The Complex Relationship Between ADHD, Autism, and Personality Disorders

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/

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?

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.

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.

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.

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

> 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.

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

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