until I understand why.  This makes me sound really anti-social.  I've found that many people react even more strongly to my lack of embarrassment about not understanding these things than they do to my not understanding them.   As I understand it, BPDs are generally very sensitive to anything they'd construe as criticism or rejection. 

A completely non-scientific hypothesis: maybe the part of BPDs that processes approval/criticism/rejection is super-active, and in Aspies it's dormant.  Sure, nobody likes criticism.  Yes, I get hurt feelings.  For me, feeling hurt by criticism is accompanied by huge frustration with myself for having failed to synthesize cues.  At the same time, I generally experience - separate from the hurt - a curiosity about the criticism.  What's happening at the meta level, does the criticism offer me a chance to improve in some way, etc.  (By now you're banging your head on a sharp object, begging someone to make me stop my analysis.)

When I voice the curiosity, I often get blamed for not "feeling" the criticism.  I just can't blend the reactions - it's like they're happening in separate parts of me.  Not dissociated, just like office work is going on in the office and plumbing is being done in the basement and chocolates are being made in the kitchen.  For me, it's all connected, but I don't want chocolate on the paperwork.


3. Because of differences in social awareness BPs are much more able to appear outwardly normal or charming, have fairly complex interpersonal interactions (provided no intimacy). They also very capable of cunning an manipulation. In comparison, people with Autism spectrum disorders just seem to be clueless or not in touch with social realities.

Oh, the work it's taken to appear (mostly) normal.  And doing that work _feels_ like manipulation.  NeverGiveUp's point struck me.  I don't like hurting people, and the idea of manipulation makes no sense to me.  One real resistance I've had over the years to doing the work and learning techniques for synthesizing 'normal' is that it feels like cheating.  Ask a BPD and a high-functioning Aspie who's done lots of work to integrate which one is manipulative, and they'll probably agree it's the Aspie.  I've developed an ability to figure out what people are likely to find humorous, and to get them to laugh.  Then I laugh, thinking it's hilarious that they're laughing.  I get it but I don't. 

4.Asperger's also is much different in terms emotional responses and self harm. They tend to not be all that self-destructive, impulsive or dysphoric from what I understand. Asperger's is not consider to be a shame-based disorder.

No big expansion to make here.  I'd say that when I do get upset, it's very much about frustration with myself.  And sometimes with normal-o's who just aren't playing fair, but I'm angry at the whole social thing rather than so much at them.  When a BPD flips out, it's scary.  Vengeful, venomous. 


I can't say I identify so much with AJ mahari's experiences.  Maybe having BPD changes the 'flavor' of Asperger's, no idea.  I'd be interested in hearing more about how exactly she got her Aspie-dx and whether it's been confirmed. 


Hmm, I'm guessing this wasn't especially relevant for the OP's question.  I can't offer much on overlapping BPD/Aspie - maybe it's another of the myriad things I just don't get.  I'm open to the idea that it's possible, but for now Rockwood's experience is exactly how I understand things.

M.

[lasagna]

The major difference, as I see it, is that AS people would love to learn how to connect better socially.  They are not happy living isolated lives. It's amazing how little they know socially compared with other kids. Like they take jokes literally.   I have worked with them and find them endearing usually. They do lack empathy. There are times that I have needed to step in and say something privately like "It looks like people are not interested in hearing about butterflies (dinosaurs, Walt disney cartoons, rock, whatever) anymore. Why dont you ask a question about Joey's new dog ?(or pool, or bike or whatever)". Reciprocal conversation is a skill that needs to be learned.  They honestly don't pick up on the social cues that people have lost interest in their topic of conversation.BUT THEY ARE AMENABLE TO CHANGE.    BPDs think that everyone else has the problem.  They don't see the need to make any changes. They can always find a new audience.

A major similarity is that their sensory input of social cues (facial expression, sound of voice) is altered.  The AS kids just don't see it till it's pointed out and learned (Storyboarding works well with these kids. Just learning simple social interaction repetitively).  BPDs tend to see social cues as negative and victimizing.  They leave little opportunity for learning new interpretations. Unless they are in therapy, with meds to calm down their emotions.     

[m_in_pain]

Until my early 20s, I thought that if people were offended by what I'd said, it was a litmus test and we wouldn't have had anything to talk about anyway.  Then I slowly recognized that I was hurting other people, albeit inadertently, which was definitely not what I wanted.  The option to be able to communicate on a wider range of wavelengths became important to me.  Around the time Asperger's became an offical diagnosis, I took a great job and almost immediately alienated my boss' boss, the company president.  My boss (who'd apparently recognized the Aspie thing when I interviewed) pushed me to talk to a doctor, who made the official diagnosis, which turned out to be so my boss could justify not firing me. 

Years later, I recognized how many opportunities I'd thrown out the window at that company by insisting that top work should be more than enough.  Cargo pants, hiking boots and baggy sweaters in a suit environment.  Cheerfully working weekends when needed but refusing to go to happy hours or events.  Stupidly thinking mismatches between press releases and my understanding of clinical trial results was something that could be explained, and asking too many questions.  I wince a bit, and I also fondly admire the dorky, optimistic kid I was.  Would I put her in the suits I've learned to wear? 

Most of my constant second-guessing myself has been around trying to get communication right in order to avoid hurting people.  It's really interesting that you point out the self-esteem thing.  All my life, various people have told me to work on my self esteem.  At some point I wondered whether I was missing signals and they were trying to tell me I _should_ have low self-esteem.  It didn't really seem to be a compliment.  Lately, I've been learning more about "adult child" issues, and can't identify when people talk about need for approval.  It's a strange twist, looking at having had NPD parents and an N husband. All of them were desperate for me to kiss up for their approval, and I just never ... that blows my mind.  All of them were fixated on appearance - which is the very last area in which I accepted the value of fitting in and figured out how to do it my way.  I must have frustrated all of them to no end.  Strange.

[LavaMeetsSea]

PEOPLE WITH ASPERGER'S DO NOT AUTOMATICALLY LACK EMPATHY. 

They've got problems with interpreting social cues up the wazoo, but that's not the same as not caring.  Do some of them, after years of being told they lack empathy, decide to give it up and say "Screw it, I'm not good at it anyway?"  Sure.  But the stereotype of individuals with autism or aspergers lacking empathy was perpetrated by Anna Freud way back in the early 1900's.  Know what else she said about autism?  That it was caused by cold or bad mothering.  Oopsy.  Turns out she was wrong.  Can you imagine the guilt and pain this admittedly well-intended and frequently brilliant woman caused countless mothers with that false statement?  I've seen some of it first-hand.  I've also worked with dozens of children with autism and Aspergers and not one of them, not one, lacked empathy.  Understanding?  You bet.  But empathy?  Oh the stories I could tell...

You see, the way our brains record and interpret facial expressions, languages, and other sensory input is just different.  We can see the differences in MRI's, but explaining them is still a work in progress.  When there are such basic differences with fairly simple abstract patterning (say ascribing an emotion to a face in a photograph - lights up a totally different part of the brain for individuals with an Autism Spectrum Disorder) then adding the complexity of human relationships, learning to read and write, to make friends, all of that is innately harder for anyone with a developmental disorder, but this one is particularly isolating.  Piaget's work on the developing moral judgement of children is relevant here.  Group pretend play can be overwhelmingly complex and disorienting for a child with aspergers or autism, and yet, without learning to extend one's own internal state or to "project" emotions on one's peers, and then shape that knowledge with feedback from the subject, how does any of us ever "empathize" with anyone else?  Is it "manipulative" to use knowledge of a person to act in ways that influence them?  What if that knowledge is as simple as a common language, and I'm asking someone to tell me the time?  That's not manipulative, m_in_pain, unless you're going by strict denotation.  Connotatively, though, if a person is reasonably aware of the terms of an exchange, then it's not seen as manipulation.  We tend to reserve that word for literal or emotional deceit and entrapment.  Just saying.

Kids with autism or aspergers need extra pretend play and social integration, sure.  All kids need it, they just need more.  But the irony is that many of them grow up feeling so lonely, that when they DO find someone that "gets" them, they are the most loyal, grateful, affectionate, soft-hearted cuddlers a behaviorist can work with.  "I want talk better please."  If they didn't care about people, why would they be so eager to work at connecting with them?  And they are.  They really are.

[lasagna]

LMS; Clearly,You have enormous fund of knowledge in this field.   So I would like to ask a question.   Don't AS kids need to learn empathy just like other social skills.  I have read this so many times and I need to know if my info is not current.     Like you, I adore AS kids and I see a bright future for them (with social coaching).   I always enjoyed working with them, and I adore my AS nephews.    But I honestly thought that they needed guidance and approval in the area of empathy.    When they do learn it, they are probably more empathic than the rest of us.  But I considered them a blank-slate in this area.  Of course, none of us are born with empathy. We learn by observation and experience.   But I thought AS kids needed more direct instruction.       For example, my AS nephew squeezed my hand so tightly that I said "OW" and he squeezed it more, thereby pushing a ring into my skin and making my skin bleed.   He is ten. his parents were humiliated, but did not address it with him. they never do.  they encourage any of his positive social behaviors, but they ignore the negative behaviors.     So my nephew is not in the best "corrective" environment.  Teachers are happy with him because he is bright and keeps to himself, even though sometimes he sucks his arm in class till it is bruised.

I asked a spec ed teacher about the handshake that hurt so much. she said that my nephew needs to learn empathy, just like anything else.  It sounds like the parents and the teachers need to learn more.  I feel bad for my nephew. he is not getting what he needs. 

[m_in_pain]

But I considered them a blank-slate in this area. 

Will be interested to read the professional opinions on here.  I don't see empathy itself as the blank slate.  But it's a big topic.

M.

[oceanheart]

People with BPD don't automatically lack empathy, either...

[oceanheart]

In the "heat of the moment" - whenever we're triggered by something (there is a lot to trigger us when we're not recovered) - I doubt whether there's any meaningful self-reflection: I and others have likened it to being an animal caught in a trap, that sheer panic and fear and doing anything to get out of the pain, e.g., chewing one's own paw off, biting the hand of the person trying to free you from the trap, etc.

If you are consumed by your own pain, you won't be aware of others' pain. Other peoples pain will not matter at all. But after an acute episode is over, I think there is enough realisation in most people with BPD that they have hurt the other person. I think, too, that they care they hurt this person. I think that they (we) hate themselves for hurting someone else. Then the shame spiral starts and in order to not emotionally implode with the intensity of the pain, some people with BPD resort to either denial or to attack to relieve themselves of the psychic burden (or they drink, or cut, or whatever.) There is awareness and remorse about hurting the other person, but it's too painful, so it's disappeared, like an informant who got caught by the mob...

What a f'd up way to exist, eh?

HG, is joho NPD? It's a different type of animal from BPD, it really is: BPD is like a bear; NPD is like a crocodile. I've known one person in my life who was undeniably NPD and he was scary. The disregard he had for his children was mind-boggling. He saw them as objects (and often as obstacles), he used them as pawns, and he wore them like cheap shoes. He treated them bad while thinking he was a good father. He abused them but was too cunning to leave proof or to do so in front of witnesses (turdturdturd____!). He was only nice to other people or did things for them for the self-aggrandizement of it - for how it made him look in the eyes of others. And he was convinced he was a paragon of virtue and an upstanding member of the community 

I don't say this often, because I'm pretty inclusive of most people, but I think there is a very, very small minority of people who don't merit our own empathy. I know our hearts should include all peoples, but I just can't include people who are... I don't use the word "evil" lightly, since I don't believe in it in a religious sense, but there are some people who truly are Old Yeller and need to be taken out back behind the barn and ... (oops, did I say that?). Ok, I don't really mean that, but it's tempting to think about.

Most people in the world deserve our empathy, since we're all together in this thing called life, and life is hard sometimes. But, a very small minority don't qualify. I know it's not my place to determine that or to judge, but I can't get around what the one NPD person I knew did to his kids. On purpose. Without remorse. With feelings of entitlement. If he was here right now, I'd spit in his face and take his kids and run.

So maybe, HG, joho is not capable of true (selfless) empathy. It's possible. And, if so, maybe she doesn't deserve yours?

Well, I've kinda hijacked the thread there, sorry. After I wrote this fairly vitriolic post, I can see how sometimes people with BPD DO lack empathy, heehee

[Up Out of It]

I have not been diagnosed with either BPD or AS but I seem to have mild symptoms of both at times so I think I can relate to either side.  While I agree that both AS and BPD's don't lack compassion but I believe that a part of these conditions makes it hard for both to have normal levels of empathy.

Empathy:  the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another.

Compassion:  a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.

In order to show compassion a person must have empathy.

The AS person has trouble "reading" other's emotions and therefore needs more "concrete" evidence to determine if they are hurting someone else.  Reading emotions can be learned over time and AS persons usually want to change.
The BPD has such internal emotional pain that they can be blinded by this pain to other's suffering.  This internal pain will cause twisted thinking which may prevent them from seeking change.

NPDs have reduced compassion and very little empathy, while ASPDs have neither compassion or empathy and sometimes enjoy hurting others.

[LavaMeetsSea]

Lasagna - 3 things come to mind with your nephew, but without knowing the situation, you'll have to fill in the details yourself when considering how potentially accurate they are.
1) Sensory processing issues, or "stimming".  A lot of kids with an Autism Spectrum Disorder have a VERY hard time feeling the dimensions of their own bodies in space, and will react strangely to things like immersion in water, twirling, fabric or cut of clothing, pressure on joints or top of the head, or back, hand squeezing or jaw-rubbing or what-have-you.  In particular, I used to do a lot of occupational therapy techniques on my kids that involved compressing bones going into the joints of wrists and fingers before learning fine motor skills, and many of the less verbal ones would encourage this (it DOES feel good) by grabbing me and "mirroring" it on me before they'd learned to say "Squeeze please".  It's possible your nephew needs some occupational therapy and has some sensory issues.  Same with language.  (It being easier to DO than to SAY for most kids with this disorder.)
2) To see what you'd do.  To get feedback.  To learn if a)it would hurt you b)it would anger you and c)if so, what you would do.  Testing.  Limits.  Power struggle.  Maybe a little anger, too.  Hard to say.
3) He could be modeling something that happened to himself.  Ten year-old boy with Asperger's being grabbed too hard by the wrist, and then having his reaction ignored?  That sort of thing NEVER happens.  The irony is he may have decided to do it to you because he considers you a decent example and/or he knew you weren't going to hurt him back, but ignoring it isn't a good solution for ANY of these three potential off-the-top-of-my-head motives.

Is he in a public school in a special education class in the US?  Without a behaviorist/integration/speech or occupational therapist?  If yes, then well no, I wouldn't count on either that kid or his teacher getting ANYTHING they need.  Also if that's all his parents were able to accomplish at the IEP, and they're "humiliated" by his disorder, then I wouldn't count on anything getting better.  This is generally the time when I'd be giving my kid's parents the phone numbers to their local CAN (Cure Autism Now)chapters and advising them to bring a lawyer with them to mediation.  Save your patience for the kid.  Use the frustration to get him some real services, cuz kiddo is getting yanked.

Just saying, if he'd been one of my clients, he would NOT still be in special ed, especially with a teacher who says he needs to "learn empathy" but doesn't actually teach around it.  Give me a break.  He doesn't even have autism and he's in special ed?  Have you ever spent a full day in your average special ed classroom?  I consider it a good one if the child doesn't regress after a week.  Man.

As for the rest...  bless you.  Great inclusion teachers are so precious.  Heck, great teachers of any kind are precious, but I've got a soft spot for the inclusion volunteers.  I bet your kids brag about being in your class at recess.  See now you're blushing, aren't you, because we've both seen that sort of thing happen.

We don't fully understand what is called antisocial personality, or is sometimes called reactive attachment disorder in children.  I don't know why some people feel glee at sadism.  I don't know what makes some children torture pets or even kill.

I just know it's not Aspergers or autism.

[oceanheart]

Sensory processing issues, or "stimming".  A lot of kids with an Autism Spectrum Disorder have a VERY hard time feeling the dimensions of their own bodies in space, and will react strangely to things like immersion in water, twirling, fabric or cut of clothing, pressure on joints or top of the head, or back, hand squeezing or jaw-rubbing or what-have-you.

Anecdotal evidence gleaned from my 2 years at Resouces for Individuals with BPD]BPDRecovery[/url] - I'm even less an expert than lava, since I don't have ANY credentials except an old BA in psych and the nerd-propensity, too - shows that many many many people with BPD have a possibly similar sensitivity, although with BPs it's more intensely sensory. One psychologist has even given it a name (of course): Highly Sensitive Person. And although HSP & BPD aren't the same (HSPs aren't necessarily pathological), there is a correlation: see the psychologist's comparison of the two. I neither support nor refute Dr. Aron's theories; I just know that I have incredibly physical sensitivity and always have: as a kid I'd have to cut the neck out of my shirts and couldn't stand long sleeves because they bothered my wrists. I can't stand anyone touching either my elbows, knees, or the back of my neck where the bone sticks out. I'm hypersensitive to light and to sound and have a strong startle reflex. I don't like certain foods because of their texture (eggs, for one).

In defining the Highly Sensitive Person, Dr. Aron provides examples of characteristic behaviors, and these are reflected in the questions she typically asks patients or interview subjects:

• Are you easily overwhelmed by such things as bright lights, strong smells, coarse fabrics, or sirens nearby?
• Do you get rattled when you have a lot to do in a short amount of time?
• Do you make a point of avoiding violent movies and TV shows?
• Do you need to withdraw during busy days, into bed or a darkened room or some other place where you can have privacy and relief from the situation?
• Do you make it a high priority to arrange your life to avoid upsetting or overwhelming situations?
• Do you notice or enjoy delicate or fine scents, tastes, sounds, or works of art?
• Do you have a rich and complex inner life?

• When you were a child, did your parents or teachers see you as sensitive or shy?

Of course, this could be related to ADD/ADHD somehow...[/list]

[A.J. Mahari]

I haven't really ever sought to combine these two realities or worlds if you will, the fact that I had and recovered from BPD and the fact that I have Asperger's Syndrome. However, since I stumbled onto this thread today and along with lots of interesting comments and questions saw in part some very troubling stereotypical stuff I now want to address this. It has been a topic that I have received a lot of email asking me to address.

I am troubled by many of the comparisons, not just here, but in general. It is not an easy subject to seek to understand the differences between BPD and Asperger's. However, I have come to some very deep understanding in my own experience about where BPD ended for me and where Asperger's remains.

I've seen a few who are not trying to forward that Asperger's Syndrome is really the diagnosis that needs to be made when one has BPD - in other words someone on line is trying to forward their own belief that BPD is a misdiagnosis of Asperger's. This troubles me greatly too. Of course we can all have our own opinions but I think this one highly irresponsible, frankly.

I have resisted going here for a number of years but now think I will write an ebook about this where I will lay out what I know from my own experience to be the vast differences between BPD and Asperger's.

I will say also though that I am fascinated on one level as to what it means for an over-all understanding that they can and do co-exist in many. I have to be clear in saying this, however, it is possible to recover from BPD - period. With Asperger's it isn't. But Asperger's isn't a mental illness. It is a very different thing. It is something with which I have found compensatory strategies that do help and do work.

I would just like to caution that it is not always helpful to try to figure these things out without professional knowledge and understanding or inside personal experience.

Stereotypes are everywhere and so I will make this point - Not everyone with BPD is the same and not everyone with Asperger's is the same. There are more male BPD's than most recognize. There are way more females with Asperger's than most recognize. There is a bias (stigma based?) in the diagnosis of each according to gender without doubt but I believe that this is the result of the limited application of the criteria necessary to diagnose each that shows up the stereotypical gender bias of those who diagnose.

There are so many females with Asperger's - and it does manifest, often, very differently in females than it does in males - who go through hell trying to get fair assessments and I know from personal experience just how much gender bias there is in those assessment tools/scales.

As I've worked my way through this question in my own life I guess it is time for me to finally write about. I don't claim to know it all or anything but I do have some strong beliefs and I do feel the need to counter what some put forth that BPD is actually Asperger's. BPD is a personality disorder and  Asperger's is a developmental "disability" on the autisitc spectrum. They are not one in the same. They are not even very similar even though things from the outside can certainly be experienced or subjectively thought to be similar.

Let me just also add on the subject of empathy. As with all other things that are general descriptors of BPD or of Asperger's Syndrome, it is so important to remember the individuality of each person with either BPD or Asperger's or those who may have both.

When I had BPD, though I had a deep capacity for empathy, it wasn't something I expressed often, outwardly. The punitive nature of BPD often holds borderlines back from showing any empathy they may well feel somewhere inside. Of course also, empathy is compromised to varying degrees in those with BPD due to splitting and other defense mechanisms.

In the group therapy process I was in when I recovered from BPD I learned a lot about just how much empathy I actually do have. More importantly, I learned how to express it. I also learned how choosing to be punitive or that type of thing compromised my ability, back then, to empathize.

When those with BPD are caught up in borderline maladaptive defense mechanisms often they end up being quite detached, aloof, uncaring, anything but empathic. This is not a total indicator of what they may feel at other times however. But the consistency can be lacking for sure.

I now also understand that my expression of empathy doesn't always make it across the divide between myself and those who do not have Asperger's.

As far as empathy and  Asperger's Syndrome goes, well, it's a thing that is used as an across the board descriptor or trait - "lack of empathy" when really, while that may be true in some, and I tread gently in venturing this observation but it is made from personal experience - my own and many males with AS that I know - it would seem (and of course there are individual differences to be taken into account among males with AS) that the manifestation or presentation of Asperger's, if you will, in many males, does impact their ability to empathize or feel or understand empathy moreso than is the case for females with Asperger's.

Again, I am a deeply empathic person but the expression of it in actual personal interaction can be challenging for me still re having Asperger's or I can be being empathic with someone and lack the facial expressions or even voice tone that is most associated with empathy.

My point here is that those of us who have Asperger's often do not lack empathy but our expression of it may often not quite match what the average expectations are of those who are Neuro-Typical - the AS world vernacular equivalent of the non borderline smiley  It's an example of where communication can go awry due to the nature of difference and not because something, empathy, in this case is lacking at all.

No worries right back to ya, A.J.

What you said about missing certain types of humor is really interesting. In the context of BPD, I know there were certain types of humor I didn't get, most especially teasing, since I'd usually get triggered because of the element of criticism (or what I believed to be criticism). I couldn't process that someone could tease you but still like you. does that make sense? I'm better now with it, tho sometimes it still triggers me, because it feels mean in some way, like I'm being picked on.

I think that makes a lot of sense. And it raises a very important difference between Asperger's and BPD as well. Most with Asperger's Syndrome don't "get" the context or realize a lot of attempts at humour, interpersonally, or in a "social context" which isn't the same as being triggered is for those with BPD. However, that said, some with Asperger's can react with anger or get very upset. I find myself I feel a little embarassed and then just say, "Oh okay" once I am told they are kidding and I can then begin to see the humour.

But your point about BPD and the polarized ways of thinking wherein one can't understand how one could be teased or even criticized and still be liked - the black-and-white thinking in that is a common borderline thing for sure.

I wish I could explain how otherwise intelligent people (Asperger's I mean here) don't "get" these things. It is something that I know people in my life have had to learn about me and have found hard to understand because it is very different from my intellectual understanding of things for example.

I'd also just like to add that a primary difference to keep in mind between BPD and Asperger's Syndrome is the cause of each. BPD, despite what many are saying about it being a "brain disorder" - which I don't agree with - likely has a mixture of causes if you will. I happen to think that the "nurture" - as in lack of it - argument is stronger than the "nature" argument. BPD, of course, is a personality disorder and therefore a form of mental illness. Whereas Asperger's Syndrome is what they call a Developmental Disability (most of us feel more blessed and gifted by strengths re the Asperger's than "disabled" however) which is in the brain's hard-wiring.

[kralya]

No, I don't think they are similar at all. If anything, I think persons with either disorder would clash

To me, BPD is closer to sociopathy and other related anti-social disorders. Not only that, most Bpd-sufferers can't stand being alone - how much more different could they get from Aspies! People with Bpd fear abandonment and emptiness, they are very insecure people who thrive on the positive feedback of others. They are more likely to bully, manipulate, distort and get into industries that involve self-exploitation (glamor modeling/stripping) or attention. Whereas those with aspergers are usually (not always) non-manipulative, are often manipulated or abused more so than others, direct about their intentions, prefer quiet scenarios, and struggle with mainstream social norms.

I'd agree that the one thing they have in common is the general alienation with life, the sense of inner isolation

[Upbeat Girl]

What happens to Asperger's kids when they grow up? Do they turn into BPD adults?

 I am a primary school teacher and have taught a number of students with Asperger's Syndrome. They are the children who show no empathy for others, prefer thier own company in social settings and often participate in parallel play.They are usually intelligent. They are often physically awkward or clumsy. They learn to relate to others by imitating what they do and say rather than having natural responses come from the 'heart'. A little Asperger's boy once told me that he didn't feel sad at his Grandmother's funeral but he made himself cry because he thought that's what his mum would want him to do. I see so many Asperger's traits in my ubpdh that it freaks me out.