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

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_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.

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?

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