Autism Symptoms in Other Disorders

[NOTE:  The following article discusses autism symptoms that may appear in other psychological disorders of adolescence and adulthood; for information on how to recognize and distinguish autism from other early childhood disorders, please click here.]

One of my clients, a young woman in her 20s, would come into session and sit for long periods in silence.  She found it almost impossible to make eye contact.  Later, I learned that she was mentally “singing” brief repetitive songs she herself had composed.  Usually they were but a few bars repeated over and over.  Or she might get a famous song “stuck in her head” and keep the loop running.  The Beatles’ “She’s Got a Ticket to Ride” was a favorite.  At those times, I felt as if she were shutting me out, almost as if I didn’t exist.

At other times in our work, she would communicate with me and use words in a normal way, although she was quite troubled and in a great deal of obvious pain.  She had a few stormy friendships; she mostly dated women and developed one intense, merged relationship that lasted more than a year.  In terms of background, she came from a chaotic and emotionally violent family;  she remembers as a small child regularly crouching behind a chair in the living room, intoning a single word over and over in a monotone way.  She had other such repetitive rituals that soothed her.  She also recalled an early childhood fascination with small hard objects and continually pressing them into her hands.  She didn’t like soft toys.

Although she thought of herself in some way as “autistic”, this young woman would never have received a diagnosis of autism because she didn’t come close to meeting the threshold for diagnosis, despite the fact that she displayed some autism symptoms.  She most closely fit the diagnostic criteria for Borderline Personality Disorder, but over the years of our work together, an understanding of what she called her “autism” gave me the greatest insight into her difficulties.

If you look through the DSM-IV diagnostic criteria for the Pervasive Developmental Disorders, you’ll see that they reflect an inability to make emotional contact with other people, whether through words, facial expressions, eye contact, etc.  An apparent lack of empathy (at least toward human beings) is the most  prominent of all the autism symptoms; current research holds that autistic individuals lack what is called a “theory of other mind” — that is, they are unable to attribute independent mental states to self and others in order to predict or explain behavior.

My client was quite able to empathize, and I can’t generalize from her experience to autism in general, especially as I’ve never worked with anyone who would have received a full diagnosis of an autism spectrum disorder.   Still, I think her emotional difficulties and how she coped with them are revealing.

This young woman had extreme issues with  separation and merger, as I discussed in an earlier post.  She couldn’t tolerate separateness, either in her relationships with other people or in our work together.  While her mental songs appeared to shut me out, she was actually merged with me in fantasy.  The breaks between our sessions, especially over the weekend, were felt as a traumatic kind of separation.  Eventually, I realized that “She’s Got a Ticket to Ride”, made flat and unemotional through endless repetition, had once held meaning:  the original feeling, now deadened, was that I indifferently “cut her loose” at the end of each session:  “She’s got a ticket to ride and she don’t care.”

Over those breaks, she kept me in her head, repeated words I’d said but with no meaning attached to them, much like her repetitive circular songs.  She defended against awareness of a physical separation between us with what she herself described as autistic means, although no mental health professional would ever have given her a diagnosis of autism.

Finding Your Own Way:

As always, when confronting these more extreme disorders, it may at first be difficult to relate or find a place within yourself that resonates.  I’d focus on two areas:  (1) deadening of emotion; and (2) issues of separation.

The wish to turn a full-bodied emotional experience (three-dimensional) into something flat (two-dimensional) and lifeless lay behind my client’s autism symptoms.  In contrast to using different emotional drugs to escape a feeling, this method focuses on mental repetition, through words and other sounds.  Do you ever find yourself with songs stuck in your head like my client?  I know that I do; with great difficulty, I can sometimes trace it back and connect it to an emotion I don’t want to feel.

Do you have problems acknowledging separateness in your relationships?  Control and manipulation are one means of expressing that difficulty, but taking your partner for granted might be another.  Some people live in deadened relationships, marked by mindless routine and little emotional contact, not because they are indifferent but because they can’t bear to feel alive to the relationship and all it entails, especially awareness of separateness and need.  How alive are your relationships?  If you make them flat and lifeless, you may be using a technique similar to my client’s to ward off something unbearable.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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13 comments

    Just a thought and I’m not sure how much you understand about this but we are all One.. Maybe it would help someone who has that problem to teach them this truth.. We are all inherently connected, made of the same exact thing and here for the same reason. Pure energy with no beginning or end to any of us, separation is an illusion created by the ego after our decent into physical reality. Love & Light, it’s all there is..

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    It’s an incorrect stereotype that people on the autism spectrum lack empathy and do not make emotional contact with others. Females on the spectrum do display differently and are usually underdiagnosed, though I ‘ve seen a number of books come out in the past year or so focusing on females on the spectrum.

    I disagree with the author that the client does not fit the Autism spectrum – Indeed, to me it sounds a lot like someone with Asperger’s Syndrome (which is on the Autism Spectrum). And just as with Autism itself, Asperger’s comes in varying degrees. Many people with Asperger’s do find a way to connect with others emotionally, it just may be difficult and take more time than a neuro-typical person. (Just as an aside, I am in the mental health field, hold a psych degree, and I have personal experience with a loved one with AS.)

    Thanks for adding to the discussion. I actually agree with you, but after hearing from a couple of autistic people who vehemently disagreed with what I’d originally written, I revised the post to understate my point of view.

    I found your article to be very informative and as a person
    who works with children, youth, and young adults with varying special needs, I found
    the article very insightful. Thank you, Paula Kavolius

    As an Art Psych., i find all of my Asperger clients, without exception, present with some attachment disorder symptoms; these match those that meet the Asperger criteria which can make for an incorrect diagnosis.
    Often being ‘different’ can cause the self to shrivel…perhaps we should have yet another label ‘Attachment Spectrum’?

    How about we get rid of all the diagnostic labels and talk about process instead? Say, let’s talk about autistic-style defenses, or narcissistic defenses. That way, we can see similarities across the spectrum of diagnostic categories.

    I have a child that has been diagnosed with ADHD< anxicty, OCD, Anger issues, and abondamont issues even depression, also with no Connative learning, i know Im her only hope and I have tryed several things to help heror even get her help, but the more i read on Autism the more it seems she is mis diagnosed?? Can Anyone help???

    I don’t think that getting a different diagnosis is your answer. These diagnostic categories are mostly illusory; there’s a large amount of overlap between all these issues. What you need is someone skilled in working with children who will address the core emotional and psychological issues. I’m not sure where you live, but if you write to me, I’ll see if I know anyone in your area, or can find you a decent referral: AfterPsy@gmail.com

    With regards to your discussion of “She’s Got a Ticket to Ride” – made flat and unemotional through endless repetition, had once held meaning: the original feeling, now deadened, was that I indifferently “cut her loose” at the end of each session: “She’s got a ticket to ride and she don’t care.” Do our choices of music, friends, movies, etc always have subconscious meaning in this way? Can’t they sometimes just be what we were listening to when we were walking in the door, or something that stuck with us for other reasons than their connection with the relationships and emotions with which we struggle?

    It’s a bit tangential to this post, but it’s a theme throughout your writing, and one of the things I’ve struggled with in my own ability to work with psychoanalytically oriented therapists. “Sometimes a cigar is just a cigar,” no? (Of course I hear echoes of my 15 y/o self protesting against studying literary motifs and symbolism in 10th grade English class, b/c “sometimes a story is just a story.” Now that I’m a little older and wiser I realize I was immature and my teacher was right).

    Not all songs that get stuck in our head have meaning. Of course not. But sometimes you will find a meaning if you look carefully.

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