I have experienced trauma my entire life. I just got out of a very emotionally abusive relationship. I developed severe PTSD symptoms in the last few years.
I’ve always felt that maybe I don’t think like most other people I encounter. I’ve always had a hard time connecting to people and seemed to attract some really bad people into my life.
I am very self aware, probably too much so. I am usually well liked and have never really had issues with social norms or anything. I do have some other habits that make me wonder. I’ve wondered if I’m schizophrenic before but I only meet a few of the criteria. My abusive ex tried to convince me I had borderline personality disorder, which I do have some symptoms of. However, these symptoms have lessoned since I left the relationship.
I think I might have high functioning autism, but I have never been evaluated. I am fairly intelligent and self aware so I know to hide a lot of my symptoms.
Anyways, I’m just wondering what are some traits you have?
Not to grill you over this but there’s a common misconception that the term neurodivergent is a euphemism for autism or autism and ADHD. Its intended use was to be an umbrella term to refer to atypical brain function and mental illness: chronic depression? Neurodivergent. Acquired brain injury? Neurodivergent. PTSD? Neurodivergent.
You get the picture.
The next thing is that if you’re in an abusive relationship or you’ve experienced a lot of abuse, it’s really common to develop features of BPD. I’m not a hard skeptic of BPD - there are people who I have encountered that definitely fit that diagnosis, however I’m of the opinion that it’s grossly overdiagnosed, often extremely hastily, and that it’s primarily used as a wastebasket diagnosis these days. So I would gently encourage people to approach this diagnosis with healthy skepticism.
Last bit as an fyi: I know that you meant no malice by it but it’s worth mentioning that the autistic self-advocacy community frowns upon categorising autism based on “severity” or “functioning” because this pathologizes people who are more unusual or who are more obvious in their autistic traits and it also conceals the fact that lots of people who appear to be very capable of expressing the “appropriate” tone, who use body language as expected, who reciprocate in communication, who navigate social interactions gracefully, and who conceal or suppress their stimming behaviour are often the people who, behind closed doors, struggle deeply with the challenges that come with being autistic. Not to make this all about me but I’m high masking, I’m reasonably smart, and I have been completely fascinated with communication and social interaction since childhood so if you met me in your day-to-day life or at a social function (depending on how much effort I’m putting in) you probably wouldn’t notice that I’m autistic. Too many psychiatrists and professionals didn’t see it in me either. Put me next to a solid third of the faculty at your university of choice and I’d say that you would notice more indications of autism in them than you would me. But with that said, I face significant challenges due to being autistic that can make day-to-day living extremely difficult. Also I will 100% be constantly: chewing gum, cracking my knuckles often, rubbing the tips of my fingers together or running them against certain textures, and my toe or knee will be jiggling. But because I’m not rocking in the fetal-position or flapping my hands, it isn’t obvious that I’m stimming in four different ways so I’m able to socially pass. But if I spent 30 seconds flapping my hands? That’s immediately going to make people think that I’m “more severe” or “lower functioning”. Hence why that framing is frowned upon.
Anyway on to your actual question (finally!):
When it comes to ADHD or autism in particular, especially for late self-identifying people, there’s a common trap in that you have built up all sorts of ways to compensate and suppress these traits in you and so you can fly under the radar (Goodness me! An autistic person using a metaphor!? What chicanery is this??) with respect to screening tests, formal assessments by professionals, and even to yourself.
In a clinical setting, autism is defined by three categories:
Restricted or repetitive interests/behaviours
Restricted or repetitive sensory behaviour
Difficulties in social communication
The thing is though, these can be very masked, subconsciously suppressed, or the person in question may be able to compensate well for these traits. The most recent DSM revision makes specific mention of people who were socialised as girls for tending to be, essentially, high-masking and they literally call out horse girls. In what is effectively the bible for psychiatric diagnoses.
So what does all this look like in a high-masking, late self-identifying autistic person exactly?
Having particular topics or interests that you have always been preoccupied with, that you likely know to a degree of depth that is bordering on expert knowledge or which rivals expert knowledge.
That kooky aunt of yours who was a bit of a social recluse and had every single surface in their house decorated with dolphin tchotchkes? Yeah, that’s very likely one of those people who went undiagnosed throughout their life.
If there’s a topic that you have always been preoccupied with or which you have an unusually extensive knowledge of, even if it’s just a particular TV show or the methods of producing pigment in the pre-modern era, then that’s an indication. Note that you don’t necessarily have to have an extensive knowledge of the topic, although it’s very common to develop a knowledge base like that due to the preoccupation with the topic. Is there a particular topic that you could probably present a lecture on for an hour or more without any notes? Is there a topic which you avoid bringing up around others because you have learnt that when you start talking about it, people get bored or insulted and you risk ostracism and rejection if you talk about it so you hold back on it? Is there a topic that you hate hearing other people talk about because they completely misunderstand so much about it that it’s low-key enraging for you?
Those are good indications.
With regards to restricted or repetitive behaviour, that’s a tricky one. This can often look like low grade OCD or it can manifest as appearing as a bit of a control freak but it’s different to both of those things.
Do you have particular ways that you do things—small processes, big procedures, anything in between—that you have a very fixed way of doing because it either feels right or it just makes sense to you to do it that way? That you feel out of sorts if you have to do it differently or change the order of things?
It often appears as having a very strong preference for doing things a certain way. You aren’t going to have a mental breakdown or feel an impending sense of doom if it isn’t done that way, you probably don’t care if other people do it differently to you, but you have a “just so” sort of approach to things.
With regards to restricted or repetitive sensory behaviours, this generally manifests as having a strong affinity for certain sensory experiences - perhaps certain smells, almost certainly particular textures (especially regarding food), or certain ways of moving your body. (There’s more to this but I’m desperately trying to salvage some shred of brevity here.) It also manifests as a strong aversions to similar things, and this is generally easier to identify - are there certain textures, such as particular fabrics, that you cannot tolerate without feeling discomfort? Are you especially sensitive to certain smells or tastes? Is there a particular food texture that you just loathe? Any particular sounds - especially high pitched squeaking, squealing, scraping or scratching sounds that set your nerves on edge?
Note that high-masking late self-identifying autistic people are usually pretty disconnected from their sensory experience and so it may take time reconnecting with your body’s response to things before you realise that there’s a lot of things that you are averse to but which you have trained yourself to tolerate because that’s what is expected.
Last of all is difficulties in social communication. (I’m going to spare you my rant about how this is not accurate and inherently pathologises something which is atypical but not necessarily deficient.)
Social communication difficulties may present in high-masking late self-identifying autistic people as a person who is especially preoccupied with making sure that they are wording things in a “correct” way so that they aren’t misunderstood, social anxiety, focusing on mirroring the emotions and body language and vocabulary of the people who you are talking to, spending a lot of effort to interpret signals and implication and body language rather than not needing to focus and to be consciously puzzling these things out when you interact with people, having a low social battery or being a serious introvert, a lot of people-pleasing behaviours, feeling like you’re like a method actor when you’re interacting with others rather than just being yourself - as if you’re playing a role that is the stage version of yourself (or even acting out a persona that you have developed in order to fit in) instead of just being you, feeling like you are following a set of instructions or a defined pattern or a flowchart when it comes to social interaction, and often realising after the fact that you have made faux pas or you were completely oblivious to what someone else was trying to get you to understand (e.g. people showing romantic interest in you, subtle invitations, seeking reassurance, perhaps even people being backhanded or passive-aggressive).
I could go on about this for a long time, clearly. But I’ve rambled too much already.
So parting thoughts:
Autism co-occuring with ADHD takes on a shape that is significantly different from either when they occur separately
Things like mental illness and significant experience of trauma can present similarly
Autism is something that starts at conception, so it’s not something that develops later in life and so these traits should have essentially been with you throughout your life
The ability to compensate for autistic traits often conceals them, even from the individual themselves
It’s better to focus on how difficult certain things are than to focus on how well you manage or perform in the domains above
Not all traits are going to be applicable and they aren’t necessarily going to be applicable all the time
It’s easier to assess your social functioning when you are exhausted, distressed, and when you are in novel or unexpected situations - in high masking autistic people this is where the traits tend to be much more apparent
I haven’t even touched on ADHD
I just realised that I didn’t touch on stimming aside from at the top part where I described a few behaviours in myself.
So there’s a lot of be said about repetitive physical behaviours, generally known as stimming, (and my comment above doesn’t have room in the character limit for me to edit this part into it 😬) and the distinction between autistic stimming and allistic (non-autistic) stimming is actually surprisingly blurry - stimming kinda problematises and stigmatises autistic self-stimulatory behaviour when just about anyone is going to rub or apply pressure to a bruise when they get hit, they’re going to move their body to a rhythm, they’re going to sing or whistle or hum.
In autistic people, stimming behaviour is much more common and sustained - an allistic person might whistle to themselves every now and then but an autistic person may hum a lot of the day every day, for example.
There’s also so many different ways that stimming manifests that it’s almost impossible to list in a comment. I can go into more depth on this in a reply if anyone’s interested but know that this offer also comes with a serious mucho texto warning.
I also forgot to mention that the above comment is focused on describing autism from the perspective of internal experience over external observations because it’s easy enough to find the info about the external observations but imo this is significantly lacking in dimension and it’s much less useful for late self-identifying autistic people in particular.
Somebody I know and like very much has bpd and with all respect for your other points I don’t think you should approach that diagnosis with that much scepticism. A lot of people with bpd just get sorted as “bad people” and dumped with their needs unadressed. I have no stats on rates of misdiagnosis but bpd should definitely be taken serious. It doesnt help that it makes people act seemingly manipulative in very clumsy ways: bpd does heavily isolate people bc the assumptions is they are liars and use the diagnosis as a shield after you were on the receiving end of one of their outbursts. What is true is that it’s very hard to help somebody who has the diagnosis from the outside. These are personal experiences, so maybe I am not seeing the larger picture
I didn’t go into much depth on my position on BPD because it was outside of the scope of my reply.
I think there’s a trend in mental health for professionals to diagnose people with BPD on the first visit or first admission to hospital without taking the time to assess the history and current circumstances of the patient. There’s also a lack of recognition of the impacts of trauma, especially if it’s fresh or it’s a person who has experienced significant institutional trauma. Another aspect is that BPD is often used where a clinician is disinclined to investigate dual diagnosis or comorbidities, or even just complex circumstances. With regards to this, it’s sorta tangential but I worked in an organisation that would conduct the MMPI on candidates. One candidate had just gone through a very recent and messy breakup just before taking the MMPI and the results that came back from this, as interpreted by the expert in the MMPI that we would consult, indicated that this candidate was a huge walking red flag. Without going into depth on it, this wasn’t actually the case and it was just reflective the emotional state of the person at that particular moment in time. Of course this isn’t the exact same thing but when someone presents at an emergency department in a mental health crisis, it takes a very skilful head psych to recognise the difference between diagnosing an emotional state and diagnosing the patient in a holistic sense.
BPD often gets used as a “too hard basket” or Mental Illness-Not Otherwise Specified diagnosis. There’s a major gender divide in diagnosis too, where afabs get BPD diagnoses and amabs get PTSD diagnoses, even when presenting with similar symptoms.
Last of all it’s really common for late-diagnosed autistic people and ADHDers to get misdiagnosed with a mood disorder prior to getting an accurate diagnosis, and BPD is one that comes up often here. There was a recent study has found that, of a range of medications, one of the most effective (and only effective ones) for BPD is methylphenidate, aka Ritalin. Of course, the overwhelming majority of the people in the study were women due to the gender disparity of BPD diagnosis. Without delving into the nitty gritty of the study design, my immediate question is - how many of those subjects are women who are actually ADHDers who have been misdiagnosed with BPD? Because there’s another cohort of people that respond in a similar way to methylphenidate and there’s a lot of overlap between this demographic and the one that the study targeted.
Like I said in above, I have encountered people who are genuinely BPD. I’m not saying that it doesn’t exist or that it shouldn’t be taken seriously, far from it, and I’m not going to try and convince anyone that my opinion holds more water than a mental health professional, it’s just that in my opinion the diagnosis of BPD needs to be viewed with healthy skepticism - is the person who is trying to convince me that I have BPD an abusive partner who is not a professional in a clinical setting, as OP described? Does the person have a history of recent trauma or significant childhood trauma? Is this a first-port-of-call diagnosis or one which is being made in an urgent care setting? Has substance use disorder been considered as the cause of the symptoms that the patient is presenting with? Have other conditions, especially autism and ADHD, been overlooked? It’s in these sorts of situations where I think that healthy skepticism of BPD diagnosis is crucial.
That’s not to say that all BPD diagnoses are incorrect under those circumstances, at least aside from the abusive partner example, but it needs to be weighed against considerations like those ones.
With all that said I’m wondering if I’m using the term skepticism to refer to like a rigorous, scientific approach to assessing how the symptoms and their etiology stack up against the diagnostic criteria but it’s giving the implication of skepticism in the sense of something like “climate change skeptic” or “COVID skeptic”, which is just a sort of reflexive rejection of facts and essentially the opposite of what I’m trying to imply with that wording choice.
Oh right, so you are coming from a very different angle. Yea, my bad. I was seeing very heavy “bad actors ruin bpd for the REAL bpd sufferers” yesterday and that shaped my perception of the paragraph. Thank you for the elaborate and thoughtful reply! I do agree with your points now
Oh yuck. Lol. That’s a really gross attitude for someone to hold.
It’s all good though, I’m glad that it was just a miscommunication and I appreciate you sharing your thoughts and giving me the opportunity to clarify.
I know it’s no consolation but there’s a similar sort of civil war raging within the autistic community - on one side is a faction where people are claiming to be the “real” autistic group, to the exclusion of higher support needs and non-speaking autistic people (these are the “it’s not a disability, it’s a superpower” types and the ones who refuse to recognise that there are difficult/harmful aspects of autism, even if they do not personally experience them, such as stims that can cause serious injury or having an extremely restricted diet to the point that it negatively impacts your health) and then on the other side is a faction that essentially wants to re-establish the Asperger’s-Autism diagnostic divide because the lower support needs autistic people are “taking over” or, sometimes, that they are “stealing” supports and services from the people who genuinely deserve them. It’s a real mess and I don’t see it clearing up any time soon. The autistic community desperately needs its own Huey P Newton figure, I think.
Yeah, I wanted to get active in my local “queer” stuff and it’s too much infighting and the well-off people dominate and make it into like protest pyramid schemes and municipality funded cop hugging parades… I am also autistic, but besides professional ngo career people there is no one speaking in our name in my place and the ngo people are doing a godawful job obviously. My idealist impulses said that solidarity needs to like make a comeback (if it ever was there)but obv it’s not that easy
For whatever it’s worth, my therapist has mentioned multiple times that bpd is over diagnosed and (some? A lot?) of his clients with it end up having something else, and do much better after getting rediagnosed and treated differently.
But yes obviously it’s real, the sufferers are real, all that.
SI
The suicide rate for people with bpd up to a certain age is pretty high, maybe that’s why I am so concerned about it being seen as a “non-serious” diagnosis
Could you speak on ADHD and Autism co-occuring?
Certainly can. I think that’s going to be a long one and I’m gonna have to sit down and dedicate a chunk of time to coming up with a good response so it’s going to take me maybe 24-48 hours to get that sorted out.
Done!
I approached this topic from an internal, experiential perspective because that’s honestly the best I’ve got - there’s very little info out there on auDHD.