.jpg)
Is there a hidden connection?
Personality Disorders (PDs) and ASDs are distinct yet interconnected psychiatric disorders/ psychological conditions. Despite fundamental differences in their symptomatology and diagnostic criteria, both disorders share certain overlapping characteristics.
Firstly, it is important to establish the defining features of PDs and ASDs.
Personality Disorders are characterised by enduring patterns of thoughts, emotions, and inflexible, maladaptive, or antisocial behaviours, which ultimately lead to impairment in various aspects of an individual's life.
There are several clusters of personality disorders. Each cluster has different symptoms in common:
Cluster A PDs (paranoid, schizoid, schizotypal) are characterised by odd thinking and behaviours.
Paranoid personality disorder is a chronic mental health condition characterised by pervasive mistrust and suspicion of others. Individuals with paranoid PD often exhibit an unwavering belief that others have malicious intent and may engage in deceitful behaviours against them. This deeply ingrained distrust not only affects their relationships but also influences their perception of the world around them, leading to constant vigilance for potential threats and unwarranted outbursts of anger or aggression. They also may display traits of jealousy, secrecy, and a tendency to scheme or plan revenge.
Schizoid Personality Disorder is a complex and often misunderstood mental health condition. Individuals with SPD experience a persistent pattern of detachment from social relationships and limited emotional expression. They tend to prefer solitary activities and have difficulty forming close relationships and may appear indifferent or detached, exhibiting little interest in social interactions or personal connections. While they may function adequately in society, their lack of emotional warmth and social participation can lead to significant impairments in various areas of life, including work and personal relationships.
Schizotypal Personality Disorder (STPD) is characterised by eccentric behaviour, unusual beliefs, and difficulties in social interactions. Individuals with STPD often exhibit distorted perceptions of reality, displaying signs of magical thinking by saying they can see into the future or read other people’s minds. They may display peculiar speech patterns and unusual dress choices as well as harbour a strong need for solitude and isolation. Although STPD shares some traits with schizophrenia, it is considered a milder form of the disorder. Individuals with SPD frequently struggle to maintain meaningful relationships due to their idiosyncratic behaviours and extreme discomfort in social settings.
Cluster B PDs (antisocial, borderline, histrionic, narcissistic) are characterised by inappropriate, volatile intense emotional responses to things/events, etc. and unpredictable behaviour.
Antisocial personality disorder (ASPD) is a complex and enduring mental health condition characterised by a pervasive pattern of disregard for and violation of the rights of others. Individuals with ASPD often display a charming and manipulative demeanour, cunningly exploiting others for personal gain without remorse or empathy. This disorder is marked by a chronic history of reckless behaviour, impulsivity, aggression, and deceitfulness. The antisocial individual may engage in criminal activities such as fraud, theft, or even violence. They tend to have difficulty forming meaningful relationships due to their inability to establish emotional connections with others.
Borderline personality disorder (BPD) is characterised by a pervasive pattern of instability in interpersonal relationships, self-image, and emotions. Individuals with BPD often experience intense fear of abandonment, leading to frantic efforts to avoid real or imagined separation. They struggle with emotional regulation and frequently exhibit impulsive behaviours such as self-harm, substance abuse, or reckless spending. Individuals with BPD also tend to have an unstable sense of self, vacillating between idealization and devaluation of themselves or others. This inconsistency makes it challenging for them to establish and maintain stable relationships.
Histrionic personality disorder (HPD) is characterised by a pattern of excessive attention-seeking behaviour, dramatic emotional expression, and a need for constant reassurance or approval from others. Individuals with HPD often display shallow and rapidly changing emotions, leading to difficulties in maintaining stable and meaningful relationships. They tend to engage in provocative behaviour in order to gain attention or praise and place great emphasis on physical appearance to draw attention towards themselves. Despite their seemingly confident and outgoing nature, individuals with HPD have fragile self-esteem that relies heavily on external validation. This disorder can significantly impair daily functioning, as their overly dramatic and exaggerated behaviours can alienate those around them.
Narcissistic personality disorder (NPD) is characterised by a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Individuals with NPD have an inflated sense of self-importance, believing they are unique and superior to others. They constantly crave attention, praise, and admiration from others in order to maintain their fragile self-esteem. Their interactions revolve around the manipulation and exploitation of others to fulfill their own needs and goals, often disregarding the feelings or rights of those around them. Despite appearing confident and charismatic on the surface, individuals with NPD can be intensely insecure underneath their façade. This disorder not only affects personal relationships but also professional settings where they may display arrogance, entitlement, and a disregard for rules or boundaries.
Cluster C PDs (avoidant, dependent, obsessive-compulsive) are defined by anxious thoughts and behaviour
Avoidant personality disorder (AVPD) is characterised by pervasive feelings of inadequacy, social inhibition, and hypersensitivity to negative evaluation. Individuals with AVPD tend to be extremely shy and reluctant to engage in social interactions out of fear of criticism or rejection. This persistent need for social acceptance often leads to isolation and severe impairment in various domains of functioning, such as work, relationships, and personal growth. People with AVPD may exhibit avoidant behaviours, such as avoiding jobs that involve interpersonal contact or refraining from making new friends.
Dependent personality disorder (DPD) is characterised by an excessive need for others to meet one's emotional and physical needs. Individuals with DPD typically experience pervasive feelings of inadequacy and fear of abandonment, leading them to rely heavily on others for decision-making, reassurance, or even basic daily activities. This reliance can often result in submissive and clingy behaviours as well as difficulty initiating relationships or engaging in independent tasks. People with DPD tend to lack self-confidence and struggle with making independent choices, potentially hindering their ability to lead fulfilling lives.
Obsessive-compulsive personality disorder (OCPD) is characterised by a pervasive pattern of perfectionism, inflexibility, and excessive devotion to work at the expense of leisure activities and relationships. Individuals with OCPD exhibit rigid thinking patterns, an overwhelming need for control, and are highly preoccupied with orderliness and organization. They meticulously follow rules and regulations, often becoming overly focused on details while losing sight of the bigger picture. People with OCPD tend to set unreasonably high standards for themselves and others, constantly striving for flawlessness. This relentless pursuit of excellence can lead to distress and impaired interpersonal functioning. (Although there may be overlaps in symptoms with obsessive-compulsive disorder (OCD), OCPD primarily involves maladaptive personality traits rather than intrusive thoughts or ritualistic behaviours. It is crucial to differentiate between these two conditions to ensure accurate diagnosis and treatment planning for individuals struggling with this debilitating disorder.)
On the other hand, ASDs are heterogeneous neurodevelopmental disorders/ conditions with both genetic and environmental components and varied patterns of persistent difficulties in social interaction, communication, cognitive and sensory processing differences, and restricted, repetitive patterns of behaviour, interests, or activities, with three levels of severity described as levels of necessary support (1) support; (2) substantial support; (3) very substantial support). Level 1 is “highest functioning” form of autism, which also includes those who would have previously been diagnosed with Asperger syndrome (AS). Individuals with ASD level 1 may have difficulty understanding social cues, the body language or emotions of the people around them and struggle to form and maintain personal relationships. However, they have normal intelligence and can carry out their day-to-day activities.
Note: In DSM-5 (2013) the “Autism Spectrum Disorder” diagnostic category was constructed, and it has absorbed the pervasive developmental disorders: Autistic disorder, Asperger’s disorder, Childhood Disintegrative Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (or atypical autism – when a person does not meet the full criteria) (Huerta et al. 2012).
What is the connection between ASD and PD?
Despite the dissimilarities between PD and ASD, researchers have identified a variety of factors in common, indicating a potential association between the two. For instance, impaired social functioning is a core feature shared by individuals with PD and those with ASD, albeit for different reasons: Individuals with PD often have difficulties establishing and maintaining intimate relationships due to their maladaptive patterns of behaviour, whereas individuals with ASD struggle with understanding social cues and norms. Furthermore, both conditions have been found to be more prevalent in males, suggesting a potential gender-related vulnerability.
Moreover, studies have shown a higher prevalence of PD traits in individuals with ASD (HFA/AS) compared to the general population. This suggests a relationship between these two disorders that extends beyond mere coincidence.
However, people with autism and an intellectual disability are less likely to receive a diagnosis of PD (Ghaziuddin 2005; Tsakanikos et al. 2006).
When checking for possible personality disorders in a group of young adults with Asperger syndrome, Lugnegård et al. (2012) showed a considerable overlap of symptoms between Asperger syndrome and some personality disorders.
Historical Note: The Dutch psychiatrist Dirk A. van Krevelen (1971) insisted that Kanner’s and Asperger’s cases “differ considerably”. He analysed clinical pictures of both conditions and came to the conclusion that Kanner’s early infantile autism should be differentiated from Asperger’s autistic personality disorder. Van Krevelen argued that Asperger had identified a personality type whereas Kanner was dealing with children who suffered from some form of brain damage that caused cognitive as well as affective impairments. He proposed using the term autism only for Kanner's syndrome (Vicedo 2023).
Dr. Grunya Efimovna Sukhareva (1925), a Russian psychiatrist, described a group of children with what would be later called AS under the name of ‘schizoid psychopathy’ (‘schizoid personality disorder’).
Findings of most studies suggest that ASD in high-functioning (and former Asperger syndrome) adults is associated with a distinct personality profile even if variability exists (Riinaldi et al. 2021).
___________________