As Someone That Has Been Diagnosed With Both Avpd And Autism, I Am Curious About That Post Shinji Was

As someone that has been diagnosed with both avpd and autism, I am curious about that post Shinji was talking about between how avpd and autism could be comorbid. Would you like to share?

Hello.. Thanks for your interest. Sorry this took so long to respond to. These thoughts are still a work in progress, so… If anyone has any input, please feel free to give it!

Just to be clear, I’m not a professional. I’m working off the research I have done, personal experience, and observations of others. Unfortunately, it is really hard to find information on this kind of thing because of the little research done about autistic adults, and how so much of it treats us like we are incapable of complex emotional behaviour because we are autistic.

The basic idea is that I think autistic people can be more inclined to develop certain personality disorders than allistic people due to how our brains are wired, how susceptible we are to abuse, and how autistic people process trauma compared to allistic people. Here, I’m talking about Avoidant Personality Disorder specifically.

#tw for talk of abuse and ableism

For AvPD, I think that when you look at the causes of it, it becomes apparent that an autistic person could easily develop it. A study taken about the relationship of those diagnosed with an autism spectrum disorder and personality disorder criteria found this:

“When markedly avoidant behavior is present in individualswith PDD/ASD, it could rather be seen as a consequence ofthe PDD/ASD. For some individuals with AS, their disabilityin interpreting social cues leads to a major concern aboutwhat impression they make on others and even a disablingfear for social situations, thus increasing the risk for avoidantbehavior. Moreover, elevated sensitivity to stressful environmentsbecause of visual and auditory perceptual difficultiesmay well contribute to avoidant behavior.” (source)

So, we can see that there is a significant portion of autistic people that display enough avoidant behaviour to mark off most if not all the criteria for the diagnosis of AvPD. I mean, this isn’t news… It’s why the differential diagnosis between AvPD and autism spectrum disorders are so controversial. There was always this assumption that many people diagnosed with AvPD were actually autistic, but with new information coming out about personality disorders, I think it’s kind of silly not to consider you can have both. 

(Obviously the world of medicine is starting to believe that it’s silly, too. Being diagnosed with a PD and an autism spectrum disorder is really common now. I don’t have any statistics for this, but I can confidently say 2/3 of the autistic people I know are also securely diagnosed with a PD.)

There is a lot of controversy about the ‘nature versus nurture’ debate with personality disorders, and that’s why PDs used to not really be diagnosed alongside autism. There’s been a lot of new research on this in general, but with AvPD, it has generally been confirmed to develop from things such as neglect, abuse, incest and peer rejection. Some people do develop AvPD and feel they have nothing that conditioned the disorder, but you can’t ignore the apparent link between PTSD/C-PTSD and AvPD. 

“… it is generally believed that these biological substrates exist within the avoidant personality as a biological foundation for the emergence of the disorder itself & that full development of APD is likely due to significant environmental influences (Millon & Everly).”

So, if we take this all into account: AvPD fully develops due to environmental factors. These environmental factors are often abuse, neglect, peer rejection, and related things. And there are studies confirming that not only do autistic people experience the world more intensely, but that they are much more susceptible to neglect and peer victimization/rejection than allistic people, and twice as susceptible to physical/sexual abuse.

Being autistic in an allistic world means living in a world that is constantly telling us to be smaller, to be quieter, to not exist. Trauma can develop in several different ways, of course, but the main point is that autistic people experience the environmental causes of AvPD at higher rates than allistic people - so why would autistic people not be more inclined to develop it? Why wouldn’t an autistic person develop AvPD when the world is constantly pushing us to be exactly what AvPD turns you into: out of mind and out of sight?

I hope someday in the future more research is done about autistic adults and trauma, as well as personality disorders. (I also hope it can be done in a way that isn’t full of stigma and demonization of autistic people and the mentally ill.) 

Anyway, um, that’s just my take on it. Sorry that it got so long-winded.

- Shinji