AIBU to think that there are adults trying to push for an autism diagnosis, that actually have a personality disorder instead?

[surelycantjustbeme]

Someone I know is currently pushing for an adult autism diagnosis. The “autistic traits” she talks about were never present in childhood and seem to have appeared only in adulthood.

From what I’ve read, that pattern can sometimes fit better with something like borderline personality disorder, where there can be a lot of symptom overlap but the difficulties are more tied to relationships, emotions and past environment, and often show more clearly from the teens onwards rather than right through childhood.

I’m posting here because I can’t really talk about this in real life, and I’m genuinely curious whether anyone has come across similar situations. Has anyone seen someone really push the idea that they’re autistic when it doesn’t quite match their history?

For context, this person has always absolutely refused to work or take on any responsibility, and whenever they’re asked to step up, they suddenly lean on “I’m autistic” as the explanation. I obviously can’t diagnose them, but I’m increasingly wondering whether something like a personality disorder might be a closer fit than autism.

Everyone who knows this person knows there have never been any such symptoms in childhood, it's only recently where responsibilities have become a real demand and it's almost being treated as a get out of jail free card.

I know people who have genuinely severely non verbal children, and I also know people who have children with genuine ADHD and are on the spectrum, and the childhood challenges it presents. So please don't read this as me being insensitive in any way.

Am I being unreasonable to think that there could be adults with personality disorders, trying to push for an autism diagnosis instead as it's more widely accepted and better understood.

'All this narrative around over diagnosis is highly inflammatory and incorrect. We are still in a state of major under diagnosis. The only reason the government and media are pushing this narrative is because Wes Streeting wants you to no longer be able to get support for mental health on benefits even though we know that this support actually helps people get into the workplace rather than keeping them out.'

Of course this conversation is really about money. But at the same time, I believe we should be investing more into better supports and easier acces to those rather than into providing more diagnoses. But I know others may disagree.

OK well I must be on the spectrum as well then-I used to sleep most days after school and I dropped out of uni after only a term as I couldn't cope.

The whole concept of diagnosis sits within a positivist paradigm. Even within the 'diagnoses', not everyone is the same. In answer to the OPs question, some people may well want an autism diagnosis rather than a personality disorder because it's aligned with being 'neurodiverse' rather than 'neurotypical' with a disorder. In some ways adhd and autism is a move away from the medical model but again, these 'diagnoses' sit within what is supposed to be a objectively defined reality. This is problematic in many ways, not least for the patient. Neuroscience itself acknowledges that we are all in fact neurodiverse. It does not group us into NT and ND. At all.

That said, there are clusters of behaviours or experience that can, I suppose, be assigned a label, personality disorder or otherwise. For example, people with borderline personality disorder struggle with very specific things, emotional dysregulation being one, parasuicidal behaviour another. These are tied up in very serious relational challenges that often prevent them from living a peaceful and productive life. There is often trauma, often sexual abuse, sometimes simply a systematic long term and intrusive relationship in the beginning. It takes a good while to sort out.

One thing is true I think - it's the idea that these disorders or diagnoses are fixed things that can be fixed with medication that is the most concerning as it stops us questioning the society within which these disorders or diagnoses exist. Which ultimately means we make no progress.

Well I’d agree with you
I’m sure validation is very good and relieving but that’s only going to last so long. Other than that diagnosis currently doesn’t really open the door to much support. I’d rather money went on helping people than on making diagnoses.

I am a qualified clinical psychologist and psychotherapist in my home country, though I don’t practice in the UK. I have discussed this with many former colleagues. I believe the term autism is overused here in the UK and often misapplied to cases that are actually personality disorders. For example, I once knew a person who was clearly borderline and was diagnosed with Asperger's disorder, which I found mind-boggling. These days, I hear many people claim to be autistic, and honestly, it’s becoming absurd, as the autism label is now a catch-all for various conditions unrelated to autism itself. This is concerning and frightening, especially when applied to children still developing, as it could lead to serious issues.

That would be nowhere near enough for a diagnosis

Only if you reach the diagnosis criteria for communication difficulties and repetitive behaviours to the extent they have a significant impact on life .

So because qualified medical professionals - who have trained for many years - sometimes make mistakes, we might as well ignore all of their knowledge and expertise altogether, and allow just anyone to decide on a diagnosis? I guess there is always Google to fall back on if people aren't quite sure?

Or is it just that you have decided in all your wisdom that neurodiversity doesn't even exist, so you think we can dispense with diagnosis altogether?

There is a lot of crossover between autism, ADHD, personality disorders like BPD and Complex PTSD. Ultimately only a psychiatrist can decide on this, and the access to treatment and support look quite similar for all of them anyway.

She’s been ill for 5 years. And also has all the other ASD symptoms. And all she does is go to university. Too tired to go out or do normal 19 year old things

What a disgusting post.

The same could be said about so many diagnoses

Whilst a diagnosis doesn't give support, without diagnosing people how do you suggest we work out who needs support?

Your ignorance is astounding. Autism and adhd are under diagnosed in this country. BPD is over diagnosed in autistic women,”Asperger’s disorder” hasn’t been used for years and unless you were the diagnostician you would not know the full diagnosis details to be mind boggled.

Yes I hugely struggle with this very odd concept that there’s an NT vs ND binary. I cannot see how that can be scientifically true.

Autism cannot be a single gene disorder or have a single biological or neurochemical cause. It’s going to be polygenic like most stuff is and therefore will exist on a spectrum depending on the dose of genes and environment you have. If people accept there’s a spectrum of severity within the diagnosis how does that spectrum not continue outside the diagnostic boundary? These are clearly behaviours that are on a normally distributed bell shaped curve throughout society

The only way in which it’s binary is because we have put an artificial boundary in and said ‘this is enough symptoms to qualify’ and ‘this is not’. It’s the same with hypertension. You have it depending on what criteria for SBP we specify and Drs have moved that at times.

Social skills are very different to communication .

My point was, why are NT people (or people who have not had a diagnosis) having all their struggles downplayed as if none of us ever reached a point we couldn't cope or had major anxiety over something?

@ArseInTheCoOpWindow you have no idea what other things I struggle with.

Needs?

ND people have the same struggles with a disability on top. That’s the difference.

More likely the other way round in my experience that bd personality has been diagnosed incorrectly when it’s actually autism

Ok but when someone say things like "I can't cope with having my routine disrupted because I'm autistic" it reads as if they think no one neurotypical would ever feel the same way. As if it's an exclusively autistic trait.

How do they differ?

I've know two people like this. Both had traumatic childhoods, long-standing mental health issues before being diagnosed with personality disorders. Now both have an autism diagnosis. There's a lot of cross over with the symptoms of cPTSD and Autism. The key difference being that autism is present from early childhood, yet adults who have experienced trauma are being diagnosed autistic without the assessor having evidence of it being present in early childhood.
It seems to be that autism is seen by some as the cause of every struggle. I thinks it's really doing a disservice to people who's difficulty arises from other things and to those who actually are autistic. I work with Autistic adults and once they have that diagnosis the mental health team can be very quick to try and discharge as autism isn't a mental disorder.
I do wonder if ADHD being diagnosed during menopause is also sometimes misdiagnosed. Women who have been successful in education and work start struggling with brain fog, anxiety and difficulty focusing which are all menopause symptoms. The reasoning they think it's ADHD being they have always struggled but could cope before menopause. Doesn't everyone struggle sometimes but they were able to function without significant impairment since early childhood, therefore, not ADHD?

NT discomfort with routine change is very different to that experienced by somebody with ASC on top particularly when it comes with communication difficulties, repetitive behaviours and sensory difficulties that all have a significant impact on life.

A lot of psychotherapy based services are offered without a diagnosis certainly in my area. You can access CBT, DBT and some other therapies without having any kind of diagnosis at all. Part of the asset would be a formulation and that would be used to guide your treatment. A diagnosis is mostly useful at a research and service design level more than for individuals.

You need historic evidence of it in childhood.

Yes.

I know many adults and kids with autism. Some very severe (non verbal, unable to live independently). Some less severe but still has an impact on their day to day life.

I also know quite a lot of adults who over the past few years have massively jumped on the autism bandwagon.

They manage to do everything they want to do ok, but when it comes to doing something they don’t want to do they say “I’m autistic”.

I also have a few (very close) family members who have struggled with relationships for as long as I have known them. Usually as a result of feelings of self importance, with a large disconnect between how they treat others and how they expect others to treat them. Major main character syndrome. Generally quite difficult and unlikeable characters, who are now convinced this is due to autism, despite displaying no actual autistic traits.