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.
The restructuring is not complete, though: a concession was granted to allow borderline personality disorder to remain for the time being due to industry concerns related to reimbursement, but the plan remains to ditch it eventually.
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?
I dislike the term because it is, in fact, not that common.
I am diagnosed ADHD but I don't have any symptom of autism (sensory overload, difficulty reading social cues, gender dysphoria, repetitive behaviour etc.) and I wish they were studied separately as the physiology, pharmacology and the effect on quality of life is completely different between ADHD and autism.
Without mentioning the effect on focus and executive function, which is basically all ADHD is, and presents the complete opposite in autism: repetitive behaviour and long-lasting focus in niche interests vs squirrel brain with flashes of hyperfocus.
If they seem comorbid on social media profiles, it might be because everybody and their dog seems to have ADHD today, so is pretty much meaningless. You could attach it to any personality disorder you wish.
Your understanding of ADHD is very limited and doesn't reflect the true scope of what ADHD entails.
Also, a lot more people being diagnosed with ADHD (who were previously masking and "blending in" while secretly suffering) doesn't make the word meaningless.
> (who were previously masking and "blending in" while secretly suffering)
Do you mind helping me understand this more? How can one mask ADHD symptoms? I have ADHD, and I cannot conceptualize what masking would even look like. Or perhaps, in better terms, what is the difference between masking ADHD and adhering to social expectations and norms?
What would not masking the condition look like? Is masking a bad? If one can mask their condition then is their condition generally less severe than those that cannot mask their condition?
I am just trying to understand because I feel like masking is the new pop-psychology term that keeps popping up, and I find it hard to discern what the nuance surrounding it.
Maybe they meant self-medicating? I used to be a heavy smoker, quit 4 years ago, and in hindsight quitting made me aware I had debilitating ADHD and I couldn't function.
I recently made the connection between quitting nicotine and my life spiraling down, that I reintroduced nicotine patches and I have found that they are better, cheaper and longer lasting than any amphetamine I was prescribed.
> I think overall the health effects are less negative
Possible but in my case amphetamines last 4 hours (lisdex lasts 6), and make me very hungry, horny and exhausted by 7pm. Also, they feel like I am the cart and the meds are the horse, i.e. they pull me around to do stuff even when I just want to relax a little.
Nicotine on the other hand gives me motivation, focus is still a bit iffy and not as pointed as with AMPH, but OTC patches last 24 hours, are cheap and don't make me tired at all (I remove the patch 3 hours before bed). Also I can drink coffee again without feeling like my heart's exploding, which is a major plus.
It's been 2 weeks of this nicotine experiment, and I feel more like myself than a very driven machine attached to an 8 hour battery. I'm using 7.5mg patches (15mg nicorette cut in half)
My med dosage was relatively low btw, I'm pretty sensitive to amphetamines. Nicotine by itself seems to be as dangerous as caffeine.
In any case, there is a lot of research correlating between nicotine inhalation (even from second hand smoke) while in utero or in youth and ADHD. My pet, non-scientific theory is that for some, their ADHD is simply "chronic nicotine withdrawal". The fact that there are a lot more diagnoses these days might be because smoking is not in vogue any more, everybody wants to quit (rightly so), but our smoking parents permanently ruined our growing brain in childhood, as so did the past 5 generations.
I personally noticed a steep drop off in efficacy once I built up tolerance each of the handful of times I’ve tried and then given up using nicotine as a medicine. It’s low reward and high risk (full blown addiction).
Interesting about your parents smoking. Mine did also, chain smoked with me in the car basically hot boxing and all their friends did too.
How did you use nicotine? The addiction/tolerance potential is proportional to how quickly it gets in your brain. Smoked/inhaled nicotine takes 7 seconds, a patch takes about 4 hours to reach peak blood concentration.
Also I do not recommend tobacco, which is much more than nicotine.
for example picking jobs (and choosing partners) that give/impose structure is a form of masking. overcompensating is another.
adhering to norms, okay but to which ones? how do you know when the norms are shifting? are you pushing for change, rocking the boat with a the trailblazers or are you cooling heads and pitching for the status quo? and of course this is where the neurodiversity dilemma is very visible, because is "pushing for change" in your personality or it's the "neuropathology"? sure, a bit of both, but if someone is bad at managing changes, seeing transformative projects to completion, then ... maybe they would fare much better if they could stay put on their butts instead of joining the youngsters (to escape the otherwise incomprehensibly harsh boredom).
> What would not masking the condition look like?
ideally, accepting that someone is simply a 1000-fold more sensitive to "boredom", getting accommodations for it, while still doing the same "boring old job" as others (instead of running away with the proverbial circus)
> If one can mask their condition then is their condition generally less severe than those that cannot mask their condition?
well. in some sense yes, of course. but maybe because they are better at keeping their mouth shut and pushing through adversity, they are in a more precarious situation in life, they simply don't have the luxury to not be okay.
for example is being rich and having the possibility to not work for months (or job hop for many years), go to fancy therapy centers and evaluations, better than being forced to work low-paying service jobs for decades?
is masking good? since it's a very broad concept (maybe if we want to somehow encapsulate it we might call it a collection of tools) the various forms have different good and bad consequences.
being kept accountable usually helps for some ADHD people. but if one's ADHD mostly manifests as various nasty emotional regulation problems, then it just condemns one to a life of depression and anxiety (impostor syndrome, low self-esteem, etc.) and here masking is just "suppressing problems" which is hopefully obviously bad.
also simply having some kind of diagnosis, knowing one's limits, weaknesses and occasional strengths helps dealing with life.
I mean neither are particularly well defined or well understood diagnosises. Just identify with whatever helps you get through the day we're all in this together. I've been diagnosed with quite severe ADHD but the psychologist admitted I was displaying several autism symptoms as well so really it could be either but the fastest route to treatment here in the UK is ADHD (still shockingly slow). Seeing as the symptoms and treatments overlap and our medical systems are generally poorly equipped to deal with either I think fussing the line is a bit of a waste of time. Also not that many people are diagnosed or identify as ADHD, most people are neurotypical hence the typical bit, if you feel like ADHD is everywhere you need to get out of whatever echo chamber has been designed to make you angry about it. More love.
well, yes, but no. there's a huge overlap, and AuDHD seems more than just the sum of its parts:
"Additional analyses revealed that individuals diagnosed with both ASD and ADHD are double-loaded with genetic predisposition for both disorders and show distinctive patterns of genetic association with other traits when compared to the ASD-only and ADHD-only subgroups."
"We identified seven loci shared by the disorders and five loci differentiating them. All five differentiating loci showed opposite allelic directions in the two disorders and significant associations with other traits, e.g., educational attainment, neuroticism and regional brain volume."
Communities are going to make language. It's what communities do. Gamers used to say Shazbot. Did we need another exclamation? No, did we adopt a new one and use it for awhile? You bet we did.
AuDHD is a neologism that some communities use. It might stick around, it might go away. We'll know if we needed the new term if it continues to be useful to people.
I think there's kind of an issue with society when we start viewing people with shared neurodivergences as a "community"
I'm diagnosed ADHD. I'm not a part of any "ADHD community". I'm not shy about sharing that I am, but it's also not some kind of "out and proud" thing for me. It's just a part of who I am, and it's a diagnosis of why I struggle with some things that other people don't
That's all it should be. Not everything needs to be a community.
I would go even further and say that many things shouldn't be a community, especially an online community . People need to build connections with their physical neighbors more than they need a community of fellow autistic or adhd people online
I wouldn't draw the line at "community", I'd draw it at "identity". It's one thing to be something, for example, I'm a picky eater, it's another to build your existence around that fact. Being a picky eater is not part of my identity, it doesn't define who I am, it's part of who I am, surely, and I wholeheartedly accept it, but if I woke up one day and craved some cauliflowers I would still be me.
I could be a part of some picky eater community, I guess, but I would quickly grow uncomfortable with it if it revolved around cherishing and celebrating how we are picky eaters.
I think at some point we took a wrong turn in the identity-based paradigm of society we now find ourselves into, and in our zeal to achieve self-acceptance, empathy and compassion we went from "you don't have to be defined by things you don't want to be defined by" to "you are defined by these and that's great". Everybody is free to base their identity around whatever they want of course, but I can hardly think of anything more dull than basing your being around some mental quirk.
Your identity is anything you define yourself with. You just identified yourself as a picky eater -- that's part of your identity. However, you choose not to make it a celebrated, core, or significant part of your identity. That's fine.
If you said "I am not a picky eater ", that's denying it's part of your identity.
Ones identity is simply the set of all traits they would use to self describe. Parts of one's identity people will push forward and parts they'll not ever emphasize or show.
ADHD is not a "mental quirk". It's a serious condition that often make people incompatible with modern world. It's like being blind. Everything blind person is doing in his/her life is affected by being blind.
I can't hide mine. People can smell it like a hound. I guess it comes with the territory when you are overtly hyperactive in your 30s. I'm not proud of it either, but I wish I could go through life a bit more discretely.
> People need to build connections with their physical neighbors more than they need a community of fellow autistic or adhd people online
Absolutely. ADHD is too diverse and too common to be a focal point of a community. Other ADHD folks are great for creating a pity-party echo-chamber, but I tend to be more pragmatic and am more interested in solutions, which said communities tend to lack in my experience e.g., all the various subreddits.
I've seen this, fwiw, in that there's less of a disability community around adhd than say autism or deafness. That said, there are probably thousands of adhd communities, some which fall into self pity and some that are very "gimme solutions please". Just a matter of finding one that works for you if you want to find one.
I'm sorry you haven't found a community to share in your disability.
Communities are incredibly useful for some disabled folks to share strategies, check experiences ("does anyone else experience... how do you deal with..."), and talk with people who will understand you better than someone without your disability.
What you are describing is isolation from others who might connect with you. No one is suggesting you only participate in communities associated with your disability, just that those communities are often incredible resources and sources of strength.
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.
Thank you for making such a well thought out comment. Describing ASD/ADHD and NPD/BPD as extremes on different axes, and relating that extremity to facets of their behavior, especially with regard to cults, is brilliant.
I've heard from a clinical psychologist and also from a bunch of people on the internet that the symptoms of BDP are often presented by (especially female) traumatized autists, and they run a high risk of being misdiagnosed with BDP. and based on the diagnosed (entirely AFAB) autistic people I know socially none of them show any signs of being unaware of or unmotivated by social validation.
Also there is a high overlap between autism and ADHD, many people have both characterizing them as opposite ends of a spectrum sounds like a stretch.
> Also there is a high overlap between autism and ADHD, many people have both characterizing them as opposite ends of a spectrum sounds like a stretch.
I think it's only a stretch if you think that someone only exists at a single point on that spectrum. If it's more like a spectrum of characteristics, then wouldn't it seem like strong autistic characteristics could exist at one end, strong adhd characteristics could exist at the other, and a lot of the shared overlapping characteristics exist in the middle?
A family relation I know exhibita both BPD and NPD. If your description is correct, that theyre opposite extremes on the same scale, I can only imagine the internal mental and emotional chaos.
> 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.
ADHD (or maybe autism?) isn't about social rejection, it's about the opposite. Sometimes people will try to reject you/put you down ("haha, you wear glasses, four-eyes"), but you don't understand the intention ("yes, this is accurate") and are just puzzled that someone would say a fact out of the blue.
Correspondingly, you might mention a fact "these jeans make your ass look fat" without meaning any judgement, and the person will take it as a rejection. That's why this is hard to navigate, not because people reject you initially.
You're describing social impairments, which are there too, but this is a different issue. More common with people that have very severe ADHD symptoms, moreso than ASD ones.
What causes the "ADHD as extreme follower" issue -- which I have speculatively explained as a concequence of repeated social rejection with the capacity and desire for acceptance.
This is quite different than in actual BPD where I'm not even really sure BPD people actually understand social acceptance or really want it. It's more extreme than that: there isnt a basic capacity for identity developed enough to actually have a BPD person understand that they are or are not accepted. Not least, since most BPD are actually readily accepted into most social groups over the short term. Whereas in ADHD, impulsive responses impair that acceptance over most time horizons.
> 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.
A therapist once told me that depression is overthinking the past while anxiety is overthinking the future.
Was an interesting way to think of how they are two sides of the same coin.
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.
I am autistic and this describes exactly my experience with my ex-wife - extreme emotional dis-regulation, extreme avoidance of shame by any means, doubling down in increasingly bizarre excuses if called out and I was the best thing ever happened to her, until I wasn't maybe 8 years in.
Thing was, it wasn't all bad by any means, and I had come to accept her for who she was, but she couldn't.
In the end she decided to placate her internal ghosts and demons and bailed, rather than consider the real life people standing in front of her.
I wasn't the first, or even the second, in her life to experience this cycle.
I had made the mistake of thinking I would be different.
> 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.
There was a very interesting article in the New Yorker about the issue with the DSM. Turns out we now have research which shows that people get very attached to the little box they are put in by the DSM and that influences how their symptoms evolve. [0] Meanwhile, evidence seems to point out that "disorders" exist on mostly continuous scales with multifaceted issues and the relevance of having boxes is far from obvious.
> Turns out we now have research which shows that people get very attached to the little box they are put in by the DSM and that influences how their symptoms evolve.
After being diagnosed with something in the DSM - I experienced this myself, and have been very aware of the Heisenbergian side effects of labelling and observing something like this in a specific concrete way.
Common wisdom with some psychological diagnoses is that the symptoms often seem to get worse after diagnosis because you start to notice the problems more. But I think there is an "identity" element to this too as you elude to.
I think this is somewhat inevitable, but the question is, even though you may be subconsciously influenced by the diagnosis itself - is it still better to have such a diagnosis and to be able to work with that information - versus not?
From my own experience, I'm not quite sure - but I'd probably lean towards having the diagnosis still being the better option.
This is a trend I noticed lately. Being autistic is trendy for instance, people talk about it on social (!) networks, about their lives and all that, which is, if you believe what they are saying, is pretty much normal, save for a few personality quirks, like, well, most humans.
I may be wrong but the "little boxes" in the DSM are not supposed to be an identity. They are supposed to represent a pathology, essentially, if one of the boxes is checked, then you need help. Which box is an indication of what kind of help is the most appropriate: a drug? which one? counselling? hospitalization?
It may be a continuous scale, like most diseases really, but how much help you need has to be quantified in order to take action. That's what the "little boxes" are for, or at least, that's how I see it.
> They are supposed to represent a pathology, essentially
The diagnosis in the DCM are built very strangely. They are basically cluster of symptoms which are statistically seen to occur together in reports (which are necessarily self report the field being psychology).
It does for a somewhat arbitrary definition of what is a pathology. The DSM has a disproportionate impact on what is and isn’t covered by insurance in the US but isn’t overall a very good tool to decide what treatment is the best and I don’t think doctors base their recommendation on what people check or don’t check in the DSM.
> like most diseases really
Psychology is fairly unique in medicine in that we have very little idea of what’s the actual root cause of people mental disorders.
A "personality disorder" is also not static. The idea is that you work with it and heal aspects that make life (more) difficult for you, so you do not have the disorder any more. Not that you make it a part of your identity and demand others to accept your "unique style".
Being put in the convenient box is commonly the difference between getting social security payments or being thrown to the wolves. Of course people are attached to the little box when it determines much of your life.
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]
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/