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.

People are allowed to question disabilities. Whatever the OP's 'aim' is, she has put the question out and it is an interesting one, and the replies are all equally interesting.

cPTSD and EUPD are honestly insignificantly different. The only difference I can see in the clinical descriptions is the prominence of nightmares and flashbacks in cPTSD vs EUPD but that depends considerably on whether you bother to ask people.

Why is it so socially unacceptable and horrifying to get an EUPD diagnosis but perfectly fine and acceptable to have cPTSD in the setting of ASD? They are pretty much just different ways of framing and describing the same issues but one you are happy to accept and the other not because it’s stigmatised.

So many people stating as fact the commonly held opinion that dumb psychiatrists are misdiagnosing ND people with EUPD whilst at the same time the same psychiatrists are held to be infallible when making the ‘correct’ diagnosis of ASD/ cPTSD. It’s because it’s all just dependent on the way you see it. They are the same symptoms with different explanatory frameworks being used. I could not care less what people want to use to describe themselves. Some people actually don’t mind an EUPD label if they feel it does describe their struggles accurately and there is literally no reason why you could not have both ASD and EUPD. If you accept you can have ASD and cPTSD and that indeed it is likely then why is EUPD so unlikely given that the cause is developmental trauma?

I think checklists are unhelpful and intelligent people can skew their answers to match the criteria. When I was assessed for ADHD the assessor didn't ask me questions initially. He simply said 'tell me why you think you have ADHD'. When I had finished, he asked a set of questions and asked follow up questions. Afterwards he said that I clearly gave answers which were authentic and crucially, for him, didn't fit with the 'cookie cutter' ADHD experiences that you find on TikTok. He said that he spent much of his day telling people that x, y and z that they'd seen in TokTok and Instagram videos didn't reach the criteria for ADHD.

Similarly, when DD2 was assessed for ASD, the things they picked up on were things that seemed tiny. An example was that DD2 used the word 'ambushed' 3 times during her telling of the picture story. They said it was a really unusual word to use in the context of the story. She also said she would live somewhere remote with her husky dogs (she didn't have any) when she was older because husky dogs didn't have a long list of demands like humans did. There were lots of other things. It wasn't the stereotypical stuff you might imagine.

I think cptsd is less stigmatising because it acknowledges the trauma within as it were and sort of gives a reason for some of the maladaptive coping strategies that would have been used for survival by suffered. BPD or eupd situates the defectiveness (fwoabw!) in the sufferer. EUPD was an attempt I think to lessen the stigma but it's ended up being a synonym for difficult women in some ways. (Please note I don't think they're difficult women - in terms of a patriarchal view I mean).

What's curious to me is why a person would rather a diagnosis that is somehow fixed, say autism or ADHD, because isn't that just the same as a personality disorder. It's just called autism disorder. Or attention deficit hyperactivity disorder.

And I think that ties in with a split view of psychiatrists - either God or the devil. That's giving an awful lot of power to psychiatry, no? Like, they're obviously really helpful and useful and super qualified as Drs. And they know a lot about the law and work within an ethical medical framework. But to suggest that human subjective experience is fixed is really old school in a way - it's history is fascinating - the old asylums etc ... And how was the DSM written - like how did they decide - for this to be a disorder, you have to have five out of nine elements? Like why not six? Or four? Why five?

Would it not be preferable to say, hey, I can really struggle in social situations and I can feel really shy, and explore that. But that might change with age, with strategies or whatever. Rather than a fixed, I struggle in social situations and I'm autistic and that'll never change. Maybe that's not a good example. It's a bit like boys who don't want to sit still at school being medicated for ADHD. Let's change the school not the boys?

Wouldn't it be better if society itself was more accommodating to idiosyncratic difference in people, less violent to women and girls so that cptsd or eupd or bpd wasn't even a thing. If we accept that there are these fixed disorders in people, we never have cause to reflect on why they have the disorder in the first place.

So for years people were being diagnosed as having BPD when they really had autism yet now we have infallible faith in the professionals every time they diagnose someone as on the spectrum?

PD onset is usually late teens, early twenties, iirc. Diagnosis is usually a lot later, if at all, as many won't accept they have a problem.

It doesn't come out of nowhere, correct. But the effects are not always evident until the young person starts making their way in the world outside their family.

Yes because previously for many years there was a lot of ignorance as regards how autism presents in girls. We are better informed now.

As highlighted on this thread it’s so sad women and girls are still experiencing abelism, discrimination and ignorance as regards autism and adhd .

In my experience personality disorder means complex trauma. Everyone I have known with it, has major trauma. Symptoms overlap. They also overlap with autism and adhd particularly. I’d imagine as we are people and not textbook, we can fit in more than one diagnosis. I have complex trauma but I also see autistic traits in my children who have no trauma so I now see that some of the way I am is likely autism as well as trauma.

Doesn't mean they always get it right now. In another 20 years who knows how autism diagnosis might've changed again.

Ok I have opinions

So back in the early 2000s after my last suicide attempt, I ended up under the MH team. Who quickly ended up diagnosing BPD.

Based on the fact that I exhibited
the following symptoms:
-A pattern of unstable, intense relationships.
-Unstable self-image or sense of self.
-Impulsivity in at least two potentially self-damaging areas.
-Recurrent suicidal behavior, gestures, threats, or self-harm.
-Extreme emotional instability.

And now this is the important context, the whole duration of this time, I was in and living in an abusive relationship. Bear in mind I couldn't tell anyone as this man insisted on opening every letter I got (which unfortunately being unable to work due to how ill I was I had to be sent a copy of as evidence I needed).

•Was I in an unstable relationship?
Absolutely, it was abusive. And whilst he never physically hurt me (though did throw a glass at my head and kicked down my door) it was mainly emotional/psychological abuse..this man genuinely made me believe that nobody including my friends or family cared about me and to quote him if it wasn't for him I'd be on the streets. So yes...rather unstable relationships....

•Unstable image or sense of self
Yup. I did. Why? Because my ex convinced me of that...he showed me that. He told me what a bad person I was, how everyone I touched turned to shit...how he wished I'd died when I attempted suicide. So yeah pretty unstable sense of self based on that experience...

•Impulsivity
Was I impulsive? Absolutely, in many ways, though now I understand very very clearly that's a core part of my ADHD

•reoccurant suicidal behaviour/self harm
I had self harmed since the age of 12 when my life was hell in school with bullies and was also suicidal since then. I've had severe and enduring depression and anxiety since then. Yes I was self harming and suicidal. (Though just to note I haven't attempted since 2009 and I haven't self harmed on 12 years now)

•extreme emotional instability
Once again, I was in an abusive relationship. Genuinely I thought having raging public rows was what every couple did. Also difficulty regulating emotions is again a core part of ADHD

Obviously at no part during this period was anyone aware of or took note of the fact I was in an abusive relationship. Or the fact that after the relationship ended I no longer met the criteria. Oh and nobody at any point ever looked into the fact I'd been displaying ADHD symptoms since childhood or even considered that.

My impulsiveness and hyperactivity ended up leading to me then being misdiagnosed and medicated for bipolar for 12 years. 12 years of needlessly having to take the max strength of several different anti psychotics.

Only at aged 36, after they decided I apparently did not have bipolar did I end up being assessed for and subsequently diagnosed with ADHD, and since I've been medicated for it, the only symptoms that matched the "bpd" (impulsiveness and emotional regulation) have been far far better. Also yes in order to be diagnosed with ADHD my psychiatrist has to rule out any of said symptoms being caused by any other disorder.

BPD I'm sorry is the go to "get out" diagnosis of the NHS. They know damn well once you label someone with it, your job is done. Its ridiculous actually that they do that as it's perceived there's no treatment but actually DBT has proven very effective for those who DO have BPD. But as we know the NHS can't cope so it's much easier to give someone a bpd diagnosis after a 10 mins appointment than it or to find out whats possibly actually happening and treat it. CPTSD has very very similar symptoms to BPD, there is a lot of overlap and arguably a lot of these people should probably be diagnosed with CPTSD and not a personality disorder, but again that costs money to treat...

I think people are trying to make a subtle point about the validity of diagnosis and classification systems.

Just repeating a well worn mantra about how women were under diagnosed with ASD in the past and it’s ableist to ever question anything is failing to respond to the argument presented.

Diagnostic and classification systems are subject to societal norms and it is not necessarily through improvement in science that they change but often through a change in society eg homosexuality was a diagnosable psychiatric illness in early editions of DSM but society decided that it’s not an illness now.

Diagnosis (not just in psychiatry) is not an unquestionable certainty and it should be OK to debate why rates of different diagnosed may change over time or between cultures without being called names.

Well my friends NHS ADHD assessment she waited
..10 years for...was not much longer than an hour. In fact she has previously been assessed and diagnosed via BUPA though her work and she actually said that was a more thorough assessment... 🤔

Also because a previous poster brought up benefits, getting an ASD diagnosis is actually probably less likely to get an award of PIP than BPD would....

BPD is treated by DWP as a "severe mental illness" so I would say (based on personal experience) more likely to be awarded

I apologise that it came across as me not accepting the possibility of having BPD/EUPD and instead C-PTSD, and I appreciate the similarities and the arguments that the diagnoses shouldn't be differentiated. For me, the C-PTSD framework better described my experiences. I suppose I should have said that better understanding my own neurodiversity is a huge part of what eliminated those symptoms to the point where I now doubt I'd be diagnosed with either BPD/EUPD or C-PTSD. It may have been a useful label to me once, but only for the span of three or four years before I accessed treatment (ADHD medication which helped my impulsive behaviour and emotional dysregulation, and a combined approach therapy mixing DBT, relational, and transactional analysis techniques) and a better support system (family, friends, employment support).

Knowing how difficult it can be to have the stigmatising BPD/EUPD diagnosis removed once diagnosed, either misdiagnosed or no longer applicable due to successful treatment, I'm glad my therapist dissuaded me from seeking official diagnosis.

I also don't consider it socially unacceptable or horrifying to have a BPD/EUPD diagnosis, as I have two close friends with that exact diagnosis and I would never consider them lesser because of it. Both are also autistic and were diagnosed with BPD/EUPD before being referred for an autism assessment, one by social services and one by an inpatient mental health team. I do however feel sympathy for the way their diagnoses affect how others treat them, especially within health services, and how their other issues often get dismissed as drama and histrionics whereas I, with only my autism and ADHD diagnoses on paper, am regularly believed and treated appropriately.

I am an autistic 38 year old woman, and i showed more traits as an adult. The older i get the more it shows. So she may well be genuine and it may not be a personality disorder. Infact i was diagnosed with BPD before the psychiatrists diagnosed autism, as people are often misdiagnosed with borderline personality disorder when it is infact autism. Its a hard one, but the psychiatrists will be able to figure out for your friend.

That's the idea of getting a diagnosis, surely? To undergo an assessment to see what the diagnosis is?

People with EUPD often get better over time even without any specific treatment so no longer meeting criteria for the diagnosis later in life is normal and does not necessarily mean the original diagnosis was incorrect. Obviously I have no idea about your particular case I am just making a general point that EUPD is not necessarily for life.

How the hell would diagnosing someone with EUPD make them ‘cheaper’ to treat than some other illness? There are still specific personality disorder services and even inpatient units and those aren’t cheap. As you say DBT is effective and is offered. What would be the expensive ‘something else’ that they’d be missing out on? It would be a whole hell
of a lot cheaper to give them all stimulants than DBT if you think they’ll all have misdiagnosed ADHD. It’s much more likely that 12 years ago awareness of adult ADHD was just much more limited.

Psychiatrists cannot be experts in the whole vast umbrella of stuff that comes under ‘mental health’ these days. Honestly most general NHS psychiatrists are best at severe enduring mental illness ie schizophrenia, bipolar, severe psychotic depression, a bit of OCD and will not be very good at diagnosing and treating ADHD and autism which after all are not mental illnesses nor will they be a huge expert in teasing apart the subtleties of cPTSD from EUPD in the vast majority of cases unless they work for a PD or trauma service or something. A psychologist will be better at that because the main treatments are psychological. A psychiatrist is mainly there for medication so if it’s not a medication treatable illness they are going to be less good with it.

It’s not a debate it’s the same posters with an agenda on MN ignoring data and professional opinion continuously invalidating and questioning disabilities in women, even making personal enquiries about their conditions and pushing their own crackpot theories over professional experience.Its hugely damaging and such behaviour on SM has even been highlighted in the NHS Taskforce on ADHD. Calling something what it is isn’t name calling .

Women with autism , adhd and BPD face huge hurdles gettibg diagnosed, stigma and abelism. That is not ok.

Hi @Cr055ing I completely understand your frustration. Just to clarify, my original post was a genuine question. I’m having to do my own research and this platform has been incredibly helpful in that process.

I’m not sure if this is the best comparison, but I once had an elderly relative who was being treated by doctors with several medications. We had to carefully research each diagnosis and prescription to truly understand what was going on. That experience taught me the importance of asking questions and seeking knowledge for ourselves.

People should absolutely feel able to ask questions and engage in open discussion. While the person I’m referring to now hasn’t been diagnosed with anything, my intention was sincere and never meant to invalidate anyone’s experience.

Please try not to assume malice or label people as ableist, as that really isn’t what’s happening here. If the topic feels triggering, it might be kinder for you to skip it rather than engage in a way that causes stress.

It most certainly is happening here and needs to be called out every single time on every single thread. The damage it causes is documented and acknowledged. Stress is caused by the abelism and the disabled are well experienced in having to call it out so you can keep your patronising. Being a carer for disabled children is far more difficult.

That person’s disability is none of your business. None.

Mumsnet is well known to be frequented with autism haters( particularly in women) who start new threads most weeks on the same theme. We see you.

You are wrong. And it’s very unfortunate that you see it that way.

I’m not,it’s a common complaint on here. Do share some links to back up your “theory”.

I don’t have a theory, and I’m certainly not in a position to propose one. What I do have is a view, one shaped by personal observation and experience. A friend has 2 children with profound and formally diagnosed autism,I’ve been told a handful of times that I should get an assessment myself, and the person I’m discussing is displaying patterns have led me to question whether they may have a personality disorder. Neither of which I’m fully knowledgeable about and I am always open to being educated in either direction. Which is why I have turned to this platform for advice and insight based on the lived or worked experience of others.

Please reference from any part of this discussion, where a person diagnosed with a disability might read and feel harmed by others’ attitudes or behaviours, or feel as though they are seen as inferior or undeserving of accommodations? From what I’ve read, that is how you define Ableism. Has anyone here expressed the view that a person with a disability has a life of lesser value or cannot contribute equally to society?

Please do share, @Cr055ing

So you're not fully knowledgeable but are questioning someone's diagnosis? Were you present at their assessment?