Asperger's Syndrome vs. Borderline Personality Disorder

[Sophist]

Lights are good, I like to see what I'm doing.

[Charlie]

Hi abach, and welcome.

Personally I cannot tell if there is an ASD or not, yes there are a lot of similar traits but it is impossible to determine from here whether they are coping strategies to deal with autism or to deal with a combination of the BPD and her previous trauma.

A lot of the difficulties on the surface appear to stem from a feeling of being inadequate and a desire to be loved, with a fear that she may mess it up and it being her fault "again". This would explain just about all the rules you mentioned, and would tie in with the rape and other issues in the past.

Thus to make her feel safe and more secure she needs constant support and reassurance in everything she does. There are a lot of defensive mechanisms involved in her life, including taking everything literally, which may be autism related, but equally may be again a way to avoid feeling hurt - using words in there true sense are a "safe" way of behaving, and so avoiding being taken advantage of (not that it works like that unfortunately).


So yes, there are a lot of things in there that do suggest autism, but as I said I think it is hard to tell as there must be so many layers to her built up over the years. That said, regardless of what it is that causes it, it may still be worthwhile to be aware of various tools or coping strategies that autistic people use as they may be useful to her deal with the similar problems or issues.

I hope that I am not coming over as dismissive of you both, and I hope that you stick around here but I guess the crucial question is do you trust the therapist enough, and what is their knowledge of the autistic spectrum like - as it can be very sketchy, although it is generally improving. If you are really concerned then it may be worth speaking to another professional about their opinion and whether to push it further and see about a diagnosis with a psychologist.

[abach]

@Charlie,

Thanks a lot for this post. It makes sense.

I've found that she lacks the ability to understand other people in depth. She'll assume they act like she does, and be surprised or shocked when they do not. She rarely asks questions to probe others, like "why did you say that". This fits into a BPD model where she jumps to firm conclusions, often negative ones, and then acts on those, but in fact totally misunderstands. She can get upset because a child looks at her in a certain way. "That kid thinks I'm useless." She thinks of herself as hyper-empathic but I think that's projection. Whenever I ask, "OK, what am I feeling", she's confused and can't answer.

She told me today that she used to consider all men as liars, and would start a conversation with a guy knowing that every word he said was a lie. We also started like that but for some reason she trusted me.

I'm teaching her that most people, most of the time, think and say, "blah blah blah". Not lies, not truth, just random filler. She will (I hope) learn to not take people and what they say too seriously, and to explicitly learn how to understand other people when it does matter.

[abach]

Regarding her therapist, I'm not decided. He seems to be helping her but has not managed, for example, to get her to talk of her sex life, which she talked to me about almost from the start, and which seems a key indicator of many aspects of her mind.

In any case I'd not want to interfere with her therapy in any way, that's her business. What I will do is continue to document. If there is anything I can learn about ASD that will help her and us...

@anthonylee, some interesting points you made. She does not manipulate others, and is not empathic, as far as I can tell, but believes she is. I see others manipulating her, trivially. She blissfully ignores body language unless it's forced into her view. She maps out her day systematically, writing all her plans in a notebook, but mostly ends up skipping a lot of stuff (especially since I occupy too much of her time right now). That does not seem to stress her too much. She does accomplish quite a busy life, always moving, meeting people.

So if you say BPD and ASD are mutually exclusive, then perhaps I should to turn it around and try to eliminate ASD as a diagnosis. Any suggestions?

[anthonylee]

Regarding her therapist, I'm not decided. He seems to be helping her but has not managed, for example, to get her to talk of her sex life, which she talked to me about almost from the start, and which seems a key indicator of many aspects of her mind.

In any case I'd not want to interfere with her therapy in any way, that's her business. What I will do is continue to document. If there is anything I can learn about ASD that will help her and us...

@anthonylee, some interesting points you made. She does not manipulate others, and is not empathic, as far as I can tell, but believes she is. I see others manipulating her, trivially. She blissfully ignores body language unless it's forced into her view. She maps out her day systematically, writing all her plans in a notebook, but mostly ends up skipping a lot of stuff (especially since I occupy too much of her time right now). That does not seem to stress her too much. She does accomplish quite a busy life, always moving, meeting people.

So if you say BPD and ASD are mutually exclusive, then perhaps I should to turn it around and try to eliminate ASD as a diagnosis. Any suggestions?

PTSD is obvious from the abuse your girlfriend suffered. It is looking more like an ASD than BPD.
I think it is likely that her past abusers brainwashed her and this has had a profound effect on her life now. It seems like shame and trust issues are there as well. There could be other issues that are as of yet undiagnosed. I will post other ideas as I come up with them to help your girlfriend. I hope she can get enough of the right kind of help from some one she can trust! Who ever did this to her should be brought to justice!! I am convinced that, and don't see how BPD and ASDs can coexist in the same person due to thier vast differences!! I have read and studied a lot of material that supports this fact!!

[phin]

I've been gone for a long time - I thought I was doing better and enjoying communicating when I first wrote, but then I had some problems and went back into my shell. I'm more of a hermit crab, always changing shape and color when I can - but it remains a shell.
But what has me writing again to say once more that yes, I personally am convinced that there are enough variants of Borderline Personality Disorder so that it can happen to most anyone who suffers diffuse anxiety, low self esteem and is capable of feeling intensely, even if you cannot share these feelings easily with another.

Emotionally I've always felt that I feel things way too deeply (even if my Mother did claim that I was like a stick of wood) and I've just came across a study whose abstract I would like to share with you all ("...data show that while the AS group scored lower on the measures of cognitive empathy and theory of mind, they were no different from controls on one affective empathy scale of the IRI (empathic concern), and scored higher than controls on the other (personal distress)"). http://www.springerlink.com/content/j2k1732t42110565/

Depression and anxiety, low self esteem, trouble with narrative identity (identity diffusion) are core elements of both. And even if we suppose the bottom line of BPD is emotional dysregulation - what does that mean? It does not turn you into a Drama Queen if you have no previous inclination for hysterics, it does turn you into someone who is suffering intense ups and downs most often in reaction to socially charged encounters - i.e. social anxiety and there is not an Aspie alive that does not know what it means to suffer socially. So you as an Aspie could already be flipping out on a daily basis, totally unable to control the ups and downs, but perhaps thanks to your Aspie mask no one will know you are emotionally bleeding to death, one drop at a time. Until the fateful day arrives when there's massive interpersonal trauma re-traumatizing the massive interpersonal trauma that already hit that you when you were still a child.
Anxious as you were to begin with, your anxiety level is now going to soar off the Richter scale, confusion will reign, and you could be in for the longest "meltdown" of your life. (And most Aspies I imagine know about "meltdowns"). And most Aspie women when their emotion regulator gets stuck on meltdown, will be in such excruciating psychic pain, that they will be drowning in a sea of anguish. ( Anguish is an emotion - as emotive as they come.) Most of us flap our arms around (or some other quasi psychotic gesture) before resining ourselves to drowning; just that is enough "acting out" to get an Aspie women dx'd BPD. And she may be Aspie, but what the psy will see is that 1) she's a woman 2)there's trauma - probably gross sexual trauma 3) permanent freefloating anxiety 4) prone to states of dysphoric frustration or anger and then 5) then the idea of a HFA might cross his mind, but he'll remember again that she's a women, and hence will dx BPD and not Aspbergers.

What I found insulting in the BPD dx is the popular view of impulsivity and of people going to bizarre lengths so as not to be abandoned attached to it. Examples I've found seem alien and insulting to my nature. But abandonment redefined as what one suffers in silence with obsessive ruminations over the one you've lost for months or even years - well I can relate to that. Also this idea of manipulation is absurd - stemming form the fact that neither BPD's or Aspies know how or dare to come right out and ask for something. If those with BPD were truly successful manipulators no one would feel manipulated. The sad truth is that they are in a lot of pain and so desperate to find someone who can alleviate the pain that they reach out/strike out blindly. This provokes intense "counter-reactions" and hence they are accused of manipulating. And Aspies are even worse off here, not able to have much of a clue to distinguish true and fiction in daily dealings, or how to provoke much of anything, and so totally vulnerable to predators of one kind or another.

[Sophist]

I have been thinking that when one has a childhood in which abandonment (physical or emotional) has been a big life lesson, traits of Borderline may be somewhat inevitable. Not necessarily a fullblown BPD.

But that also makes it difficult to discern the two, traits from fullblown, because BPD seems more often dxed by those push-pull attachment problems rather than the full syndromic criteria. So loads of people with problematic childhoods get labeled BPD even if they only resemble that one trait.

Let's face it, LOADS of people have Borderline traits because of crappy childhoods. Humans don't exactly have a 100% success rate in raising healthy children.

[SomethingElse]

I also think that more extreme examples get more 'fame' and are taken as the stereotype because they're easier to read. For example, I should imagine that passive autistic people are less noticed or written about than aloof, or active but odd (and are more 'famous' examples, because they're easier to portray and explain).

I have a 'friend' who has BPD and he is very 'typical'. This also means that he gets a lot of professional support, because he's very loud about how he feels, is happy to talk about himself at length, gets really upset and hysterical very easily. Whereas, if he was quite quiet and inside himself, he'd be easier to fob off and no one would be concerned about him.

[phin]

I totally agree with both of you.
I think what I'm concerned about though is that I'm so profoundly convinced that this ("fullblown") BPD thing is a real illness, whereas for me having traits that some called autistic, others Aspergers - well it's not an illness. For better or worse it's just us.
BPD can be treated (I know, been there, done that - but much too late in life). But if we can retrain our brain, even if it's a long painful process, it could well be worth it. And like Benji said, there are those with BPD who are very active in letting people know they're hurting. Aspies, I would say, mostly don't. I certainly didn't reach out to anyone. The type (one type among many) of person with BPD who is actually more histrionic , tends to get his/her anger out easily and actually suffers less (others around him suffer more, finally the amount of suffering may well be the same?) than the type of person with BPD who turns their anger/shame/self loathing inwards and suffers intensely painful dysphoric states over and over that can last for weeks, or years . And therefore those Aspies with BPD are most probably suffering horrendously and perhaps needlessly, confusing their dx of Aspergers with an illness that is tearing them up on the inside. An illness that, I repeat, can be treated. At least it's worth a try.
Just an aside - I've found my life has changed greatly for the better since my doctor decided to aggressively medicate my insomnia a few years back. Just that could do a lot to improve our quality of life - and do away with a lot of angst in those of us who are more anxious and hypersensitive by nature. Again if I had only discovered this sooner...

[Sophist]

Sleep is a must. Can't battle day-to-day if you're not driving with on at least four cylinders.

[Anna]

Wow, this is a very interesting assessment, Phin.

I agree, that really is a great, insightful evaluation.

Bernard Crespi has written an interesting article about BPD in The Evolution & Medicine Review: http://evmedreview.com/?p=535 The article is about BPD, not Asperger's Syndrom. However, from its insights, BPD appear quite contrary to autism at its core:

A recent study of Borderline Personality Disorder by Franzen et al. (2010) in Psychiatry Research provides evidence that this condition involves superior psychological function with regard to ‘theory of mind’, a core adaptation of human sociality. These results, coupled with previous studies of enhanced empathy in Borderline Personality Disorder, indicate that a hyper-functioning, ‘social brain’ may be at least as psychologically maladaptive as one that is under-functional.

As a result of 'hyperfunctioning Theory of Mind', BPD sufferers can't filter out the emotions of other people and clearly distinguish them from their own. That sounds quite in line with your description, Phin.