The Complex Relationship Between ADHD, Autism, and Personality Disorders

https://www.traudhd.com/p/autism-adhd-personality-disorders-narcissism

by rendx • 2 years ago

78 59 2 years ago

mjburgess3• 2 years ago

My own pet theory of the relevant personality disorders is this: Narcissism and Boderline are extremes on the same scale, namely, how you manage your identity.

BPDs are "extreme followers" which seek whole systems of validation, identity and meaning from their local social environment. NPDs are "extreme leaders" which cannot receive this validation socially, so push-out a delusional theory of their own identity (, role, value system, etc.). -- Which is why, so often, the structure of a cult is one NPD leader and a coterie of BPD followers.

If this scale exists, ie., from follower-to-leader... then many conditions can influence your position on it. A "healthy" person is presumably one who, I'd say, is mostly a mild follower but will adopt a mild leader position when required (eg., by role).

In ASD, my guess is that since some social mirror / double-empathy /etc. is different/impair, you get NPD-like problems because you're not getting that social validation feedback signal, so you're having to push out some validation/identity/etc. system of your own.

Likewise in ADHD, you tend to find a lot of social rejection due to impulsive behaviours that alienate people.. so you get a comorbid BPD-ish quality where you're aware of the social validation available, but are constantly fighting your own impulsive undermining of receiving it.

One diagnostic difference between the ASD-ADHD vs. NPD-BDP categorisation should be the possibility of self-awareness, where in the former you'd expect improving self-awareness to have some immediate benefits -- but in the later, often none. Since position on the leader-follower line in ASD/ADHD is effectively an "ecological concequence" of repeated accidental behaviours, whereas in NPD/BPD its something stranger and I think less well understood. One imagines, most probably, very early infant trauma that has severely impaired psycho-social development.

whatnotests2• 2 years ago

Thank you for making such a well thought out comment. Describing ASD/ADHD and NPD/BPD as extremes on different axes, and relating that extremity to facets of their behavior, especially with regard to cults, is brilliant.

tailspin20192• 2 years ago

My own pet theory

As pet theories go - this seems like a pretty good one!

Very interesting.

Which is why, so often, the structure of a cult is one NPD leader and a coterie of BPD followers.

I've definitely observed this in a business setting and can think of some well-known (tech company) examples too.

stavros2• 2 years ago

Likewise in ADHD, you tend to find a lot of social rejection due to impulsive behaviours that alienate people.. so you get a comorbid BPD-ish quality where you're aware of the social validation available, but are constantly fighting your own impulsive undermining of receiving it.

ADHD (or maybe autism?) isn't about social rejection, it's about the opposite. Sometimes people will try to reject you/put you down ("haha, you wear glasses, four-eyes"), but you don't understand the intention ("yes, this is accurate") and are just puzzled that someone would say a fact out of the blue.

Correspondingly, you might mention a fact "these jeans make your ass look fat" without meaning any judgement, and the person will take it as a rejection. That's why this is hard to navigate, not because people reject you initially.

jdub• 2 years ago

You're thinking of a stereotype of autism.

ADHD frequently involves Rejection Sensitivity Dysmorphia, which makes someone more attuned to, while also more likely to misconstrue, social signals.

liminvorous• 2 years ago

I've heard from a clinical psychologist and also from a bunch of people on the internet that the symptoms of BDP are often presented by (especially female) traumatized autists, and they run a high risk of being misdiagnosed with BDP. and based on the diagnosed (entirely AFAB) autistic people I know socially none of them show any signs of being unaware of or unmotivated by social validation.

Also there is a high overlap between autism and ADHD, many people have both characterizing them as opposite ends of a spectrum sounds like a stretch.

bluefirebrand2• 2 years ago

Also there is a high overlap between autism and ADHD, many people have both characterizing them as opposite ends of a spectrum sounds like a stretch.

I think it's only a stretch if you think that someone only exists at a single point on that spectrum. If it's more like a spectrum of characteristics, then wouldn't it seem like strong autistic characteristics could exist at one end, strong adhd characteristics could exist at the other, and a lot of the shared overlapping characteristics exist in the middle?

mjburgess3• 2 years ago

The most common BPD misdiagnosis is with CPTSD, especially in girls.

Tbh, "BPD" as far as young women goes is so often essentially misogyny on the part of the diagnostician.

That said, I've not heard of the traumatised autistic angle -- this would be consistent with CPTSD, since that's the co-morbidity you would diagnose.

thelittleone• 2 years ago

A family relation I know exhibita both BPD and NPD. If your description is correct, that theyre opposite extremes on the same scale, I can only imagine the internal mental and emotional chaos.

AbstractH243• 2 years ago

My own pet theory of the relevant personality disorders is this: Narcissism and Boderline are extremes on the same scale, namely, how you manage your identity.

A therapist once told me that depression is overthinking the past while anxiety is overthinking the future.

Was an interesting way to think of how they are two sides of the same coin.

nusl• 2 years ago

TIL about the term "AuDHD." I have both, but the term itself seems kinda strange. I get that it's common, though is there a need for that term or rather a convenience/"pop" term?

hombre_fatal• 2 years ago

Needs to be short enough to fit in a social media bio.

hungie5• 2 years ago

Communities are going to make language. It's what communities do. Gamers used to say Shazbot. Did we need another exclamation? No, did we adopt a new one and use it for awhile? You bet we did.

AuDHD is a neologism that some communities use. It might stick around, it might go away. We'll know if we needed the new term if it continues to be useful to people.

swayvil3• 2 years ago

Somebody seems to be killing your replies.

bluefirebrand2• 2 years ago

I think there's kind of an issue with society when we start viewing people with shared neurodivergences as a "community"

I'm diagnosed ADHD. I'm not a part of any "ADHD community". I'm not shy about sharing that I am, but it's also not some kind of "out and proud" thing for me. It's just a part of who I am, and it's a diagnosis of why I struggle with some things that other people don't

That's all it should be. Not everything needs to be a community.

I would go even further and say that many things shouldn't be a community, especially an online community . People need to build connections with their physical neighbors more than they need a community of fellow autistic or adhd people online

sph4• 2 years ago

I dislike the term because it is, in fact, not that common.

I am diagnosed ADHD but I don't have any symptom of autism (sensory overload, difficulty reading social cues, gender dysphoria, repetitive behaviour etc.) and I wish they were studied separately as the physiology, pharmacology and the effect on quality of life is completely different between ADHD and autism.

Without mentioning the effect on focus and executive function, which is basically all ADHD is, and presents the complete opposite in autism: repetitive behaviour and long-lasting focus in niche interests vs squirrel brain with flashes of hyperfocus.

If they seem comorbid on social media profiles, it might be because everybody and their dog seems to have ADHD today, so is pretty much meaningless. You could attach it to any personality disorder you wish.

nobodywasishere• 2 years ago

Your understanding of ADHD is very limited and doesn't reflect the true scope of what ADHD entails.

Also, a lot more people being diagnosed with ADHD (who were previously masking and "blending in" while secretly suffering) doesn't make the word meaningless.

ozzcer• 2 years ago

I mean neither are particularly well defined or well understood diagnosises. Just identify with whatever helps you get through the day we're all in this together. I've been diagnosed with quite severe ADHD but the psychologist admitted I was displaying several autism symptoms as well so really it could be either but the fastest route to treatment here in the UK is ADHD (still shockingly slow). Seeing as the symptoms and treatments overlap and our medical systems are generally poorly equipped to deal with either I think fussing the line is a bit of a waste of time. Also not that many people are diagnosed or identify as ADHD, most people are neurotypical hence the typical bit, if you feel like ADHD is everywhere you need to get out of whatever echo chamber has been designed to make you angry about it. More love.

ddmf• 2 years ago

I'm diagnosed with both and I like using the term. I find it much more palatable than "neurospicy"

adadsh• 2 years ago

Posted because of the Tim Peters controversy? We can cut that one short: The narcissists and dark triad personalities are in the Steering Council.

CoastalCoder2• 2 years ago

After hearing about psychology's reproducibility crises, I have no idea how much stock to put in articles like this.

swayvil3• 2 years ago

We could always take a firsthand look.

Does anybody do that anymore or are we all ok with this consensual dream?

CoastalCoder2• 2 years ago

Could you clarify? I'm afraid I don't understand either of your statements.

RandomThoughts32• 2 years ago

There was a very interesting article in the New Yorker about the issue with the DSM. Turns out we now have research which shows that people get very attached to the little box they are put in by the DSM and that influences how their symptoms evolve. [0] Meanwhile, evidence seems to point out that "disorders" exist on mostly continuous scales with multifaceted issues and the relevance of having boxes is far from obvious.

[0] https://www.newyorker.com/magazine/2024/05/13/why-were-turni...

tailspin20192• 2 years ago

Turns out we now have research which shows that people get very attached to the little box they are put in by the DSM and that influences how their symptoms evolve.

After being diagnosed with something in the DSM - I experienced this myself, and have been very aware of the Heisenbergian side effects of labelling and observing something like this in a specific concrete way.

Common wisdom with some psychological diagnoses is that the symptoms often seem to get worse after diagnosis because you start to notice the problems more. But I think there is an "identity" element to this too as you elude to.

I think this is somewhat inevitable, but the question is, even though you may be subconsciously influenced by the diagnosis itself - is it still better to have such a diagnosis and to be able to work with that information - versus not?

From my own experience, I'm not quite sure - but I'd probably lean towards having the diagnosis still being the better option.

GuB-42• 2 years ago

This is a trend I noticed lately. Being autistic is trendy for instance, people talk about it on social (!) networks, about their lives and all that, which is, if you believe what they are saying, is pretty much normal, save for a few personality quirks, like, well, most humans.

I may be wrong but the "little boxes" in the DSM are not supposed to be an identity. They are supposed to represent a pathology, essentially, if one of the boxes is checked, then you need help. Which box is an indication of what kind of help is the most appropriate: a drug? which one? counselling? hospitalization?

It may be a continuous scale, like most diseases really, but how much help you need has to be quantified in order to take action. That's what the "little boxes" are for, or at least, that's how I see it.

plsbenice34• 2 years ago

Being put in the convenient box is commonly the difference between getting social security payments or being thrown to the wolves. Of course people are attached to the little box when it determines much of your life.

keepamovin• 2 years ago

Don't forget about psi abilities. They're well established, and interestingly, people labelled autists (or possible mislabeled) often have some overlap in capacity with those with psi-enhanced skills.

For an overview of this idea and research into it, see the "New Thinking Allowed" video: Psychic Abilities of Autistic Savants with Diane Hennacy Powell[1]

[1] https://www.youtube.com/watch?v=MIYk0ZGcVnE

baseballdork• 2 years ago

I think "well established" is greatly overstating things. It seems to fall far below "established" at all.

conjectures• 2 years ago

The paper this blog cites w.r.t. adhd has this in its results section:

Conversely, we found a low prevalence of Narcissistic (5.7%) and Histrionic (5.7%) traits, and no patient showed Borderline personality traits or disorder.

Which directly contradicts across the argument advanced in the blog. Now the source paper itself has low sample size too, but it's pointing in the other direction.

While on ASD the blog says:

In fact, the chance of developing a personality disorder is more than three times higher1 for people with autism spectrum condition.

The cited ASD related paper says:

Finally, although we investigated many psychiatric disorders, we did not examine all. For example, schizophrenia, bipolar disorder, and personality disorders were not taken into consideration.

So it's uh, unclear, how the bloggers squeezed blood from that stone. It rather looks like they wrote some stuff and then found a couple of related looking links to science it up a bit.

s0kr8s2• 2 years ago

On an international level, there is a grand plan to ditch old Freudian categories like narcisissm, borderline, etc. in the upcoming ICD11.

There was never much evidence for such diagnostic categories, and I was told that if you look at notes from old proceedings of the DSM-III committee that their inclusion was an artifact of the political need to get buy-in from the then-powerful psychoanalytic groups at the time.

The ICD11 plan to have a single personality disorder bucket makes more sense to me. At its core, a personality disorder consists of a heavily reinforced and entrenched cluster of behavior that is significantly self-defeating and that actively resists common intervention strategies. From that perspective, you could either have endless personality disorder categories or a single category that summarizes the phenomenon.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9881116/

rendx2• 2 years ago

ICD11 is final and released (though not "adopted" in most countries yet?), so the restructuring is not a "plan" any more.

s0kr8s2• 2 years ago

The restructuring is not complete, though: a concession was granted to allow borderline personality disorder to remain for the time being due to industry concerns related to reimbursement, but the plan remains to ditch it eventually.

bbminner• 2 years ago

For those less familiar with npd/bpd - at the core of both (and codependency to a certain extent) lies inability to self-regulate emotions (especially difficult emotions like shame), that makes people with these PDs use those around them as "human pacifiers" that must regulate them in some way. In case of NPD by establishing superiority of the narcissist, in case of BPD via a fantasy of the other being a "perfect rescuer/knight in shining armour" who will save them from their own internal shame-based turmoil (and via seeing oneself as this knight/martyr saving a lost soul in case of codependency) . When a real human (obviously, eventually) fails to live up to the fantasy, they become "the issue" and are used to push the blame for unregulated feelings and behaviors (caused by shame that goes out of control without external soothing), until a new "fantasy person" is found, repeating the cycle.

Honestly, that's where I would draw the line between these two PDs and other conditions like ahdh and asd - is the behavior motivated by the frantic attempts to escape shame and shift blame?

Some anecdotally observed pattern suggests that many codependants in relationship with BPDs are either diagnosed with ADHD/ASD or suspect that they might have it, not sure what the causal link is.

airbreather• 2 years ago

I am autistic and this describes exactly my experience with my ex-wife - extreme emotional dis-regulation, extreme avoidance of shame by any means, doubling down in increasingly bizarre excuses if called out and I was the best thing ever happened to her, until I wasn't maybe 8 years in.

Thing was, it wasn't all bad by any means, and I had come to accept her for who she was, but she couldn't.

In the end she decided to placate her internal ghosts and demons and bailed, rather than consider the real life people standing in front of her.

I wasn't the first, or even the second, in her life to experience this cycle.

I had made the mistake of thinking I would be different.

motohagiography• 2 years ago

Personally, I have had an experience with an ex-partner who was diagnosed with autism but showed clear traits of narcissistic personality disorder.

so shocked. I'd reject the whole thing on principle. while autism and other neurological problems are real, personality disorders seem largely cultural.

usually, a psychopath is someone you got into a power struggle with, a sociopath is someone who doesn't share your values, and a narcissist is someone you felt insulted by. They didn't merely steal or cheat, but were surely afflicted by a mania, they don't have beliefs or experiences, but are in fact expressing a phobia, and they were not exercising agency, but responding to a trauma. to me the whole framework is intended to externalize your locus of control and it has the uncanniness of predation.

further, what people call "empathy," is a self-justifying shim for viewing people as subjects of external forces, of which your impact on them is just an indifferent and neutral one of many, which absolves either of you of moral agency.

I often object to the language of psychotherapy because it's the artifact of an inferior ontology- what you are left with when you don't have (or are deprived of) a sense of faith. these psychological tropes don't appear in alternatives like compassion, dignity, charity, faith, fraternity, which are ideas from better moral systems than psychotherapy. maybe instead of medicalizing and pathologizing our ex-es for political ends there is an opportunity for a more spiritual reflection.

there is value in therapy, and i see how it helps, but just as all medicine and care is predicated on consent, you can't ethically apply psychotheraputic criticism to someone you hate. we should challenge this stuff when we see it because it becomes a pernicious justification for darker things.

The Complex Relationship Between ADHD, Autism, and Personality Disorders

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