Selfcare 106: When the Diagnosis Isn’t Clear: Understanding My Adult Child’s Struggles With Autism or a Personality Disorder

Dear Friend,

I hear the questions weighing on your heart — the quiet confusion, the worry that doesn’t go away, and the ache of not knowing what your child is really going through.
Maybe you've recently heard the word autism spoken by a professional or whispered it in your own thoughts. And maybe you’re thinking, this doesn’t quite fit. I’ve always wondered if it was something else… maybe a personality disorder?

You’re not alone in wondering. It’s a tender and deeply personal question:
Could it be Autism Spectrum Disorder — or is it really something else? Maybe something harder, more complicated, like a personality disorder? Or could it even be both?

These questions are not only valid — they’re courageous. They show how deeply you care and how much you want to understand the real experience of your loved one. It’s not about labels. It’s about wanting to see clearly — so you can love more clearly, too.

Let me gently say this: the differences between Autism Spectrum Disorder (ASD) and certain personality disorders can be incredibly nuanced. There can be overlapping traits — emotional detachment, social difficulties, rigid thinking, or struggles with empathy and connection. But the roots are often different, and understanding those roots can help you respond with more precision, more grace, and the right kind of support.

ASD is about how a person’s brain is wired from the start. It's not a flaw — it's a different operating system. A person with ASD may struggle to intuit social rules, read between the lines, or respond in expected emotional ways. But this isn’t a sign of emotional brokenness — it’s a different way of processing the world.

Personality disorders, on the other hand, often emerge from complex life experiences, sometimes as coping strategies shaped by trauma, unmet needs, or long-standing relational patterns. They’re not chosen, but they often reflect deep emotional pain that comes out in patterns of behavior over time.

Could there be overlap? Yes. Could someone have both? It’s possible. But more than anything, what matters most is not just what we call it, but how we show up in response.

A diagnosis — whether ASD, a personality disorder, or both — is not a definition of your child’s worth. It’s a lens. And the clearer that lens, the more compassion, clarity, and direction it can give us. It helps us understand not what’s “wrong” — but what kind of environment, support, and relationship will help your child thrive.

You don’t have to figure it all out today. And you don’t have to do it alone.
Your willingness to ask hard questions is a powerful act of love. Your openness is the beginning of wisdom. And your care — even in uncertainty — is a steady light for your child.

Let’s walk this road together — one layer at a time, one insight at a time. There is clarity ahead, and there is hope. 

💌 THERE IS HELP AVAILABLE:

When you are ready for a session with me

just send me a personal message on Messenger: Jiji Harner

Here is more information about my services: https://safeguardmentalhealth.org/

                                                            Photo by Rejen Bosquite

Some or many of the personality traits or disorders you're describing — Schizotypal, Borderline, Schizoid, Avoidant, Passive-Aggressive, and Depressive — may overlap with or be misdiagnosed in the presence of Autism Spectrum Disorder (ASD) Level 1, especially in adults or in late-diagnosed individuals.

Sometimes the personality disorder presentation may reflect an underlying or misrecognized Autism Spectrum Disorder Level 1, particularly if the individual has a longstanding pattern of social and emotional difficulties starting in childhood.

If you're working with or caring for someone in this situation, an accurate diagnosis could significantly shift the treatment focus and improve outcomes.

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Key Points to Consider:

1. Symptom Overlap Between ASD and Personality Disorders:

• ASD Level 1 (formerly Asperger’s) includes:
• Social difficulties
• Rigid thinking
• Unusual interests or behaviors
• Emotional dysregulation (less common but possible)

 

• Schizotypal Personality Disorder includes:
• Odd beliefs and behaviors
• Paranoia or suspiciousness
• Social anxiety and detachment

 

• Borderline Personality Disorder (BPD) includes:
• Instability in emotions and relationships
• Fear of abandonment
• Impulsivity
• Identity disturbance

 

• Schizoid Personality Traits

• Emotional detachment: Little or no interest in social relationships, including family
• Preference for solitude: Chooses solitary activities; rarely seeks or enjoys close relationships
• Limited emotional expression: Appears indifferent to praise or criticism; emotionally cold or flat.
• Lack of desire for intimacy: Minimal interest in sexual or close interpersonal experiences

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2. Avoidant Personality Traits

o   Social inhibition: Avoids social interactions due to fear of rejection or criticism.

o   Feelings of inadequacy: Chronic self-doubt and low self-esteem.

o   Hypersensitivity to negative evaluation: Very sensitive to others' opinions and rejection.

o   Reluctance to take risks: Avoids new activities or people due to fear of embarrassment

 

• Schizoid, Avoidant, Depressive, and Passive-Aggressive Traits also reflect issues with:
• Social withdrawal or inhibition
• Negative affectivity or emotional pain
• Resistance to authority or demands (in passive-aggressive) 

⚠️ Many of these features can be seen in someone with ASD, particularly if they’ve experienced chronic invalidation, bullying, trauma, or misunderstood social development.

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2. Misdiagnosis Risk:

• Adults with ASD often go undiagnosed or are misdiagnosed as having personality disorders, especially if their developmental history wasn't well understood.
• For example:
• Social communication difficulties in ASD can resemble Schizoid or Avoidant traits.
• Emotional dysregulation and meltdowns in ASD might be mistaken for Borderline traits.
• Unusual thinking patterns may resemble Schizotypal features.

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3. Co-occurrence is also Possible:

• ASD and personality disorders can co-occur. For example, someone with ASD may also develop Borderline Personality Disorder due to chronic emotional invalidation or trauma.
• However, many personality traits may soften or shift once ASD is identified and better understood, especially with appropriate support.

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Clinical Recommendation:

To clarify the picture:

• A comprehensive neurodevelopmental and psychiatric assessment is ideal.
• Include developmental history, school records, family interviews, and standardized tools like the ADOS-2 or RAADS-R for autism.
• Evaluate for trauma and attachment-related issues, which can influence both ASD and personality dynamics.

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🔍 Differential Diagnosis Chart: ASD vs. Personality Disorders

Domain	Autism Spectrum Disorder (Level 1)	Personality Disorders (PDs)
Onset	Early childhood (even if not diagnosed until later)	Usually adolescence or early adulthood
Social Communication	Difficulty with social reciprocity, reading social cues; literal thinking	Can include interpersonal dysfunction, but often with emotional volatility or detachment depending on PD type
Relationships	Struggles to initiate/maintain relationships; often desires connection but lacks skill	BPD: intense/unstable Schizoid: indifferent Avoidant: desires connection but fears rejection
Emotional Regulation	May have meltdowns or shutdowns; difficulty naming or processing emotions (alexithymia)	BPD: affective instability, rage Depressive PD: chronic sadness Passive-aggressive: indirect resistance
Theory of Mind (understanding others' mental states)	Often impaired	Usually intact (though it can vary in BPD or Schizotypal)
Cognitive Patterns	Rigid thinking, need for sameness, intense interests	Schizotypal: magical or paranoid thinking Depressive: negative self-schema
Sensory Issues	Common (hypo/hyper-sensitivities to sound, light, texture, etc.)	Rare or absent in PDs
Empathy	Cognitive empathy may be impaired; emotional empathy often intact	BPD: high emotional empathy Schizoid: low empathy Others vary
Self-Image	Confusion due to neurodivergence; may mask to fit in	BPD: unstable identity Depressive: chronic low self-worth
Interests / Routines	Intense focus on specific interests; adherence to routines	Usually not present; PDs more focused on interpersonal/emotional patterns
Response to Structure	Improves with clear structure, routine, and predictability	Mixed; BPD may react with impulsivity, Schizoid may not care, Avoidant may need gentle encouragement
Developmental History	Social and sensory differences since early life; possible academic/peer difficulties	Often no clear developmental delays, but may have trauma or attachment disruptions

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🔎 Targeted Assessment Questions

Here are the areas needed for you to consider:

🧠 Developmental History

• Did you struggle with making friends or understanding others as a child?
• Were there specific routines or rituals you strongly preferred?
• Any early fixations or intense interests?

 

🗣️ Social Interaction

• Do you find small talk confusing or exhausting?
• Do people misunderstand your tone, facial expressions, or body language?
• Have you been told you seem “too blunt” or “robotic”?

 

💥 Emotional Regulation

• When upset, do you shut down, become overwhelmed, or feel physically uncomfortable?
• Do you have trouble identifying or describing your emotions?

 

🧩 Rigid Thinking or Interests

• Do you find it hard to adapt when plans change?
• Are there subjects or hobbies you can talk about for hours, even if others aren’t interested?

 

🧍 Personality Disorder Indicators

• Do you feel extreme fear of abandonment (BPD)?
• Do you tend to sabotage relationships without knowing why?
• Do you believe others are out to get you or that you have special powers (Schizotypal)?
• Do you avoid others because you’re afraid of being judged (Avoidant)?

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🛠️ Clinical Tools (for clinicians or referrals)

• ADOS-2 (Autism Diagnostic Observation Schedule)
• RAADS-R (Ritvo Autism Asperger Diagnostic Scale – Revised)
• SCID-5-PD (Structured Clinical Interview for DSM-5 Personality Disorders)
• EQ & SQ-R (Empathy and Systemizing Quotients)

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✅ Summary

When ASD Level 1 is misdiagnosed or overlaps with personality pathology, it’s often because:

• Emotional dysregulation is mistaken for BPD
• Social detachment is mistaken for Schizoid
• Odd beliefs or behaviors are mistaken for Schizotypal
• Social inhibition is mistaken for Avoidant
• Chronic invalidation creates secondary traits like depressive or passive-aggressive features

But ASD usually has earlier onset, sensory issues, cognitive rigidity, and a different flavor of social difficulty than most personality disorders.