B. Mental Health and Behaviour Disorders
Common Mis-Diagnoses and Co-Morbid Conditions

Prior to 1994, when Asperger Syndrome first appeared in the DSM-IV, people at the high functioning end of the autistic spectrum were usually diagnosed with a mental illness such as schizophrenia or a personality disorder. This still happens, although less frequently now that milder forms of autism are being recognized.

Aside from the list below, autistic newsgroup posters have also been (mis)diagnosed with:

  • Social Phobia
  • Dissociative Disorders
  • Separation Anxiety


  1. Personality Disorders
    1. Schizoid
    2. Obsessive Compulsive
    3. Avoidant
    4. Borderline
  2. Schizophrenia
  3. Obsessive Compulsive Disorder
  4. Attention Deficit Hyperactivity Disorder
  5. Oppositional Defiant Disorder
  6. Mood Disorders
    1. Bipolar Disorder
    2. Depression
  7. Psychoneuroses (neurosis)

See also:

1. Personality Disorders

A personality disorder is a severe disturbance in the characterological constitution and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorders tend to appear in late childhood or adolescence and continues to be manifest into adulthood. It is therefore unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years. General diagnostic guidelines applying to all personality disorders are presented below; supplementary descriptions are provided with each of the subtypes.

Although none of these personality disorders can be properly diagnosed with a Pervasive Developmental Disorder, there are some which share characteristics of PDDs.

  1. Schizoid Personality Disorder
  2. Diagnostic criteria: DSM-IV, ICD-10.
    This is probably the personality disorder most similar to autism. It is characterised by detatcment from social relationships and a restricted range of emotional expression (affect) interpersonal settings.

  3. Obsessive Compulsive Personality Disorder
  4. Diagnostic criteria: DSM-IV, ICD-10.
    Different from Obsessive Compulsive Disorder (OCD), OCPD is a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

  5. Avoidant Personality Disorder
  6. Diagnostic criteria: DSM-IV, ICD-10.
    Another disorder involving primarily social withdrawl or inhibition. In the case of the avoidant personality, the withdrawl is due to feelings of inadequacy, and hypersensitivity to negative evaluation

  7. Borderline Personality Disorder
  8. Diagnostic criteria: DSM-IV, ICD-10.
    Less diagnostically similar to autism, this is still a relatively common misdiagnosis. Perhaps not even a "true" disorder, Borderline Personality Disorder is a label given to almost any female who engages in self-injury or has relationship problems regardless of whether the other criteria are met. According to the DSM-IV, it is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.
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2. Schizophrenia

Diagnostic criteria: ICD-10, DSM-IV

In the past, the definition of schizophrenia included more of an emphasis on "blunted affect" (ie people who didn't show their emotions), loose associations (ie talking in a rather "stream of consciousness" manner), ambivalence (ie indecision) and social withdrawal (living in your own head). Obviously, such a definition allowed for much confusion with autism, which can appear very similar if this definition is used.

Unfortunately, many high functioning autistic adults are misdiagnosed with schizophrenia, even to this day, even though the diagnosis of autism does not allow for such things as auditory and visual hallucinations.

This may come about due to problems such as AC literalism, for instance, that classic mistake, the psychiatrist says "Do you hear voices?" and the AC replied (perfectly honestly and literally) "Yes" (meaning he hears the psych's voice, his own voice etc). It may also occur because the diagnostic criteria do not mention autism within the list of alternative conditions that must be excluded (such as organic brain disorder and drug abuse) and many psychiatrists are not familiar with ASDs.

Also, what is now called "PDD-NOS" used to be called "childhood schizophrenia". Many professionals and patients alike do not realise this, and so may continue to label such adult patients as schizophrenic when they might actually be ASD.

An excerpt from the ICD-10 description of schizophrenia:

"A minimum requirement is one of the following symptoms: thought echo, insertion, withdrawal, broadcasting, passivity phenomena, delusional perception, third person hallucinations, and persistent delusions - all in clear consciousness.

Other symptoms used to make the diagnosis (2 must be present) include persistent hallucinations in any modality, thought blocking, thought disorder, catatonic behaviour, negative symptoms, loss of social function."

Symptoms should have been present for at least one month. This emphasis on the form of the illness helps exclude patients with transient psychotic symptoms or signs. Affective disorder should have been excluded. Symptoms should be present in the absence of overt brain disease, drug use, or epilepsy ( which can all mimic schizophrenia). ICD-10 lists the following types paranoid, hebephrenic, catatonic, residual (a chronic state) and simple.

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3. Obsessive Compulsive Disorder and Anxiety

Diagnostic criteria: DSM-IV, ICD-10

Obsessions are an inherent aspect of autism, but the obsessions and compulsions of Obsessive Compulsive Disorder (OCD) are different in quality and quantity. OCD may occur with autism although it is difficult to diagnose because of the overlap of symptoms. There is very likely a genetic link between autism and OCD.

Obsessive Compulsive Disorder (OCD) is a neurobiological illness, classified as an anxiety disorder. the individual with OCD experiences and attempts to suppress recurrent, intrusive thoughts (obsessions) that cause anxiety or discomfort. Ritualistic behaviors (compulsions) follow and are performed to neutralize and prevent this unease, though the relief is only of a temporary nature. The person realizes that the obsessions are a product of his or her own mind and that the behavior is excessive or unreasonable. Compulsions may consist of mental rituals only, and therefore may be unnoticed by others. Until the illness becomes moderate to severe, the compulsions are often done secretively or are well disguised, so that the person's closest associates are not aware of them. Generally the person feels that he/she is going 'crazy', feels ashamed, and fears telling others about it.

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4. Attention Deficit Hyperactivity Disorder (ADHD)

Diagnostic criteria: DSM-IV, ICD-10

ADHD is a neuro-biological disorder that causes a difficulty in directing attention. It is characterised by distractibility, impulsivity and hyperactivity, although there is a form of ADHD, called "Predominantly inattentive" that does not necessarily include the hyperactivity component (formerly known simple as ADD, although DSM-IV no longer uses that term).

ADHD is a condition sometimes mistaken for, and sometimes co-morbid with ASDs, and in fact, some experts believe it is related to the Autism Spectrum. It is certainly true that many ACs were first diagnosed ADHD, before being discovered to have an ASD.

Whilst some people are given the dual diagnosis of ADHD with ASD, hyperactivity and distractibility can be a component of ASDs. However, studies have shown that the majority of ACs lack the ability to shift attention quickly, as people with ADHD can do.

Treatment for ADHD includes low doses of stimulant drugs, which are thought to enhance that part of the brain that is underactive in the ADHDer (the part of the brain that controls attention and impulse-control). There are some 300 drugs regular used to treat ADHD, but probably the most famous are Ritalin and Adderall.

Contrary to extremist remarks made in the press, the drugs to treat ADHD are generally considered safe, when used in accordance with medical advice, but it is important that sufferers also receive appropriate therapy and behavioural management and are regularly monitored.

In autistic people, on the other hand, either with ADHD or with hyperactivity associated with their autism, ADHD medications are much more problematic: It is reported that severely negative reactions are much more common than in this population (Note: this also applies to other psychiatric drugs, such as antidepressants and tranquillizers).

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5. Oppositional Defiant Disorder (ODD)

Diagnostic criteria: DSM-IV, ICD-10

Oppositional Defiant Disorder (ODD) is a persistent pattern of negativistic, hostile, disobedient, and defiant behaviour. Sometimes autistics, especially those with Asperger Syndrome, are mis-diagnosed or also diagnosed with Oppositional Defiant Disorder. ODD is similar to Conduct Disorder (which is like Antisocial Personality Disorder) in which the child has no regard for the rights of others and is destructive. However, ODD is milder and there is little or no destructiveness or deliberate hurting people or animals. It is difficult to say whether the characteristics of ODD are part of an autistic spectrum disorder (severe tantrums are very common in autism) or whether they warrant a separate diagnosis. Here is some information about ODD, but there is much more available. See also: Attention Deficit (Hyperactivity) Disorder.

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6. Mood Disorders (Bipolar Disorder and Depression)

Mood disorders are more common in the families of autistics. This may be due to genetics or other factors such as stress.

  1. Bipolar (I and II)
  2. Diagnostic criteria: DSM-IV (Bipolar I), DSM-IV (Bipolar II), ICD-10
    Formerly known as "manic depression", Bipolar Disorder is characterised by highs (mania) and lows (depression). The DSM-IV has separated bipolar into two types: Bipolar I, which involves at least one classic manic episode; Bipolar II, in which the person's highs are not as extreme (hypomania). This condition may also be more common among autistic people and their families for reasons which are not yet fully understood.

  3. Depression
  4. Diagnostic criteria: DSM-IV, ICD-10
    Depression is far more common in people with Asperger Syndrome than in the general population. This may be due to lack of acceptance and understanding of their disability by themselves and others, as well as discrepancies between desire to perform (socially, academically, or otherwise) and their abilities to do so. While some autistic people do not desire social relationships, others feel a deep sense of isolation.
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7. Psychoneuroses (neurosis)

Psychiatrists, unfamiliar with people with higher functioning autism or AS may mistake anxiety symptoms and lack of social skills to a neurotic condition, such as used to be called "psychoneurosis". To many of us, undiagnosed throughout childhood, this seemed to be a way of psychiatric professionals telling us we didn't really have a problem, and to go away.

Gary (?AS) explains the defintion in a newsgroup post:

Also called NEUROSIS, plural PSYCHONEUROSES, OR NEUROSES, mental disorder that causes a sense of distress and deficit in functioning. Neuroses are characterized by anxiety, depression, or other feelings of unhappiness or distress that are out of proportion to the circumstances of a person's life. They may impair a person's functioning in virtually any area of his life, relationships, or external affairs, but they are not severe enough to incapacitate the person. Neurotic patients generally do not suffer from the loss of the sense of reality seen in persons with psychoses.

Psychiatrists first used the term "neurosis" in the mid-19th century to categorize symptoms thought to be neurological in origin; the prefix "psycho-" was added some decades later when it became clear that mental and emotional factors were important in the etiology of these disorders. The terms are now used interchangeably, although the shorter word is more common.

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