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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: DIFFERENCES|COMORBIDITY: Borderline PD and Aspergers/autism spectrum disorder  (Read 49408 times)
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« on: February 12, 2006, 06:03:56 AM »

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.
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ddz
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« Reply #1 on: February 21, 2006, 12:41:10 PM »

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. 

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ian
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« Reply #2 on: September 14, 2007, 03:45:32 PM »

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.
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« Reply #3 on: September 18, 2007, 07:35:53 PM »

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.   smiley  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.   smiley

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)
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nevergiveup
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« Reply #4 on: September 19, 2007, 12:44:17 PM »

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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rockwood
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« Reply #5 on: January 19, 2008, 02:04:38 AM »

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.
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m_in_pain
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« Reply #6 on: January 19, 2008, 01:42:50 PM »

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.  wink)

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.
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lasagna
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« Reply #7 on: January 19, 2008, 04:00:33 PM »

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.     
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m_in_pain
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« Reply #8 on: January 19, 2008, 07:24:00 PM »

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.
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« Reply #9 on: January 19, 2008, 08:43:36 PM »

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.
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