Autism Spectrum Disorder vs. Borderline & Narcissistic Personality Disorders

Autism Spectrum Disorder vs. Borderline & Narcissistic Personality Disorders


Welcome to my scientifically informed insider look at mental health topics. If you find this video to be interesting or helpful, please like it and subscribe to my channel. Hello, this is Dr. Grande. Today’s question is how can we differentiate Autism Spectrum Disorder (ASD) from personality disorders? So here specifically when I talk about autism spectrum disorder I’m referring to the high-functioning end of the Autism spectrum and a presentation that doesn’t have intellectual impairment. I’m using a couple of different articles for this video and I’ll put the references for those articles in the description for this video. So we know that when we talk about Autism Spectrum Disorder and we’re talking about high functioning Autism without the intellectual impairment, we know that this particular type of presentation is often diagnosed late in life. It’s often misdiagnosed and a lot of the time it’s confused with personality disorders. So somebody may be diagnosed with a personality disorder instead of Autism Spectrum Disorder and one of the difficulties here is that Autism Spectrum Disorder and personality disorders share a few different things in common and one of those features is they’re both egosyntonic. Which means that there’s a lack of insight. It means when somebody looks at their behavioral characteristics and their thinking and their feelings, they find them acceptable even though they lead to dysfunction. That’s what ego-syntonic means. Now distinguishing Autism Spectrum Disorder as I’m talking about it here with personality disorders is challenging and it does require careful assessment including childhood behavior and development over the lifespan and there’s really a lot to it. There’s a lot of components that have to be assessed when you’re trying to differentiate these disorders. But here in this video, I’ll be talking about some of the elements that are in common between personality disorders and Autism Spectrum Disorder and some of the dissimilarities, some of the areas that might help to differentiate these disorders from one another. So to help with this differentiation, I’m going to be looking at Autism Spectrum Disorder and specifically 2 personality disorders: Borderline Personality Disorder and Narcissistic Personality Disorder because these are the ones featured in one of the articles that I read but also these two personality orders are the ones that are most likely to be confused with Autism Spectrum Disorder. We see that every now and then Autism Spectrum Disorder is confused with other personality disorders, but it’s just not that common. So let’s take a look at these disorders individually. So with Autism Spectrum Disorder, we know that this is listed in the Diagnostic and Statistical Manual (DSM-5) and here we see this disorder is characterized by deficits in social communication and social interaction. As well as restrictive, repetitive patterns of behavior, interests, and activities. Now when we move over to the personality disorders again specifically Borderline and Narcissistic (BPD and NPD) we see that these are both Cluster B personality disorders. So they’re both in the same cluster, the dramatic erratic cluster. With Borderline we see a pattern of unstable relationships, unstable mood, impulsivity, identity disturbance, anger, a chronic feeling of emptiness and we also see an increased risk of suicidal ideation (gestures, threats and other behaviors) With Narcissistic Personality Disorder (NPD) we see characteristics like being arrogant, being jealous other people, having a lack of empathy, requiring excessive admiration, a tendency to manipulate people and having a sense of entitlement So there is some overlap between BPD and NPD but usually we can distinguish these two from one other. It’s also important to remember that Borderline and Narcissistic personalities can be co-morbid and Autism Spectrum Disorder (ASD) Can also be co-morbid with these personality disorders. So just because somebody has a diagnosis of ASD doesn’t mean that the personality disorders would be excluded. Somebody could have Borderline & ASD, Narcissistic & ASD or all three of these disorders. Co-morbid presentations are a little more complex (when somebody has been one disorder) and specifically, we know that when somebody has ASD and BPD at the same time, there’s an increased risk of suicidal ideation. So it is important to correctly identify and diagnose these disorders because the risks are different depending on what combination of disorders somebody presents with. If we look specifically at NPD and compare it to ASD and look at some of the similarities and dissimilarities we see that individuals with NPD tend to focus predominantly on themselves and we also see this with ASD. We also see reduced empathic abilities. So a decrease in empathy. And I mentioned that lack of empathy specifically with NPD. We also see that with ASD. Now the way the lack of empathy appears in each disorder is a little bit different and it gives us some idea of how we can differentiate between the two disorders. With NPD, we see someone who has reduced *emotional empathy. For example, they don’t demonstrate as much sympathy and compassion. With ASD we see more impaired *cognitive empathy, which is a difficulty recognizing and defining emotional expressions in other people. Now something else that’s interesting about NPD is that individuals with this disorder usually don’t have difficulty identifying the feelings of others but they’re less interested in other people’s mental states. So this is why we believe we see less empathy and compassion, it’s the level of interest that’s actually decreased. So those are some of the differences between NPD and ASD but what about BPD and ASD? (Borderline Personality Disorder and Autism Spectrum Disorder) Well here we see a lot of similarities. We see similar levels of social avoidance, callousness, restricted expressiveness, persistent difficulties in interpersonal relationships and we also see intense anger in both of these disorders. There’s another characteristic shared between these disorders as well. It’s called Systemizing and Systemizing is when somebody can identify rules and patterns, and actually it’s considered a strength and the level of Systemising that we see for BPD is actually quite similar to what we see with ASD. Another similarity is self- injurious behavior. We see this with both BPD and ASD. But just like the lack of empathy that we see with NPD and ASD, we believe the mechanism and the manifestation is a little different. So when we talk about self-injurious behavior with ASD we usually think of it as reducing aversive inner tension caused by a sensory overload. So somebody is in an environment where there’s just too much going on, there’s too much stimulation and that self-injurious behavior kind of releases tension. (This is with ASD) Now with BPD we see kind of a different setup when it comes to self-injurious behavior, a different characteristic. We see someone who is injuring themselves because of interpersonal reasons. Maybe they’re angry or trying to get attention We also see emotional or affective reasons like to relieve anxiety or to decrease emotional pain. We also see cognitive reasons like if somebody’s trying to punish themselves or if they’re feeling numb. So we see a lot of differences there between these two disorders when it comes to the self-injurious behavior And again, really understanding the details of *why somebody is engaged in that behavior can help us to differentiate. It can help us to know which disorder may be present. Another characteristic that’s shared between BPD and ASD is suicidal ideation and specifically with the type of presentation of ASD I’m talking about here, (high-functioning and without intellectual impairment) We know that with this type of presentation, rates of depression are fairly high and suicidal ideation is high. Of course, when we see higher levels of depression, we normally do observe higher levels of suicidal ideation. This is really to be expected. And with BPD, Suicidal ideation is fairly common as well. So again, this construct is something that’s shared between BPD and ASD. So those are some of the ways to differentiate these disorders based on symptoms and how the symptoms manifest and why they manifest but what about personality? Are there personality differences between ASD, NPD and BPD? This is actually a really interesting question because we know that NPD and BPD are both personality disorders. So the personality characteristics of those who have those disorders has been studied fairly extensively and this particular study that I referenced in the article that deals with ASD, NPD and BPD really looked at how ASD was different than NPD and BPD, what we could see in autism spectrum disorder that may be able to be used diagnostically. Now the way they compared the personality characteristics was using a model called the five factor model and the five factor model is very popular and it’s well studied. There are five big traits in the model. I remember them through the acronym OCEAN, openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. And what we see here is that when we compare ASD to NPD, ASD has lower openness to experience and lower extraversion. So being more Introverted. We also see higher conscientiousness and we see roughly the same levels of agreeableness and neuroticism. When comparing ASD to BPD, There are some similarities and some differences in terms of what we saw with the NPD comparison. We still see lower scores with ASD on openness to experience and extraversion but in terms of conscientiousness we see much higher conscientiousness with ASD as compared to BPD and lower neuroticism with ASD as compared to BPD, but the agreeableness trait is the same between both of these disorders. So there we have some ways to differentiate these disorders based on the symptoms and characteristics as well as personality profiles. Although this research did note that we don’t have a lot of information about these particular differences. So we have to be careful jumping ahead and using these diagnostically as if they’re 100% valid. They may be helpful diagnostically, but the results of the study are far from definitive. Now when we talk about autism and personality disorders, I’ve received a lot of questions on this topic and that’s of course why I covered it in this video And it’s interesting because I think in the mental health community there’s this idea that autism is *easy to spot and rarely comorbid with other conditions and you really wouldn’t expect somebody to have autism spectrum disorder and to go into adulthood without it being detected and of course, we know that Autism spectrum disorder is not easy to spot. It’s often comorbid with other disorders and it’s often undetected. So I think there’s a lot of misinformation and misunderstanding around autism. I think also on the mental health community, clinicians tend to look at autism spectrum disorder and just kind of put it way off in a category by itself. So they create a lot of distance conceptually between autism spectrum disorder and personality disorders. But really, they’re closer to each other than one may think. And again, that’s what these studies really looked at. These disorders can be easily confused with one another. If you have any thoughts on autism and personality disorders. If you agree or disagree with something that I indicate in this video, please put those thoughts and opinions in the comments. As always, I hope you found this description of autism spectrum disorder and personality disorders to be interesting. Thanks for watching.

100 comments / Add your comment below

  1. Dr. Todd, please cover the idea of empathy in NPD and ASPD. I thought I heard you say that those with these disorders even sociopaths may have empathy but they disregard it. I had thought someone with severe sociooathy was devoid of any empathy. I have an autistic daughter who is moderately severe. I do recall some minor signs of empathy before regression into autism.. I think she may be slightly affected by others tears but with very minor ability to understand language this is extremely limited.

  2. Sweet Jesus I've been looking for somebody to help explain this for a while.
    The question I have after watching this is what sort of treatment is available for ASD, if any. 
    So, off I go.
    Thanks again for a great video.

  3. Thank you for your excellent presentations. Do you have any thoughts on Avoidant Personality Disorder and Autistic Spectrum Disorder? I had a diagnosis of PDD-NOS at age 12 in 1977. I only found out about this 3 years ago. I have had a Dx of AvPD and Major Depression for the past 10 years. I was tested in a clinic for ASD two years ago but they said it was inconclusive because of my age and coping skills. I feel a Dx like Aspergers generally fits and my AQ scores were very high.

  4. I have autism but also some pretty extreme narcissistic personality traits, always wondered what the connections are. it was worse when I was a child, as narcissism is for most people lol, but I used to manipulate and mess with people for my own entertainment or gain – told lies about an event to a person who was present until they believed my version to be true, allowed boys to develop crushes on me so they would buy me things etc, compulsively stole things. only as i've got older have I stopped these behaviours, because my ability to feel empathy has become strong enough to stop me acting badly. I always felt a lot of guilt as a child but it never deterred me from stealing or gaslighting people. I think I wasn't recognising my own unhappiness as an undiagnosed autistic child and that stopped me from understanding that i shouldn't do to others would i wouldn't want done to me. However I still deal with thoughts of selfishness and urges to take things that aren't mine, to make up stories, and if my partner shows any level of attraction to someone else I will silently be enraged/explosively jealous even though I know logically it doesn't mean anything. It also affects my self esteem – I have these perfect standards for myself that I can never meet, because somewhere deep in my brain i believe I am or have to be an extraordinary person. It's like having two people in my head at all times lol

  5. I was diagnosed at 16 with ADHD. After doing years of my own research I suspected that I had Autism Spectrum Disorder (specifically Asperger's Syndrome – which they no longer use as a diagnosis). I went through full psychological testing about two years ago, at 37 years old, and I was diagnosed with PTSD, ADHD, and Autism Spectrum Disorder. I think a lot of people don't realize that autism presents differently in females than in males. Dr. Tony Attwood has done a lot of work on females with Asperger's Syndrome. Thank you so much for your videos and insight, Dr. Grande. I appreciate you so much!

  6. And I thought I was the only person who was confused about some of this. You have locked onto a great forum – your subscribers ask great questions! And Thank you again 🙂

  7. Thank you for being factual regarding this (you're the most factual source I've found on here so far)…I was going to ask you to look into ASD further. It'd be awesome if I could go to someone like you over here but whose specialities also include ASD and ADHD along with other lovely "quirks" that can accompany It like Auditory Processing disorder etc. Also comorbidity, trauma, not following stereotypes regarding gender and autism so much…I don't feel I've a male or female brain.. I've always had a complex that I'm not female enough or that I'll be mistaken for a male. I'm not transgender but I'm not "butch" either I'm just not feminine in the way most women are.. I've also been mistaken for being a lesbian, I'm not but recently I've discovered I must be Bi. It's extremely frustrating at times that ppl assume Bi isn't a real thing. It is…Imo the 'straightest' ppl are full homosexuals lol.
    Backtracking, there's many comorbidities with ASD and ADHD.

  8. Thanks a lot for the video, it did clear up a lot! As others have commented, i think the sensory issues can be a good marker to distinguish apd from personality disorders. I also hold the belief that if a patient is diagnosed correctly and are educated about the disorder, they might come to a point where they feel reliefed. At least that's what i guess why many patients are angry about false diagnosis – they must have suspected that something is wrong, or it didn't feel right. Of course, that would be more true for certain disorders than for others.
    Anyway, what I actually wanted to say: great video

  9. I can see how asd can be mistaken for both of these. I know I bloviate like a narcissist, and I know some apsies that have been diagnosed borderline too. Women aspies get diagnosed a lot with borderline, but I present like a typical male aspie so narcissistic it is.

  10. Dr. Grande, what do you mean "lack of insight" in people with ASD, and what are the treatments? I've been diagnosed with ASD as an adult.

  11. The great difficulty of psychology is the absence of causation as a descriptor of disorders.
    The rest of medicine operates mostly by classifications based on cause.

  12. How does Anxiety play a role in these disorders? I feel like I was misdiagnosed and it's all Autism. My two oldest sons and me feel like we have our own language if it makes sense.

  13. My family pushed me to get tested for Asperger's (ASD) when I was in my 20s and was diagnosed with Schizoid PD instead. The older I get the more I believe I was misdiagnosed and really have ASD. I would love a video comparing ASD and SPD.

  14. Thank you as always, Dr. Grande, for a very informative presentation. I wonder if ASD can be co-morbid with bipolar disorder.

  15. Dr. Grande, thank you for a great presentation. If one looks at the traits of OCPD and high functioning ASD they overlap to a huge extent. How do you differentiate one from another?

  16. Dr. Grande, Thank you for your informative video. I am married to someone that has Autism Spectrum Disorder. And, recently I am coming to the conclusion that he also has Narcissistic Personality Disorder. What a living hell for me! When I first started realizing that my husband may have some other mental health issue other than ASD I thought I must be the only person in the world that has a family member with these two disorders. How do I tell my counselor I think my husband has these illnesses. She will think I am off my rocker! My husband has never had a professional diagnoses. And, after 13 years of living with him I can safely tell you he would never seek help. After watching a number of videos on NPD I feel as if a boulder has been lifted off me. I feel free. Free to live life again. I'm no longer burdened with the thought of, how do I try to get through to my husband to help him. He can't be helped. He would never allow that. And, why? Well, because, really, there is nothing wrong with him. There is something wrong with everyone else, not him. Your videos have been a life saver because they have lifted a terrible, heavy veil from me. And, now I can see! See what is really wrong in my marriage. I wish you knew how much you are helping others with this information. Thank you for giving me relief. Jeanette

  17. Great information, thank you! I’ve often wondered about the connection between ASD and NPD or BPD. I’ve noticed in forums or on YouTube narcissism channel comments that it seemed like a high number of people stated they previously had a narcissistic partner and also had a child diagnosed with autism. Not generalizing, just noticed a pattern of this mentioned frequently by many. I’m also interested in your thoughts regarding dissociative identity disorder.

  18. Adult Autism also has very high frequency toward teen and adult substance abuse. That the mix of autism and multiple substance abuse would resemble bipolar. Sometimes there's no diagnosis with the adult autistic but multiple substance abuse. This I find confusing. Co-morbidity gets complicated, like a chess game, and it's interesting to find out how psychiatrists/psychologists make the diagnoses; similar to adding up traits etc?

  19. The subject matter of this video is one that really hits home for me. I believe I'm high functioning ASD and BPD, but counselors have told me I'm neither. Thanks for posting this Dr Grande!

  20. Do you have any viewpoints from a mental health perpective about the whole Jussie Smollett incident…I know a lot of people are like why?! My personal opinion without knowing him..is leaning towards histrionic traits of needing to be the center of attention. Even his interview with Robin Roberts proclaiming that the incident happened just screams histrionic personality traits!

  21. I need to rewatch this video. All those acronyms are confusing. Plus, I have some hearing damage that is making it hard to hear the difference between them.

  22. Dr. Grande I'm always wondering why OCPD is a Cluster C personality disorder.
    Cluster C PD's are the anxious, fearful personalities. When reading in the DSM-5 about the criteria of OCPD it isn't clear to me what makes these persons with OCPD actually feel anxious or fearful about.

    Is it being anxious for making any mistakes or being rejected by others when they don't 'behave perfectly'? Is it having become too sensitive of being criticized or does their commitment with perfectionism leads to a lot of inner stress? Is it that they get easily anxious when things are not being ordered and/or being as 'perfect' as possible in their lives?

    Isn't that perfectionistic behaviour in everything they do actually not a learned surviving behavior strategy, based on a hudge fear of being negatively evaluated and/or getting punished? (This might be the case often with a person who developed a OCPD I assume?)

    People with a OCPD often had a very critical and stricked parent(s) during their childhood I think?
    These OCPD are also something that's all in the family often. So then it might be 'just' some kind of classical conditioning?

    What about the genetics? Are these people born with some kind of 'perfectionistic' genes we still don't know of? Not all the children in one family, who have been raised by a parent(s) with OCPD, develop a OCPD!!
    Some develop also OCPD and some just don't, but they have been raised by these same very strict parent(s), who probably have a OCPD themselve?

    People with OCPD feel actually very easily angry, frustrated or irritated, because they are allergic to imperfections I guess.

    I know you have been posting some videos about OCPD, but I'm still stucked with all these questions.
    I totally understand you have not all the answers about my so many questions, because like you have said already in a video, that there has not been done so many research about OCPD yet, like BPD for example(even if OCPD or AvPD might be probably the most common PD's)

    I know this comment isn't about the video you did and it has become far too long this time, but I hope you didn't mind.
    Anyway as always thank you so much for your time in reading this Dr. Grande.

    You receive so many questions, I fully understand you can't answer them all 😃

  23. I come from the opposite end. my 11yr old son was diagnosed with autism just before he was 2. as years went on, he had added diagnosis (OCD,tourette's,severe speech + learning, dyspraxia). As you are well aware, people can have multiple diagnosis. now from an adult perspective, I've worked with adults on the spectrum that also have mood/personality disorders but seem to go under the radar + failed by 'the system'. it seem harder to diagnose an adult than a child who has ASD, with other conditions.

  24. Yet another unique and interesting topic Dr. Grande; thank you! This is extremely helpful for fine tuning diagnostic considerations.

  25. Todd, thank you for this interesting talk. I love the way you impart your knowledge in a sensitive way. It’s absolutely crucial to get diagnoses correct isn’t it, and your talks help with this. In my experience (and I think you mentioned this) individuals with high functioning ASD can experience lower functioning cognitive empathy but well functioning emotional empathy, whereas this is flipped with the cluster B disorders. They have a tendency to have well functioning cognitive empathy but an impaired ability to feel emotional empathy. Another observation I have is that Cluster B personality disorders have a tendency to be interpersonally manipulative, but I don't think this is usually the case with individuals who have ASD. Keep up the great work!

  26. ow, great video! just what i needed. i recently diagnosed myself with Aspereger's syndrome. i thought for quite a while that i have a combination of some personality disorders and depression. but, even though it was the closest thing i found to what i have it wasn't enough, it didn't explain many things that bothered me (like awkwardness, and feeling different all my life but with no actual validation, even the opposite).
    i think that the main issue was that because i have ASD i couldn't explain how i feel until i learned to put it in words myself by reading and searching (alot) i mean, at the time that i read about having special interests i realized that this was one.
    when i saw therapists as a kid and teenager i would camouflage as a normal kid by what i would think would be the best "script", because i was scared to upset my parents, they overlooked so much that it's crazy and they pushed me to (pretend to) behave normal. so i was like any other kid, except having huge "explosions" very often and suffer great deal for that.
    before i diagnosed myself even with personality disorders, i couldn't explain more than the "obvious" that i knew. so i could only say things that show that i have depression, unless they would really ask and look for it. but they never did and i knew what you're supposed to say. that's one of the things i hate most, that the mask works even on the people you come to for help.
    i think that the reason people are diagnosed later than childhood, is because, unless you dig real deep, only the person with the (high functioning) ASD can find out they have it.

  27. Thank you Dr. Grande! This is really thought provoking ideas/concepts. I think I may have been on the spectrum of Autism, or had a very strange puberty, and adolesence one. Things adjusted out as an adult, but still, there are dominate themes that continue to pervade for myself. Thanks.

  28. I am a diagnosed ASD but I suspect that I also somewhere on the vulnerable dark triad. I have prominent borderline, covert narc and secondary psychopathic traits-with the emphasis being on the borderline.

  29. Great, great video! Thank you! I watched it multiple times b/c it's so packed with great info. There are many overlapping symptoms of ASD and Cluster B PDs. I know someone with BPD and has a daughter who's been diagnosed with ASD… but the daughter also exhibits core BPD traits, e.g., fear of abandonment, unstable relationships, etc. And the mom with BPD exhibited ASD traits, esp. very smart (IQ, pattern recognition, but not EQ), deficits at reading emotions.

  30. I've wondered about the possibility of me having Aspergers rather than BPD for some time now. This was very interesting. Thank you.

  31. Dr. Grande, could you please make a video about what I have heard being referred to as a "theme" around which a personality style is organized. This concept of a "theme" was mentioned by Nancy McWilliams in one of her lectures, so it is likely to be a psychoanalytic way of looking at personalities. She gave an example that a narcissistic personality is not about either a high self-esteem or a low-self-esteem, but rather that it is organized around the theme of self-esteem. This I take to mean that self-esteem, and related things like self-presentation, image-management, image-anxiety, etc., are the principal "hub" around which the whole "wheel" of narcissistic personality turns. Perhaps in the same vein, the main theme of a borderline personality might be abandonment, while the main theme of obsessive-compulsive personality might be order. These are not diagnostic criteria, of course, but such themes might furnish useful ways to capture core differences between personality types that might look confusingly similar by applying the DSM-5 criteria (there are simply too many of those, and too many overlaps, especially taking into account various possible combinations of N out of M criteria). Also, the description of personality disorders by DSM-5 criteria leaves one with an impression that such people are psychologically static and free of internal conflicts and tensions, which does not resemble any real human. Anyway, it would be great if you could share your thoughts on this "theme" concept in a video. Thank you.

  32. I'm a pw BPD who was suggested to be tested for autism but it's hard without a supportive family to answer questions about your childhood. i wonder how many are people are undiagnosed / misdiagnosed simply because of the neglectful family.

  33. I am diagnosed with ASD and BPD and I suspect there is a misdiagnosis but not sure in which, I've seen 3 different people, 1 diagnosed both, 1 diagnosed BPD but never considered ASD, and 1 diagnosed BPD but is considering ASD too. Do you think this sounds correct? what do you think?

  34. Personally I think that personality disorders and pervasive developmental disorders are interchangeable. PDs are also PDDs because they either are the result of the person’s abnormal development or can result in an abnormal development. On the other hand PDDs are also PDs because they shape one’s personality in an unhealthy way.
    The differences are these. PDDs are usually diagnosed in children whereas PDs are diagnosed in adults. Then PDDs are usually innate – but some PDs can be present since birth as well

  35. I love the way you made it so easy to understand the difference between 3 very complex disorders, in less than 15 minutes! Thank you again and again Dr. Grande!

  36. Dr Grande. Love your work. Excellent presentations clearly presented and very engaging. I have a question, is PTSD a temporary disorder? And if so, how does cPTSD/PTSD impact or alter a person's character as defined by the 5-factor model? Ie does it fundamentally alter any of the persons character on any one, or all of the factors and how would the change manifest? Thanks

  37. A few comments mention ASD vs schizoid PD. I'd also be interested in that. I've always wondered if the two could go hand in hand, or if schizoid-like traits could be a maladaptive coping strategy for poor social adjustment.

  38. Dr. G, what do you recommend someone do if they suspect they may have high-functioning ASD that's gone undiagnosed into adulthood? I.e. when is it worth it to pursue an official diagnosis, how does the diagnostic process work for adults being tested for ASD (since generally people are evaluated as children, it's my understanding that many of the tests are designed for children), and what tools might an adult with ASD use to support them in their daily life?

  39. This is a little off-subject but is greed a mental disorder? Is there an obsessive-compulsive ingredient to it? A symptom of or factor in Narcissistic Personality Disorder? Many times it has struck me that 'too much isn't enough', and that there seems to be an out of control aspect to greed.

  40. Thank you very much for this long waited for video on the similiarities and differences between ASD and PDs!! But may I suggest one "correction": From my point of view the PDs most likely to get confused with ASD are Avoidant PD (especially in females with ASD), Schizoid PD (more so in men) and Obsessive Compulsive PD. It would be VERY interesting and important to do research into the similiarities and differences of these PDs and ASD!!! I think that especially so many "high functioning" women with ASD (because they tend to present somewhat differently than most men with ASD) are or have been misdiagnosed with a (or a couple of) PD(s) earlier in life for lack of knowledge about ASD by a lot of psycholigists and psychiatrists.

  41. I appreciate that you took your time to produce this video, mr Grande.

    What i find very interesting about your layout, is the propensity of being discerning, objective – and adhering to the
    underlying facts in terms of being critical.

    I furthermore, find that your distinction is one of great importance – As i upon personal attempts of trying to discern the
    genotypes, phenotypes and other forms of integrations – have stumbeled upon chasms of information.

    It can, truly – be difficult to verse in a digestable matter – without being a neuroscientist.

    Thank you.

  42. I know there are 'fear of missing out' videos on youtube & I'm planning on making a series on that subject too….. but I was wondering if you could talk about 'fear of missing out' from a dr's psychological point of view

  43. Interestingly, my daughter has diagnosed ASD, but is missing the axis of the disorder that deals with having reduced empathy and lack of a full spectrum of emotions. She has the other two that involve perseverating and sensory. She just has pretty much normal emotional function. Except occasionally her emotionality is a little off. Like she might go from acting completely normal to crying hysterically once she sort of reaches her limit instead of getting there gradually which is more of the normal thing you would see. It's almost like she's unaware of her own emotions but she is aware of other people's. Just an odd thing. She is though, very gentle and kind and aware of animals.

  44. This needs to be more in depth on what you’d see out loud as well I mean not just describing characteristics or posssible behaviors I’m talking a real deal difference. I can tell borderline from autism and when someone has both. The beginning of this was misleading, some doctors don’t need nearly as much analysis than you stated. A person could get an autism diagnosis from having auditory processing disorder and failing a hearing test completely but not being deaf, resulting in evidence of an underlying problem, when you mix these issues with limited eye contact , slow or odd speech pattern and tone, awkward posture, a doctor can be more than able to diagnose with autism. Even when an outside person sees them as totally normal. So. Yeah it’s not that complicated I can mix other Senarios I’ve seen from experience on how people came across diagnosis and it was not with a formal testing. There are family cases when you can put it together based on criteria from a family doctor there are so many ways to detect autism

  45. By far the main reason why people with BPD often self harm (they do not all self harm) is to alleviate severe emotional anguish, and not typically for attention. This anguish that they experience also helps to explain a lot of their typical behavior. Of course, each individual with BPD is different, and they do not all present the same way.

  46. This was a very interesting video as I recently went through a long assessment period and the results were Aspergers syndrome with recurrant depressions. It took half a year and I fulfill criteria on anxiety disorders (phobia and GAD) unspecified personality disorders, but BPD in particular as well as OCPD and DPD. There's also a strong possibility of some kind of bipolar disorder. In Norway, they follow the ICD-10 and Aspergers is still a diagnosis on its own apart from ASD. It would be so helpful with more on this topic of comorbidity, similarities and misdiagnosing.

  47. I am married to one with autism. I don't think there is a lack of empathy, it is just not what we expect it to look like. When he says "Oh, that sucks" if I am truly upset by womething, I must not doubt wether he really thinks it sucks, just because he said it flatly. However, he can be kinda cold when the kids cry, because it didn't look like it hurt to him, but many parents can be like that, not just those with autism. I think the main difference is that a person with autism is trustworthy, dependable and loyal, while someone with Borderline or NPD will cause intrigue, drama, scandals, yell for things that they are not really upset about, try to manipulate your feelings, abuse people – at least they are more likely to than a person with autism. They might be flat and seem a bit nonchalant, cold and lack empathy, but they will not go out of their way to cause havoc. On the contrary.

  48. I strongly disagree with you that "callousness" describes ASD, as that would imply reduced emotional empathy, not cognitive empathy which you pointed out. I think it would be prudent to mention that while people with ASD have limited cognitive empathy, the research shows they also have increased emotional empathy.

  49. Please do something on
    Anxiety disorders. Pure o , o ocd, and I think it’s c personality disorders. Sometimes I think I’m skitzoid or have a nervous disorder. I’m super empathetic and a people pleaser

  50. Though it's now much easier to differentiate ASD from BPD, it's still confusing to know how ASD comorbid with BPD would present.. Which key features would help us know when such association is present? Should we focus on repetitive behavior and sensory issues to make sure ASD is present when someone seems to have BPD?

  51. Autistics do not have the narcissistic smirk when they know they hurt you…that s my way of telling the difference and it s pretty accurate I d say

  52. Right now I'm confused… Children can be diagnosed with ASD but not with BPD. I beleive it's because BPD is a personality disorder. Children are not formed yet and therfore cannot be diagnosed with personality disorders. Well I disagree with that. My daughter is 8 years old, officially she has ASD. I always thought that a lot of her behaviors did not match with ASD but I went along with what the doc told me. But now I know about BPD and this fits my daughter behavior perfectly. I don't know how to deal with BPD… The ASD technics won't work on my daughter. So I keep looking for something that works. I'll read any suggestions!

  53. I got my Autism Spectrum Disorder diagnose just 4 years ago (when I was 35). I also got diagnosed with ADD at the same time. I were under investigastion for Bipolar 1 in 2011, but got epelepsy and that medication almost took away all my symthom of that so the doctors could not continue on with path but they belive I do have that. I am medicated and it working well 🙂

  54. As someone with "High functioning Autism" whatever this means^^, I feel like people might be misinformed and think of me as a narcissist which doesn't help.

  55. Dr. Grande, please forgive me for asking such a complex question here in a comment. I could not find any other contact information for you via links.

    How likely do you think a woman with a chromosomal translocation and two severely autistic sons is to have some form on undiagnosed autism herself? The woman in question shows minor levels of cognitive impairment and was in special classes for some time in school that focused on reading comprehension.

  56. Dante's Divine Comedy begins with Virgil taking him through Hell, where he has to learn not to be seduced into feeling empathy for the damned who had earned their damnation. About halfway down to Lucifer himself, Dante figures out a contradiction. You can't have empathy with both the sinner and the sinner's victims. For example, the selfish unfit mother who smokes in in a car with her children cannot be granted empathy without denying empathy for her children who deserve protection from her selfish act.

  57. Please do a video on your opinion of the cause of autism. The potential impacts vaccines, soil based probiotics and pro/anti inflammatory diets.

  58. Sad irony that I see an ad for aba autism therapy below the video. ABA is often abusive and traumatic for people with autism, there’s been numerous testimonials and studies are starting to back this up as well

  59. I think the biggest difference it the empathy. ASD does not understand the emotional information vs NPD does not care about your emotions.

  60. I am a female diagnosed as having asd during a thorough testing and interview with a psychologist. When I was younger I was diagnosed bpd by a psychologist who saw me for only an hour-long of interview. My son and grandson both have ASD.

  61. I would have thought the glaringly obvious difference between Autism Spectrum Disorder and Narcissistic Personality Disorders is intentional malevolence. People with ASD may hurt other people but they don't intend to, nor do they extract pleasure or 'supply' from doing so. They are unaware of hurting others. Whereas people with NPD intend to hurt others and thoroughly enjoy doing so, in fact, that's their whole purpose in life, to feed off the narcissistic supply they gain from physical or emotional sadism.

    I shouldn't be surprised that Dr. Grande has made no mention of this very crucial difference between the two, as therapists these days (unfortunately) have to maintain a sympathetic attitude to all potential patients, no matter how undeserving. However, there is such a thing as turning a blind eye, for the sake of 'political correctness'. People should be made aware of these differences.

  62. What about PDD-NOS? Pervasive Developmental Delay No Specific autism? My 9 year old has PDD-NOS, ADHD.
    and low IQ but is extremely high functioning. Is there a difference with ASD and PDD-NOS empathic wise? Thank you. My daughter is a handful to say the least. I know it’s mainly the autism and ADHD but sometimes with her symptoms borders on narcissism of course her and I have been through some domestic violence so I know that’s a contributing factor as well. But at the end of the day everyone calls her sweet and even though she is in special needs classroom at school she is high functioning but sometimes her symptoms mirror narcissism although I know it’s her conditions.

  63. Cognitive empathy so-called deficit in autistic people is more complicated. There's a lot of anecdotal evidence (and there needs to be more studies) that the current understanding as presented here is not accurate. Autistic people can understand and predict how other people feel or would feel in given circumstances – the problem is communicating this with neurotypical people. Especially with the type of ASD presentation we're assuming in this video, if you tell an autistic person a story about something that happened to someone and ask "How do you think that made them feel?" they can give a reasonable answer. They may even be able to think of several possibilities. OTOH if you show them a picture of a person's facial expression and ask "how is this person feeling?" well then the test is structured in a way that the result will be a "cognitive empathy deficit."

  64. I was MISdiagnosed with BPD when really I'm autistic. Now with the right dx, everything makes perfect sense…my whole life. Only after my son was diagnosed did I even think I may be autistic. The self injury with female ASD can also be caused by emotional overwhelm/stress too.

  65. How would you define high functioning autism? I personally don’t like the term and I’m not alone. Would you call me high functioning or low functioning? People can be diagnosed with both personality disorders and autism just to make things more complicated. Just out of interest, why not include some of the many autistic creators in your next autism video? I can usually see how others feel and respond in an appropriate manner, I have always worked with vulnerable people and have to be able to show empathy.

  66. How do you distinguish asperger's (high functioning intellect) from schizoid. (in schizoid, bizarre beliefs for what is pleasurable is "schizotypal"? What if an older adult doesn't seek relationships because they were not attractive enough to others so they tried to "outflank" them — the MGTOW idea ("Economic Invincibility" talks about MGTOW a lot on his channel and he is very articulate.)

  67. I recently asked my psychiatrist about the possibility of my having ASD rather than BPD and he nearly laughed me out of his office! He said that the two were SO incredibly different that there was NO WAY I could have been misdiagnosed. Wish you were my doc, Doc.

  68. Wow this is strange. Why wouldn't ASD be confused with schizoid, or OCPD? Cluster B would not be the first thing that comes to my mind. And I remember seeing "autistic personality" being listed as one of features of covert schizoid in one of the classifications on its Wikipedia page.

  69. Can you perhaps do a video doing a rough profile of common characteristics of someone who is autistic/is on the AS and is comorbid with BPD or NPD? (Or another personality disorder?) I know you have a lot of videos on similar topics but I am definitely interested in this as someone who is diagnosed with BPD but is looking into an ASD dx as well.

  70. Thank you for this video. Based on my dating experience with 2 electrical engineers, and being a medical professional myself, I have a very hard time distinguishing between the traits of Autistic Spectrum Disorder and particularly Vulnerable Narcissism. Also, I see similarities between ASD and Schizotypal Disorder in one of them, including having psychotic delusions, also paranoia in both. Perhaps co-morbid? Have you seen this trait in many with a ASD diagnosis? Perhaps a video on the similarities and differences of these two if you ever see it? Thanks for all you do!

  71. I think "disorder" has now been dropped from the description of Autism Spectrum, even if it is still on the books. Co-morbidity is, I think, in the case of AS & BPD confounded in the case of people, especially young adults, who have grown to maturity without ever having been diagnosed with autism. This can develop into an overwhelming sense of alienation & bitterness, the consequences of which are easy to attribute to BPD – which probably does not help the individual at all.

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