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.

We did personality type assessment at work - DISC.

One of the leadership team came out as a cross between Dominant and Supportive (the other two being Influencing and Compliant).

It helped rationalise a lot of his behaviour. He was incredibly controlling, but also latched onto taking sides if there were issues at work. It made sense to me that perhaps controlling people do tend to fit into that sort of type - fixated on people but also dominating them.

They stressed that all personalities were just different, none better than the other. But they were selling the training, and they could hardly say, "yeah, so you have the personality type of an abuser".

(Yes, some people think these are no better than horoscopes, but that attitude has often stemmed from criticism of Myers-Briggs who were - wait for it! - women! A mother and daughter team who were discredited by male professionals. Whereas it entirely makes sense at an evolutionary level for humans to have different dispositions that support survival in different, complementary ways.)

@FuzzyWolf *I’m not aware of any benefits that are dependent upon a diagnosis. Which ones do you believe are?

Things like PIP etc require additional care needs and medical support proving them. PIP also has been assessed by the DWP as having a 0% fraud rate*
I always find it scary that posters use this DWP statistic as some kind of proof that PIP isn't subject to fraud. All it proves is that the DWP have very little idea of how much fraud there is and they can't even give us a semi-realistic estimate. The 0% simply reflects the amount of people that they have caught defrauding the system, not how many people are actually doing it. I think even the biggest proponents of the current PIP system would accept that it 0% fraud level is a ridiculous suggestion.

A basic level of critical thinking would highlight that catching people claiming PIP when they really shouldn't be is much more difficult to prove than someone claiming Child Benefit fraudulently for example. Forensic accounting and paperwork trails can be used to identify fraud related to most benefits in a way that it just can't be for PIP. How can the DWP prove that you aren't as depressed as you say you are or that your bad back isn't as bad as you insist it is? Without a huge amount of surveillance and a large amount of intrusion into people's private lives it is almost impossible to prove. Hence we have no idea how much fraud is going on but we can all use our life experiences to gauge that it's certainly isn't 0%

How would you ever know that?

I am not ASD or ADHD but I am rarely 80% me unless I'm around family or very close friends. Professionally I am 20% me and 80% projecting a character. Socially with most people I am at absolute most 50% myself and 50% adapting and changing based one who I am talking to and the common ground I feel we have. Different people can have totally different experiences of me. I don't think this is unusual at all! My husband is the same. At work is seen as responsible, dependable and serious but amongst his friendship group he is seen as the life and soul of the party.

Multiple professionals in the private and public sector are diagnosing people on the basis of a one hour assessment, often online, all the time. Yes there will be some pre screening forms etc but one hour is the standard amount of time for an initial appointment and lots of people are either not being offered or not paying for more than a one off.

Look I actually am a very experienced psychiatrist and I can tell you that it is not so easy and anyone who tells you that it is lacks insight into their own bias. People working in private online practice that exclusively do autism and ADHD assessments are going to see it everywhere. When you only have a hammer everything looks like a nail. Plus people come with their strong preconceived expectation of receiving a diagnosis and have looked it all up online so that they can provide the evidence required for you to tick the boxes. I would personally prefer not to make these kinds of diagnoses outside of a therapeutic relationship where I have had a chance to see the person for multiple appointments over a period of time (which is why I don’t take the easy cash to do private online assessments which I very easily could do) but rarely would I be afforded that chance in this day and age.

I think that the reality of the thing is messy and complicated and I don't agree that 'current thinking' (as people have said on this thread) is that eupd is actually misdiagnosed ADHD or autism. I don't think it's that easy. While there may be an overlap, the differences are huge. And the bits that are different have significantly difficult implications for the person.

The mess is possibly to do with the reputation that eupd sufferers have. They cause havoc, it must be said. Their ability to appraise relationships realistically is seriously impaired, their sensitivity to rupture and rejection, however slight, is acute. They often feel persecuted, paranoid. Their propensity to use parasuicidal behaviour is significant, sometimes daily during a crisis. Their ability to cause anxiety or evoke strong feelings in those that care for them is second to none. Through no fault of their own! Their histories are usually replete with chaos and abuse. Their ability to mentalise is limited. Some of them are bordering on the psychotic, hence the name, 'borderline'. Some of them have narcissistic traits, they can be exploitative, manipulative. Their capacity for healthy guilt is low, concern for others, low. Some have a gargantuan sense of grievance rather than face the sadness and disappointment in life - the sadness of the borderline anyone? Bottomless. The emptiness, the dissociation. It's a very serious condition.

Is this really the same as Autism or ADHD?

But in terms of the OP, I'm not surprised some would rather an autism or ADHD diagnosis. And maybe some have indeed been misdiagnosed - diagnosis can be a very crude instrument. Lots of medical professionals run for the hills at the mention of an eupd patient. The ability of a borderline patient to strike fear into the heart of some psychiatrists is impressive. And this, coming back to my first post, is, I think, might be because psychiatry rests in a positivist paradigm - symptoms, check, meds, check, reality observed, check - and because almost all of the eupd patients problems rest within the relationship: intensely subjective, idiosyncratic, messy, a diagnosis and meds alone doesn't resolve the issue. If only the medical would move aside and allow the more hermeneutic aspects of care in (although there is also a history there lol!) Complicated.

I totally disagree with you. I’m diagnosed PD. I have NO relationship issues.

I am empathetic. My background has no trauma within it. My family state I am supportive, emotionally aware, calm. My life is not chaotic. I am not manipulative. I have no fear of abandonment.

You are quoting a stereotype and it’s not right.

This - I 100% agree. This has been my experience too.

You know how to slip in and out of these roles and where and when one is appropriate because you have been easily able to pick up social rules along the way. That is the difference.

Is there much need for a distinction though? Whether they are autistic or have a personality disorder, they have a neurodivegency that makes life difficult.

@PurpleLovecats

problematic and pervasive relationship difficulties significantly impacting the individual and those around them are a core criteria for personality disorder diagnosis.

You think you are misdiagnosed, no?

It's not a stereotype, it's a cluster of behaviours or experiences that form a diagnosis which can then be treated with medication. That's literally what diagnosis is. The DSM is literally - here's the list, meet 5 out of the 9, apply meds. Problem solved.

Although you're right - in a way a diagnosis is a kind of stereotype. That's why I'm also saying diagnosis itself is problematic. How does it help?

Apart from ‘apply meds’ which should not be applied to EUPD the rest I agree with. It should be apply DBT ideally. Diagnosis is a collection of descriptions of behaviour that are observed to cluster together. The same is true of autism as of PD. It’s not like there’s a scan or a blood test that can tell you that you have either.

@Shrinkhole yes fair enough

I think we can all agree that diagnoses being made on the strength of a one hour assessment are problematic. I am shocked that those are being carried out. Surely that is not the case in the NHS?

Not in my experience at all. Really don’t see how you could. Our NHS diagnoses were masses of paperwork, 3 x very long over 3 hour sessions with ADOS included and then the feedback which was long with a lengthy report. My experience of private assessments children have had via work are most definitely not an hour long. They include paperwork from professionals and school and long diagnosis sessions.

Maybe those making these allegations could link to the private providers they think are doing this.

I was misdiagnosed with EUPD after a ten minute consultation with a psychiatrist who hadn't even so much as looked at my notes. I guess I just didn't fit in any other box and he wanted me off his caseload. I ended up being put on a medication that made me so dissociated it basically robbed me from months of my life, having to attend group therapy sessions with people who found it completely hilarious to discuss how they liked to hurt other people, and couldn't get life insurance or critical illness cover when I took out my mortgage.

I knew it wasn't right and luckily I am articulate enough and have the tenacity to fight the decision. As autism awareness was increasing I did a lot of reading up myself and suddenly realised my entire life made sense (traits had been noticed as young as five years old but I didn't know this until I asked my mum). I had a second opinion and it was confirmed that I'd been misdiagnosed - however that still doesn't remove the initial diagnosis from my records.

I actually also work in mental health and my situation is sadly incredibly common, including a young women who completed suicide because she couldn't face the stigma of what turned out to be a wrong diagnosis.

So no, I think your OP actually reflects the opposite of what is really happening

Every single psychiatric diagnosis is made on the basis of observed behaviour. There is no way to distinguish biologically between any of them. Even autism. We are told it’s genetic, but there is no genetic test to identify it, no biomarkers, only what is observed. There are massive overlaps between all these diagnoses, but somehow autism and adhd are more palatable because they are no-one’s “fault”. They are more socially acceptable, and people are much more likely to have needs accommodated if they say they have autism that if they have a personality disorder. People with that diagnosis get written off, and less help. Why wouldn’t you push for an autism diagnosis instead?

What a truly awful post, I totally disagree and it’s not what we’ve been told by professionals either. BPD is over diagnosed in women. I’d be making complaints if professionals said such shocking things. These are patients who have suffered trauma and if you only like easy patients you shouldn’t be working with any. The professionals working with my dc always spoke of her very warmly and she has always had good relationships with them hence her amazing progress. Both my adult children have ASC, ADHD and emerging BPD and they are more ashamed of their autism diagnosis than BPD. Neither had chaotic lives but trauma.

Thank you for the replies. I hadn’t really considered that misdiagnosis often happens in the opposite direction too.

My post isn't about me, but I’ve been told a handful of times as an adult that I should get assessed, that my quirks and certain traits might place me on the spectrum. Quite honestly, I find that infuriating. If I look at the list of traits, I could easily tick many of them myself, and use that to excuse many of my behaviours, struggles or timeline predicaments up to this point, but I've chosen to flip that and instead look at the very many other factors (and there are so many) that can instead provide answers, which has helped me a lot. I have no regrets, and I am so glad the labelling wasn't around when I was younger. As it hasn't disabled me. And I do not need medicating for who I am. Or who I am not. And I guess this contributes to my views on the person I'm speaking about, and one of the reasons for the thread.

I am learning a lot from this thread, so thanks. Regarding the person I know, someone mentioned 'masking' which I have considered. But with the research I have done, it has lead me to understand that they would have had to prove the behaviours were impacting them throughout childhood too. So sensory issues, for example, that they claim to have, and the selective need to wear ear muffs when out and about, would surely have been a problem in childhood that surely a child can't mask. Whereas it's only started (intermittently, and when they can post online to show that they are wearing them) within the last 12 months or so. And I feel that there are so many other explanations for the other traits too.

I know I'm not a professional and it does seem like I'm interfering where it's not my business, but without going into more detail, it is my business based on who the person is, and how their life choices impact the world I'm in. So I'm in a way having to research myself, so I can potentially put something forward to help guide the situation, if that makes any sense. And to better understand it myself.

I do understand that some people find comfort and clarity in a diagnosis. But perhaps it’s the world that has changed more than we realise. Maybe we're just navigating a system that no longer reflects how humans are evolving. To label someone as what's deemed as 'not typical' to others who fit into the mould of how humans should be programmed to operate in the world around them. I wonder what is the 'typical world' and how old is the definition of this world?

I know that a full diagnosis goes much deeper, and I am sorry if I come across as ignorant, but I do know 2 children who are profoundly autistic and non-verbal, I can appreciate how frustrating it must feel for their families when adults self-identify based on a shared traits. And I agree with a PP who said it needs to be separate from those profoundly autistic whose disability is life limiting.

And I think that people with personality disorders deserve clearer diagnoses, better support, and far less stigma. More genuine understanding overall.

I think you need to step outside yourself and learn about internalised ableism and what autism and ADHD actually are before you decide to have any more grand speeches like this nonsense.

Misdiagnosis with EUPD of autistic women is an NHS scandal.

Many, many women suffered while doctors diagnosed males with 'Aspergers' and women with unstable emotions.

What's it to you anyway?

There's an awful lot of nope in this.

The thing is, your assertion that this individual didn't have any traits when they were younger is something you cannot possibly know. Your example about the sensory issues is one I can definitely talk about - I've always had the exact same sensory issues, which I compensated for with increased energy expenditure when I was younger because I could back then. I can't now. That's why I now wear noise-cancelling earbuds with transparency when I'm in noisy environments; apart from the fact that they didn't exist when I was younger, I'd cover my confusion and lack of attention in such places by focusing really hard, by lip-reading, by constantly being ultra-alert. My parents thought I was "completely normal", but didn't make the link between that behaviour and the fact that I'd shut myself in my room to read with the lights dimmed for the next three days (school aside) to recover from the effort. They just thought I was a bit of a bookworm.

I carried on doing that throughout my 20s and 30s, until COVID happened. When we came out of lockdown (which was a fabulous time for me), I discovered that I couldn't compensate like I used to any more; I just no longer have the energy or the ability to constantly stay on alert. Some days, even whole weeks, I just can't deal with real life at all without support. That's when I ended up being diagnosed autistic.

This is something really important to understand: autism is not a static condition. As well as being variable day-to-day, it almost always changes over the years. The internal experience is often constant-ish long-term, but the outward expression and tolerance changes with age.

Did I suddenly get access to support that made everything better after my diagnosis? No. Did it change my life for the better? Yes, because I can suddenly forgive myself for everything people have told me I was doing wrong all my life. And I can stop trying to pretend I'm the same as everyone else. That alone is something that neurotypical people have never seemed to understand (not least because the ones around us don't want to come face-to-face with the fact that their expectations and behaviour towards us is has been at least partially responsible for our discomfort for years/decades).

The big one, though, is that you seem to think that someone can somehow "push" for a diagnosis; that's not remotely how this works. The diagnostic process is gruelling, heavy and exhaustive...and the assessors are much more attuned than a lot of people seem to think, and the process is designed specifically to avoid false-positives. It's not a test you can revise for, and it's not something you can fake like back pain.

I completely agree with you about how awful it can be. My last sentence speaks of how I'd like it to be.

Perhaps I'm not being clear, but I think it's complicated.

I'm glad you've had a good experience and the support you've been given has made a difference.

I would agree with this but add that it seems less disruptive to others than the disruptive type. So in other words they’re not interrupting the teacher at school or annoying their classmates while they’re trying to work. BUT they may forget to bring in their homework, struggle to understand the teacher’s assignment instructions, find it hard to organise their revision or plan their studies. They may find social relationships difficult which makes school or workplaces uniquely painful.

Because they’re not disruptive their difficulties can be overlooked by the teacher or their families but then they don’t get the help and support they desperately need to make normal organisational and social challenges easier.

I am talking about an adult assessment. NHS is more reliable and I would trust it a lot more but the waiting list is basically theoretical in our area at the moment. Well over 3 years.
I’m not going to provide links because I won’t advertise them you can just literally google and look it up.
I just did that for the top 3 results off Google for adult autism and ADHD assessments (Berkeley, Harley and diverse diagnostics)
Each of them has the same process. Fill in a few questionnaires, one or 2x one hour online appointments, pays your money and you get your report. The 1st one doesn’t say how long/ how many appts, 2nd one says it’s split over 4 appointments but the first appt is 15 mins chat and the total is ‘a few hours’
The 3rd one says it’s two x one hour assessments
People of course want to feel they are having a proper in depth assessment so likely to expect more than one hour but for a private provider it’s a numbers game. More assessments more money so they are hardly likely to want to prolong it plus they won’t be competitive on price if they pay too much for clinical time.
How do I know? A lot of my mates do private practice in this area for various companies around the country mostly online so I know what they are all doing. It’s pretty easy to get into.