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psych (DSM IV - BPD/EUPD Criteria (3. Identity disturbance: markedly and…
psych
DSM IV - BPD/EUPD Criteria
3. Identity disturbance: markedly and persistently unstable self image or sense of self.
:green_cross:
FOR
keep changing career path. but disability does that. so nope
poor self image - yes - but not unstable. i have pretty consistently thought i was ugly challenging this is slow and may appear to be unstable.
AGAINST
Friend a
- I really don't know. Like?! You know what you like and what you don't like. You've never changed how you dress or anything to emulate someone you are idolising. You use masking, to limited effect, but not to the extent many ASD females do (i.e. I have over time changed fashion, accent, pretended to enjoy things I haven't to a far greater degree and I still know who I am). Basically I don't even know what this means but you are Eden and I think most people that are actually friends with you know and can predict what you do and don't like and these things don't change.
I have the same goals same interests i did when i was 11. I still want to be a doctor I've just accepted that is something that my disabilities won't allow and so i have to find a different path to what i want to do. I degree in neuroscience could allow me to pursue a path I can and WANT to do. I love research. Even at age 10/11 I was a medievalist. my core identity is unchanged by trauma the passage of time.
4. Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self- mutilating behavior covered in Criterion 5
:green_cross:
FOR
AGAINST
Friend a
- You just aren't impulsive. Things might appear impulsive if someone doesn't realise you are 'coping, coping, coping' then say get out of a meeting and just fall apart and that may include self-harm of some kind but it isn't actually impulsive. Also you've never even done like most of the things on this list, and lots of people have by their early twenties!
none of the above displayed. Except possibly spending according to john but no-one else thinks so. never ever been in debt, always had several thousand in savings. . Every purchase I make is well reasoned and well used.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
:green_cross:
FOR
Parents,plausibly. nope just weird. It does not compute. I love my parents whether or not i have contact with them. sometimes I forget, then i remember. I still love them want contact even though they make my mh worse because confused and frustrated. I still love them., i still want them i just don't want the way my mum treats me.
AGAINST
Friend a
- I don't think you idolise then hate people. For instance I have at times bluntly told you 'I can't deal with this'/ 'this is not ok' and you have not flipped to hating me. What I DO think happens is that you trust people (because why would they be lying, i.e. person c) and then you find out and understandibly are confused, hurt and feel manipulated. These are rational responses.
Stable relationship with John for over 18 months, not perfect by any means especially given were both autistic and have social difficulties doing really well.
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.
:green_cross:
AGAINST
Friend a
- Not something I have ever observed even in extreme distress and when you HAVE been unable to help yourself you have never made threats or anything of the like to make me/ others help you. You can be bluntly honest about your behaviour and risk which should mean that procedures are followed but this is blunt honesty not a fear. Notably you are effectively abandoned by your parents, I don't see you seeking out 'parent figures' to replicate this care (which, I, actually do do and I don't have BPD!).
Speech and language problems again. I fear being bullied; I do not fear rejection/abandonment. is social rejection the same as abandonment? truban paper?. I prefer being alone??
FOR
Parents, yes my mum can be
confusing
but i don't fear abandonment. I just don't understand like really it makes no sense. sometimes i feel sad because i wish things were easier, simpler.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) :check:
FOR
I struggle to identify emotions alexthymia
yes but could it be explained by autism
Could be explained by autism see truban paper.
Friend a
- True for anxiety, not true for anything else. Anxiety very much fits with the anxiety seen in ASD. No episodic irritability, obviously occasionally irritated by life but very much in the realm of normal and expressed very well/ maturely.
AGAINST
I can be quite difficult read due to masking. which could explain why people think i am not depressed when i am/ think my mood is labile.
John - if anything she is under emotional and has persistent low mood.
7. Chronic feelings of emptiness.
:question:
FOR
Alexthymic
AGAINST
Friend a
Again, I think you know who you are and what you would like to do in life. Some upset at times in relation to not being easily able to do everything you want due to physical disability and the political climate (lack of access to work etc.). I would say this is the opposite of emptiness!
Speech and language issues. What is feeling empty? do we have the same viewpoint. If actually about goals/ interests or emotions. i often can't identify emotions so in some ways empty. is empty the same as sad?
Alexthymia is common in ASD
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
:green_cross:
FOR
????? When has this ever happened. the only time i fight is in the context of reenactment which is not the same.
AGAINST
Rarely do i get angry and it is usually very controlled. I do not lash out nor have i been involved in physical fights. More likely to be passive, just grin and bare it
friend A
- Nope. Meltdowns may (?) appear like anger but are intense over stimulation.
I had to be taught to get angry. I have the opposite problem.
Transient, stress related paranoid ideation or severe dissociation symptoms
:check:
FOR
Although not currently doing so I frequently would dissociate (usually derealization) in response to extreme distress
Triggers - WHEN and WHERE
Loud, bright environments such as public transport, city roads or primary education
Processing trauma (although i did try to distract after counselling such as ice skating that is a sensory rich environment)
Medication. I found that certain medications particularly citalopram trigger dissociation.
Anxiety
Also have stopped dissociating.
Consequences
= Self Harm
Friend a
No paranoia. Do have dissociative symptoms, not unusual for someone who has had chronic pain since childhood and autism over-stimulation, lack of control over medical intervention as a child that caused pain
AGAINST
I first remember dissociating at 7 years old. 7yr olds are unlikely to have EUPD so there is probably a better explanation.
autistic females internalise; males externalise (1)
. Is dissociation a coping strategy a result of internalising and hiding an anxiety and distress resulting from sensory and social input :question:
Am I dissociating becuase of sensory distress. my brain can't filter information (sound,light,touch) in the way NTs do so maybe inorder to withstand sensory information my brain has to dissociate to withstand the imput. Is my dissociation a form of autistic shutdown?
Is dissociation a consequence of severe depression? the only time I have dissociated with fugue (loss of long periods of time) was during a period of severe depression on all other occasions in relates more to sensory overload than emotional distress
Severe??? propabably but questionably
5. Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior. :check:
AGAINST
Could be explained by depression in the context of ASD.
I don't intend to threaten suicide i will usually say I experience thoughts
FOR
Friend a
- Yes you self-harm, this is a coping mechanism. You don't do so in a 'threatening' way, again you are at times bluntly honest about risk. Self-harm is seen in many people and is not unique to personality disorders.
I show my arms?? I didn't realise i was supposed to hide them I hate the sensation of loose cloths on them. Bad habit. please tell me if I do
Autism
Window of tolerance
personal accounts
Friend a - I have known since October 2016
Friend b - I have known since I was 13 (Sept 2009)
John known since early 2015 now partner of 18 months
Journal articles
Under-identification of ASD in Females Truban et al. key points
summary - specific symptom presentation in females in 3 areas
Psychiatric commorbidities
traits resembling borderline PD
Depression
Anxiety
Emotional dysregulation
unique core manifestation
social processing difficulties
-insistence on sameness
lack of social engagement
Fewer outward restrictive and repetitive behaviours
Social Ambivalence
"they actively avoided situations that involved interacting with unfamiliar people"
"More comfortable being alone"
Lack of insight in regards to friendships
BPD traits
"In a sample of treatment seeking BPD patients (n = 41), Ryden and colleagues found that 15% of the female patients had ASD and 32% had autistic traits"
Overlap
LESS
evident
anger
identity
MORE
evident
problems with interpersonal relationships
self damaging behaviour
"It may be that their anxiety and depressive symptoms, in combination with difficulty understanding social relationships leads to what appears to be traits of that are characteristic of BPD"
"As observed by several researchers the symptoms seen in female researches often resemble BPD traits"
psychiatric comorbidity
"In a sample of children and adolescents with ASD, soloman and colleagues found that females had significantly more internalising symptoms"
"Combination of anxiety, depression and somatic symptoms as compared to age matched typically functioning peers"
"Autistic females in the sample were the only females to fall within the clinical range on a self-report measure of depression (26% met the cut off) "
Females internalise; Males externalise
Emotion regulation difficulties
"Many individuals with ASD struggle with emotion regulation (makafsky et al) "
Expressed as
Alexthymia
Management of emotion
"some autistic individuals show a significant lack of emotional expression; other have difficulty controlling strong emotions"
"Elevated levels of distress mimic other disorders"
Clinical Implications
"the interaction between these symptoms (anxiety and depression) and affected individual and social difficulties may ultimately
resemble
traits that are characteristic of BPD"
"Although Individuals with ASD and BPD share several characteristics there are marked differences (absence of substance misuse) in ASD that should be considered" - ryden et al
"
Treatment may need to modified
to effectively treat such symptoms in individuals with ASD"
"It is critical to be mindful of potential comorbid symptoms"
"It is possible that females with ASD experience greater difficulty with emotion regulation than males" - Further research needed
Treatment
what I think would be helpful
OT - to help with routine