Ways That Autism Spectrum Disorder Resembles Personality Disorders
Differential diagnosis, comorbidities and overlaps with other disorders are common among people with ASD, but clinical assessments often omit screening for personality disorders, which are especially common in people with high-functioning autism (ASD level 1) where there is less need for support.
ASD level 1 is associated with a distinct personality profile even if variability exists. “Cluster A” and “cluster C” personality disorders are the most frequent co-occurring personality disorders, but overlapping features should be investigated. Exploring personality may provide greater understanding of people on the spectrum by identifying strengths and weaknesses, and could give pertinent information for the development of specific treatments.
Here we will look at the basic traits of several personality disorders and how they may overlap with traits of ASD:
Traits of Narcissistic Personality Disorder (NPD):
- Grandiosity and exaggerated sense of self-importance
- Preoccupation with fantasies of success, power, beauty, or ideal love
- Belief in being special or unique and deserving of special treatment
- Need for excessive admiration and attention
- Exploitative behavior towards others to achieve personal goals
- Lack of empathy and unwillingness to recognize or meet the needs of others
- Arrogant and haughty attitude towards others
- Envy of others or belief that others envy them
- Difficulty handling criticism or rejection
- Tendency to react with rage or humiliation when criticized or questioned
NPD traits that may overlap with ASD:
- Lack of empathy and unwillingness to recognize or meet the needs of others (often due to mindblindness and alexithymia)
- Difficulty handling criticism or rejection (often due to low self-esteem and childhood trauma)
- Tendency to react with rage or humiliation when criticized or questioned (often due to low self-esteem and childhood trauma)
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Traits of Antisocial Personality Disorder (APD):
- Lack of empathy for others
- Disregard for the law and social norms
- Deceitfulness and manipulation of others
- Impulsivity and failure to plan ahead
- Irresponsibility and lack of accountability
- Aggressiveness and hostility towards others
- Reckless disregard for safety of self or others
- Consistent irresponsibility and lack of accountability
- Lack of remorse or guilt for actions that harm others
- Superficial charm and ability to manipulate others for personal gain
APD traits that may overlap with ASD:
- Lack of empathy for others (often due to mindblindness and alexithymia)
- Deceitfulness and manipulation of others (often due to conflict-avoidance behaviors)
- Impulsivity and failure to plan ahead (often due to executive function deficits)
- Irresponsibility and lack of accountability (often due to mindblindness and alexithymia)
- Aggressiveness and hostility towards others (often due to sensory sensitivities, poor self-esteem, childhood trauma, meltdowns, anxiety-overload)
- Reckless disregard for safety of self or others (often due to mindblindness, alexithymia, preoccupation with his/her own special interests; this occurs most frequently in his/her role as a parent)
- Lack of remorse or guilt for actions that harm others (often due to mindblindness and alexithymia)
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Traits of Borderline Personality Disorder (BPD):
- intense and unstable emotions
- impulsive behavior
- fear of abandonment
- unstable relationships
- distorted self-image
- self-destructive behaviors
- feelings of emptiness
- difficulty controlling anger
- dissociative symptoms
BPD traits that may overlap with ASD:
- intense and unstable emotions (often due to anxiety and sensory sensitivities)
- impulsive behavior (often due to executive function deficits)
- fear of abandonment (often due to childhood issues such as peer-rejection)
- unstable relationships (often due to mindblindness, alexithymia, executive function deficits, anxiety)
- distorted self-image (often due to mindblindness and alexithymia)
- self-destructive behaviors (often due to anxiety, depression, substance abuse, low self-esteem)
- feelings of emptiness (often due to being on the receiving end of disapproval throughout the life-span in a neurotypical world)
- difficulty controlling anger (often due to anxiety and low-self-esteem)
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Traits of Histrionic Personality Disorder (HPD):
- need for constant attention and admiration
- dramatic and exaggerated expressions of emotion
- excessive concern with physical appearance
- tendency to be easily influenced by others
- tendency to be suggestible and easily swayed by others
- lack of concern for consequences or responsibilities
- tendency to be overly dramatic, theatrical, or flamboyant
- tendency to be self-centered and self-absorbed
- tendency to be easily bored and to seek out new and exciting experiences
- tendency to be manipulative in order to get attention or affection from others
HPD traits that may overlap with ASD:
- dramatic and exaggerated expressions of emotion (often due to anxiety, meltdowns, shutdowns)
- tendency to be easily influenced or manipulated by others (often due to naiveté because of low social skills and mindblindness)
- lack of concern for consequences or responsibilities (often due to mindblindness and alexithymia)
- tendency to be self-centered and self-absorbed (often due to mindblindness, alexithymia, preoccupation with his/her own agenda)
- tendency to be easily bored and to seek out new and exciting experiences (often due to having only one special interest, having a strong aversion to change or deviation from his/her usual routine)
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Traits of Obsessive-Compulsive Personality Disorder (OCPD):
- preoccupation with perfectionism, orderliness, control, and extreme attention to detail
- need for strict rules and order
- excessive devotion to work
- reluctance to delegate tasks or work with others
- tendency to hoard or collect items
- inflexibility in thinking and behavior
- overall rigidity in personality
- struggles with decision-making
- difficulty expressing warmth and affection
- overly critical of themselves and others
OCPD traits that may overlap with ASD:
- preoccupation with perfectionism, orderliness, control, and extreme attention to detail (often due to having a strong need for predictability)
- need for strict rules and order (often due to having a strong need for predictability)
- excessive devotion to work (often due to having only one special interest)
- reluctance to delegate tasks or work with others (often due to having a strong need for autonomy)
- inflexibility in thinking and behavior (often due to executive function deficits and a strong need for sameness)
- struggles with decision-making (often due to executive function deficits)
- difficulty expressing warmth and affection (often due to alexithymia)
- overly critical of themselves and others (often due to poor self-esteem)
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Traits of Paranoid Personality Disorder (PPD):
- Suspicion and distrust of others
- Perception of others’ motives as malevolent
- Being guarded and defensive
- Perceiving innocent remarks or situations as personal attacks or threats
- Holding grudges and being unforgiving
- Refusal to confide in others
- Reading hidden meanings into benign remarks or events
- Being hypersensitive to criticism
- Being quick to react with anger or aggression
- Difficulty in forming close relationships
PPD traits that may overlap with ASD:
- Suspicion and distrust of others (often due to poor self-esteem, childhood trauma, problems with prediction, mindblindness)
- Being guarded and defensive (often due to poor self-esteem, childhood trauma, mindblindness)
- Perceiving innocent remarks or situations as personal attacks or threats (often due to poor self-esteem, childhood trauma, mindblindness)
- Being hypersensitive to criticism (often due to poor self-esteem, childhood trauma, mindblindness)
- Being quick to react with anger or aggression (often due to sensory sensitivities, meltdowns, shutdowns, anxiety)
- Difficulty in forming close relationships (often due to poor social skills and low emotional intelligence)
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Traits of Schizoid Personality Disorder (SPD):
- A preference for solitary activities
- Limited emotional expression
- Lack of interest in social relationships
- Difficulty in making friends and maintaining social relationships
- Indifference or apathy towards other people
- Anhedonia or inability to experience pleasure
- Lack of motivation and drive
- Difficulty in understanding social cues and emotions of others
- Emotional coldness and detachment
SPD traits that may overlap with ASD:
- A preference for solitary activities (often due to social anxiety)
- Limited emotional expression (often due to alexithymia)
- Lack of interest in social relationships (often due to low social/emotional skills)
- Difficulty in making friends and maintaining social relationships (often due to low social/emotional skills)
- Indifference or apathy towards other people (often due to low social/emotional skills)
- Difficulty in understanding social cues and emotions of others (often due to low social/emotional skills)
- Emotional coldness and detachment (often mindblindness and alexithymia)
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Traits of Schizotypal Personality Disorder ScPD:
- Odd beliefs or magical thinking
- Unusual perceptual experiences, such as hearing voices or seeing things that aren't there
- Suspiciousness or paranoid ideation
- Inappropriate or constricted affect
- Odd or eccentric behavior or appearance
- Lack of close friends or confidants
- Social anxiety or discomfort in social situations
- Odd speech, such as rambling or tangential conversation
- Excessive social isolation
- Lack of emotional expression or inappropriate emotional responses
ScPD traits that may overlap with ASD:
- Suspiciousness or paranoid ideation (often due to mindblindness)
- Inappropriate or constricted affect (often due to alexithymia)
- Odd or eccentric behavior or appearance (often due to low social/emotional skills)
- Social anxiety or discomfort in social situations (often due to low social/emotional skills)
- Odd speech, such as rambling or tangential conversation (often due to executive function deficits)
- Excessive social isolation (often due to special interests of a non-social nature)
- Lack of emotional expression or inappropriate emotional responses (often due to alithymia)
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Traits of Avoidant Personality Disorder (APD):
- exhibit a pattern of social inhibition
- feelings of inadequacy
- hypersensitivity to negative evaluation
- tend to avoid social situations out of fear of being criticized or rejected
- often feel socially inept or inferior to others
- have few close relationships
- struggle to trust others
- reluctance to take risks or try new things
- tendency to be self-critical
- fear of disapproval or rejection
APD traits that may overlap with ASD:
- exhibit a pattern of social inhibition (often due to low social-contact needs)
- feelings of inadequacy (often due to low self-esteem)
- hypersensitivity to negative evaluation (often due to low self-esteem)
- tend to avoid social situations out of fear of being criticized or rejected (often due to low self-esteem)
- have few close relationships (often due to low social-contact needs)
- struggle to trust others (often due to mindblindness)
- tendency to be self-critical (often due to low self-esteem)
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Traits of Dependent Personality Disorder (DPD):
- Difficulty making decisions without excessive advice and reassurance from others
- Difficulty expressing disagreement with others due to fear of losing support or approval
- Difficulty initiating projects or doing things on their own because they lack self-confidence and feel helpless without support
- Difficulty functioning when alone, such as feeling lonely, helpless, or sad
- Urgently seeking another relationship as a source of care and support when a close relationship ends
- Unrealistic preoccupation with fears of being left to take care of oneself
- Difficulty starting or maintaining relationships with people outside their family or immediate circle
- Difficulty doing things independently, such as shopping, driving, or going to work or school
DPD traits that may overlap with ASD:
- Difficulty starting or maintaining relationships with people outside their family or immediate circle (often due to low social/emotional skills)
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