I have done a rigorous job of self diagnosis. I am autistic. I’ve also had the privilege of being able to pursue meditation, therapy, and other self development practices: I’m not as severely autistic as I was as a young man. I also have childhood trauma that I know contributes to many of my autistic presentations — see the last section on comorbidity. I also have some distinct ADHD symptoms but have never pursued that path because my hyperfocus tends to win out often enough that it’s not a hindrance to productivity. But it still causes problems elsewhere in my life.
For some people these diagnoses will be a very good fit with clear predictive outcomes. But many of us have a grab-bag of traits from several categories and still mostly get along in life, maybe with some assistance particular to one of these diagnosis but no more help overall than anyone else needs otherwise.
The diagnostic models suck. They are too broad here, too narrow there, misunderstood by professionals. I had a psychiatrist (mis)diagnose me as bipolar based on a 45 minute appointment when I was in some sort of crisis in my early 30s and that ended up haunting me years later when applying for a job with a security clearance. I didn’t even know about it at the time. This was one of the top rated doctors in a major metro area. What a sham.
The field is a mess. It has a terrible history of horrific abuse. Some autistic children still receive involuntary-to-them ECT. I think we should be supportive of research into these topics while also being critical of the very obvious problems with them.
Your experience illustrates something that often gets lost in the autism-vs-not-autism debate: many people don’t fall into clean diagnostic categories. You’re describing a profile that mixes autism traits, trauma adaptations, ADHD features, and developmental history, and instead of neatly labeling you, the system failed you outright with a bipolar misdiagnosis. That alone shows how fragile clinical certainty really is.
I think the most important part of what you wrote is that you changed over time. Whether that improvement came from meditation, therapy, maturity, trauma processing, or simply growing into yourself, it challenges the idea that autism is a static essence. Development, coping skills, neurology, and environment interact in ways the current diagnostic boundaries don’t fully capture.
Where I push back slightly is on the conclusion that self-diagnosis can automatically fill the gaps. For some people it’s deeply accurate and validating, for others it may explain one part of their experience but obscure another. As you said, many people carry a “grab-bag” of traits, and a single label can illuminate or compress that complexity depending on how it’s used.
You’re right that the field has a painful history and uneven present. Misdiagnosis is real. Forced treatment is real. Diagnostic tools are blunt instruments for a very diverse human reality. Supporting research while staying critical of the system makes sense, not because autism isn’t real, but because the categories we have are still evolving. Your story is a perfect example of why humility in diagnosis matters, whether it’s done by a psychiatrist or by oneself.
Mental healthcare in-general tends to suck. I went for years to a boutique psych that had suspect people working for them and that would just increase dose until prescribing the max allowed of various meds.
What I’ve noticed is that if a doctor’s or dentist office looks stylish, consider moving to a different one. It’s not worth ruining your life, health, teeth, etc.
I was also misdiagnosed as bipolar due to a crisis years ago, which destroyed my career path in the military and post service. Since then I’ve been diagnosed as autistic, but much like you I’m just capable enough to kind of run the rat race but not quite capable enough to thrive.
Not the OP, but after a couple of decades of people pointedly talking about eye contact, small talk, and body language, you learn “coping mechanisms” to deal with neurotypicals and make them more comfortable.
Did your sporting team have success on the weekend? Wonderful, direct eye contact, smile, mirror. Ok, now, to business:
Commonly called masking - learning the 'rules of the road' for peopling - the hardest thing that young folks with autism or ADHD need to learn is that you must learn how to do this, the world will not (often or always) change to accommodate you - but once you do it, you can appear more or less normal most of the time.
There's nothing in the diagnostic models for nearly any mental health concern that presumes a patient would forever earn that diagnosis nor (certainly) that its presentation would be identical through their life even if the diagnosis stood.
There are some clinicians and unfortunately now many patients and caregivers that nonetheless take an essentialist view of diagnosis and come to identify their patient/self/child/peer with what's really just meant to be a guideline for support with ongoing dysfunctions.
In reality, most people face some fluctuating bag of dysfunctions over the course of their life, with fluctuating intensity, with contributing causes too diffuse and numerous to identify. They might be diagnosed squarely by one clinician with one thing thing at one time, then see some other clinician the same day who thinks the diagnosis was overstated or preposterous. Or they might find that a qualifying symptom that seemed very salient at one time of their life hasn't been an issue for them for a long time because of some new learned behavior, some change of circumstance, etc. Likewise, they may even find themselves facing new or greater dysfunctions compared to what they'd experienced or noticed before, precipitated through known or unknown reasons.
For people most intensely disabled by mental health dysfunction, they often can't escape that dysfunction entirely without the discovery and resolution of some kind of radical physiological or environmental issue.
But for the majority of people who just found that they had a hard time with their daily life, but were otherwise independent, and received a diagnosis that helped them see some constellation of related factors and opportunities for accommodation or treatment, things are hardly so static.
For most of early psychology, this marked the distinction between "psychotic" and "neurotic" presentations. The former represented a disruption so severe that escaping disability and achieving independence were largely out of reach, whereas the latter were understood to be real but fluctuating or even ephemeral disturbances.
It's not really until very recently, when so many people started to obsess with "identifying" themselves with this thing or that thing in some kind of permanent way, that this distinction began to fall out of mind.
In the case of those diagnosed with autism as part of generally independent and functional lives, it's not hard to find people who have experienced changes to the symptoms that originally qualified them for the diagnosis -- sometimes positively, sometimes negatively; sometimes during certain times, sometimes permanently. It's also not hard to find people who received such a diagnosis at one time and either felt comfortable fully rejecting that diagnosis at some later time or had a clinician who strongly questioned it or refused to confirm it. None of this stuff is static and much of it is subjective.
I strongly believe I was misdiagnosed with autism when in reality the traits were caused by traumatic backlash from those I was supposed to trust towards ADHD traits that would have calmed down after adolescence. The diagnosis was largely a red herring for me and led me down treatment paths that did not address the root of my issues, and I believe I suffered unnecessarily as a result. It is insane to me that people are sooner to blame vaccines and diet than childhood upbringing/environment for causing symptoms construed as autism or ADHD. It makes sense though - no parent wants to be blamed for their child's lifelong disorder, just as mine still don't to this day. Cancer might just be curable, but a parent who refuses to change their mind will never be.
I am doing better these days but I sometimes wonder how I would have turned out if I got help sooner, instead of spending years and years searching for the wrong kind of help. It doesn't help that society is talking more about this and inadvertently leading people to believe that these problems are just the way things are, without considering upbringing and environmental factors.
At the same time, blaming the wrong problem is different then spending all one's time blaming the right problem, which is different than letting go of the past and doing the best one can with one's life. It is nearly insurmountable for me but I try to put forth an effort each day.
BTW, there's research that shows that schizotypy (schizotypal/schizophrenia) is sort of the opposite of autism. You have to squint your eyes a bit, for example both of these neurotypes involve social difficulties, like the subjective feeling of being alien in the world (known as Anderssein in German psychiatry). However if you peel off the social layer then the remaining autistic features become anti-correlated with the remaining schizotypal features on the scale of the population. There are also some decent theories that suggest this should be the case - for example in the predictive coding theory it is believed that autistic brains over-weigh sensory inputs over their model of the world, whereas schizotypal brains over-weigh their model of the world over the sensory inputs. Or the Big Five traits, openness to experience is usually low in autism and high in schizophrenia.
Something fascinating that has been noticed by many people is that LLMs with a low temperature setting produce output similar to autism and high temperature is schizo in style. You even see the AIs get stuck in repetitive loops at very low temperature settings.
> BTW, there's research that shows that schizotypy (schizotypal/schizophrenia) is sort of the opposite of autism.
And I disagree with that. There is a wide overlap of symptoms in all mood disorders. People with ASD show many traits of the negative symptoms of schizophrenia. This paper might change your mind:
Yeah, at face value the two diagnoses are positively correlated. This is simply true. And traits of these two only become negatively correlated if you remove the shared social difficulties, which includes a lot of the negative symptoms. Unfortunately everything is positively correlated in psychiatry. If you want to explore this deeper I recommend the "p factor" (general psychopathology factor), which is a serious, multi-year attempt at identifying something like the "first eigenvector of psychiatry", a loading common to all psychopathology, including substance use, affective disorders, psychotic disorders, conduct/personality disorders, ... The idea is that if you only know that someone has whatever goes into this vector then you know that person is quite likely to develop some disorder, but you don't know which one.
I would only add that ASDs do not have "real" negative symptoms of schizophrenia, but what they do have can look a bit similar. The research on anti-correlation was using questionnaires and binned the social questions taking that into account.
Given we're long evolved, and also tribal based animals, and that culture is an evolutionary pressure feedback mechanism, and prediction is fundamentally useful to our reality, different "thinking styles" (ways to predict/understand outcomes) are useful, aannnd, tribally we used people for their usefulness, I often wonder if "faulty" is the correct lens. That is to say, If prediction variation was useful to tribes, having both 'trust the model' and 'trust the senses' type people, I suppose framing these as disorders rather than trade offs is probably the wrong lens entirely. Society/culture/reality is so narrow and predictable these days, faulty in what context, you know? If you breed 20 generations of "best night watchers", in the jungle at night looking down, quiet, still, dark... you'd probably be selecting for specific traits, and creating new traits, retinal rod density and sensitivity, faster dark adaptation/contrast etc, attention/vigilance traits, pattern detection, anxiety adjacent traits in hypervigilance,
prob something about circadian rhythm tolerance etc etc. (https://www.researchgate.net/publication/40886135_Not_By_Gen...)
Yes, but not always faulty. My (diagnosed) OCD and Anxiety have saved me from many bad situation. I see the many many many possibilities that something can go wrong and I have very low risk tolerance.
There is a school of thought that all psychiatric crap can be expressed in terms of disordered synaptic plasticity ... Dementia it falls apart; psychosis it forms and prunes "wrongly", etc.
Unfortunately this view is a little ahead of technical capability to observe and intervene at that level so it's more of a clarifying viewpoint than a predictive tool
Wouldn't the implication of them being "opposite" be that in some sense they are mutually exclusive? I don't really see evidence of that. Your example of sensory input vs world model weight is a bit flawed, because both of those are extremely multifaceted. One can have extreme weight in sensory input in one sense but not others, as well as extreme weight on world model for certain aspects of life.
> Or the Big Five traits, openness to experience is usually low in autism
Openness (to experience) in the Five Factor Model is quite strongly correlated to IQ, so I'd rather expect that highly intelligent autistic people would score much higher regarding openness.
Oh schizophrenic brains ... I remember reading a journal article that the immune system was to blame... The immune system in the brain is used to remove axonal connections between different neurons ... Because this is overactive, control of ones mind is well harder...
Yeah, the "mirror image" idea makes a lot of sense to me. Both groups feel out of sync socially, but for opposite reasons: autistic cognition leans too hard on raw sensory input, schizotypal cognition leans too hard on internal interpretations
I don't think there's much underlying relationship. True they will both impact social relationships. But it's more like how being blind or being deaf will impact social relationships. The mechanics might be the same but the cause is very different.
IMHO schizophrenia is a breakdown in the barrier between imagination and processing of reality.
Autism and the like is an inability to process social cues like a blind person might have a damaged visual cortex.
Autism is more broad-spectrum than just related to social processing. It's most visible in social processing because that's the cognitive area that humans have highly specialized in as a species, where expectations of performance are very high, and thus where deficiencies processing complex information in real-time are most visible. If we were birds, we'd probably think autism had something to do with flying. Instead, we are talking tribal apes, so when someone has the cognitive differences that lead to autism, we notice most strongly that they are having trouble being a normal talking tribal ape.
But the effects of autism are visible outside of social interaction too, with repetitive behaviors, intense focused interests, trouble with adapting to change, rigidity in lifestyle, etc.
You're saying that relative to the 'typical individual', autistic brains weigh sensory inputs more heavily than their internal model. And that in schizotypal brains, relative to the 'typical individual', the internal model is weighed more heavily than the sensory input, right?
I don't know much about this area, so I can't comment on the correctness. However, I think we should be cautious in saying 'over-weigh' and 'under-weigh' because I really do think that there may be a real normative undertone when we say 'over-weigh'. I think it needlessly elevates what the typical individual experiences into what we should consider to be the norm and, by implicit extension, the 'correct way' of doing cognition.
I don't say this to try to undermine the challenges by people with autism or schizotypy. However, I think it's also fair to say that if we consider what the 'typical' person really is and how the 'typical' person really acts, they frequently do a lot of illogical and --- simply-put --- 'crazy' things.
>However, I think we should be cautious in saying 'over-weigh' and 'under-weigh' because I really do think that there may be a real normative undertone when we say 'over-weigh'. I think it needlessly elevates what the typical individual experiences into what we should consider to be the norm and, by implicit extension, the 'correct way' of doing cognition.
No biggie, there's a real normative undertone to the world in general too.
Norm itself means "what the majority does" or the socially (i.e. majority) accepted yardstick ("norma" in latin was a literal yardstick-like tool).
It's not about the typical person _always_ doing things in a better way, or the autistic person always doing things differently. It's about the distribution of typical vs atypical behavior. So, it's not very useful to characterize such atypical behavior better or worse based on absolute moral or technical judgement. Morality changes over time, cultures, and even social groups, to a bigger or smaller degree.
If, however, we use "degree of comformity with majority behaviors/expectations" as the measurement, autistics do perform worse on that.
Isn't "what the typical individual experiences" pretty much the definition of "normal"?
Whether "normal" is also "correct" is a completely separate question. There are plenty of fields where the behavior of the typical person is also widely perceived to be incorrect, like personal finance or exercise routines.
I think part of the tension here comes from the way autism is understood both as a broad, fully-continuous, multivariate spectrum, and as a binary diagnosis.
To be sure, clinically, thresholds are useful because services, insurance, and research all rely on clear binary classifications, in our current society. But outside that context, it isn’t obvious that everyday language needs to mirror that line. Self-identification can be a way of making sense of one’s life, not an attempt to claim a clinical label.
But at the same time, the spectrum includes people with very high support needs, and there’s understandable concern that broad or casual uses of the term can hide those realities in ways that impact care.
To me, none of this means people are wrong for wondering about autism. And I do not have the experience to advocate for or against "anxiety disorders" being weighted more heavily in clinicians' priors than they currently are (as the OP article heavily implies with its length). I mean only to highlight the mismatch between a binary diagnostic system and a very heterogeneous spectrum, and the need for language that acknowledges self-understanding without flattening anyone’s experience.
The largest confusion with Autism is the ever changing definition from one DSM to the next where whole areas are suddenly included and others excluded.
It seems in the DSM 5 the definition was narrowed specifically to focus on two performance deficits: 1) immediate harms either to the inflicted or to those they interact with due to social interactions, 2) catastrophic academic failures due strictly to input/output perception irregularities not otherwise explained by neuro-transmission disorders (things that can be treated with drugs) or low intelligence measures.
That excludes a massive host of social and perception abnormalities that do result in less immediate social rejection and abstract reasoning failures.
As far as I can tell, the definition of autism coincides with the desire of healthcare to address it without having to carve out 100+ variations of behavioral outcomes to get insurance to pay for it.
We know autism affects all sorts of long term outcomes, but if you tried to split it into actual diagnoses, you end up with insurance companies dividing and conquering approvals.
So instead of having several definitions, we put them all behind autism because that has already received appreopiate laws that establish requirements to treat both at school and in healthcare settings.
So basically, once it breached the "we need to address this", rather than every new diagnosis having to struggle to say "look, this problem effects society", it just grows offshoots and spectrum status.
Because it's definitely not a physically identifiable disability. It's all behavioral and that will always have more coincidences.
> It seems in the DSM 5 the definition was narrowed
I think it may have been narrowed in theory, but often not in practice.
Here in Australia, making DSM-5 ASD a shortcut to getting funded by our national disability insurance scheme (NDIS) caused a lot of pressure to broaden the diagnosis in practice - if clinicians have to stretch the diagnosis to get someone the support they need, they feel ethically obliged to engage in that stretching, since it is in the best interests of their client (who are experiencing real challenges, even if those challenges map poorly to the official diagnostic criteria).
And Australia is not unique in providing funding pressures for ASD diagnosis, although NDIS is arguably a global outlier in the scale of that pressure. Apart from funding, growing popular and clinical mindshare of the diagnosis creates independent pressure to broaden its definition.
So a theoretical narrowing coexists with a practical broadening - and the latter is arguably what really counts
The day-to-day impact of being diagnosed is practically non-existant for me. It might explain "why" I might react to a specific stimuli but it doesn't stop the reaction. At best it's something to laugh about with my wife. It does also offer an early-warning system when I'm over stimulated and that I need to 'get home' soon.
> The day-to-day impact of being diagnosed is practically non-existant for me.
Yeah, as the old adage goes: with an ADH?D diagnosis you get to try drugs like lisdex or methylphenidate (or the non-stim options if those aren't suitable), but with an Autism/ASD diagnosis you get some pamphlets, coffee morning invites and a reading list.
I don't have a formal diagnosis but my child does and that made me read lots on the subject. Authors like Eliza Fricker, Ellie Middleton, Pete Wharmby amongst others.
It's opened my eyes to many other related aspects, specifically Rejection Sensitivity Dysphoria (RSD) and Pathalogical Demand Avoidance (PDA) and how those play into both ADH?D and ASD. In reading about them I've worked out just how much they apply to my-undiagnosed-self and how understanding the triggers and recognising the early behaviour has allowed me to adapt to minimise their impact.
"Rejection Sensitivity Dysphoria" is not medically recognized and is literally just something a guy with a blog made up.
(Note, the guy with the blog is a doctor, but he specifically recommends certain medications for this that I don't think anyone else who discusses RSD online would agree with if they knew this.)
Personally, I think it just sounds like a description of anxiety.
For my sister, getting diagnosed was important to her because she always felt like she was broken but now sees herself as simply different. I'm not aware of any workplace accommodations she has requested but it has been good for her self-esteem, which is a benefit in of itself.
Being able to laugh about it, and know what is going on however is huge. Especially compared to being shit on all the time by others and self blaming (a common pattern!).
If you happen to have built a functioning support nets already, being diagnosed is at best a curiosity. If you didn't, or your existing ones have crumbled, it gives you tools to do that.
> But autism may also be the only relevant diagnosis they’ve heard of or are familiar with. They haven’t seen any cool TikToks about being schizoid. No one’s offering them quizzes about being schizotypal.
Don't underestimate TikTok. You can find all sorts of weird fad mental illness there. For a while tourette syndrome was all the rage and the platform was filled with kids faking tics. There are fake epileptics faking seizures too. OCD is another common "cool" self-diagnosis and there are online quizzes to tell you how OCD, or ADHD or bipolar you are. It wouldn't surprise me at all if schizoid or schizotypal caught on.
I think some people are looking for the self-validation that can come with a diagnoses, an explanation for why they are the way the are, feel the way they do, or why they struggle with certain things. Others are just looking for views, attention, or a community to belong to.
While it can be fairly harmless the ability for mass sociogenic illness to spread via social media is interesting and a bit frightening.
> For a while tourette syndrome was all the rage and the platform was filled with kids faking tics.
Kind of like all those kids in Le Roy, NY who began experiencing involuntary tics. IIRC, it was interesting that it was mostly girls who were affected by the "craze".
There was (perhaps still is) a lot of stuff on there by people claiming to have dissociative identity disorder (what used to be called multiple personalities)
Also see specialisms WITHIN Autism that are different to the mainstream Autism
The one I know most about is
PDA: Pathological Demand Avoidance [1]
PDA presents differently and needs very different strategies to mainstream Autism.
Main signs… kids under 12 attend school. However they explode at home or in private. At school the PDAers are masking (pretending to fit in) which is draining. When they get home the pent up frustration is released (explosively). So the family at home see a very different kid to the one that school/extended family witness. If this is an A-Ha! lightbulb moment for you or your child, see the questionnaire at the PDA Society[1]
Is it due to stimulous overload or anxiety? I think that's the difference.
The point being misdiagnosis ocd as pda is a risk if autism is the only thing people consider. Maybe not a a huge deal since realistically a misdiagnosis often means you get a pamphlet with broadly similar advice and maybe and cbt anyway ... but maybe I'm being overly cycnical.
If you think you (or a loved one) may have a psychological condition, go to a psychologist and get a screening. The diagnosis isn't the important part. The value is in the 20-something pages of detailed analysis by a professional.
At a bare minimum, it will give you a fresh perspective on things you already knew. In my experiences, there will be things you didn't realize about yourself.
They aren't going to tell you what the solution is to all your problems; that's for you and your doctor to figure out. They will give you everything you need to make well-informed decisions, and that's priceless.
The problem is such screenings are incredibly expensive (at least in the US), and for things like ADHD or Autism, you need a specific screening that is often even more expensive.
And even then if you get an autism diagnosis as an adult, this report is effectively all you get, there are no medicines or treatment options that this opens up afaict.
> If you think you (or a loved one) may have a psychological condition, go to a psychologist and get a screening. The diagnosis isn't the important part. The value is in the 20-something pages of detailed analysis by a professional.
Throughout my entire interaction with psychiatry (years, on and off) I never figured this is a thing. Go figure.
Get screened for whatever you think you've got. Think you've got ADHD? Go get an ADHD screening. Autism? It's not easy to find a psych who does adult Autism screenings, but they're out there. OCD? You get the idea.
Regardless of whether the conclusion is "yes you have x" or "no you don't have x" the diagnosis will be accompanied by a detailed analysis of your psychological condition. Whether or not you are diagnosed, that analysis will cover the issues that led you to believe you may have that condition.
I'm getting a full neuro-psych screening next month because my therapist suspects I may have OCD. It's a 4-6 hour series of tests/interviews (and probably other stuff, I'll find out). I'm guessing that's what they're referring to?
I never understood why people, especially americans, are so hyperfocused on "mental health" and wear their pseudoscientific bullshit diagnoses like medals. I agree that there is a small fraction of people that do have mental issues, but it is very likely that most of the people that encourage "therapy" and yap about "mental health" very likely don't have any meaningful issues worth diagnosing and are just unnecessary burden on the medical system. The term "autism" in itself is so overused nowadays that it doesn't mean absolutely anything anymore, the fact that it doesn't have precise, rigorous definition doesn't help either.
By downvoting we missed out a joke: Lets apply the article to the comment
>> I never understood why ... americans ... wear their pseudoscientific bullshit diagnoses like medals.
> Borderline Personality
Borderline personality disorder involves intense emotional instability, ... and devaluation of others.
>Social Communication Disorder
... knowing how much detail to give, adjusting their speaking style for different situations, understanding implied meanings or hints,
> B5: Antisocial personality disorder (ASPD): People diagnosed with ASPD show a lack of respect toward others. They generally don’t follow socially accepted rules.
> B5: Narcissistic personality disorder (NPD): People diagnosed with NPD have a sense of being better than others... They lack empathy for others
---
> I agree that there is a small fraction of people
What exactly makes you believe the fraction is small?
It feels like some people just say things these days. Research shows that autism and ADHD are highly comorbid, I forget the exact numbers off the top of my head but they're something like ~50% of autistic people having ADHD, and ~20% of people with ADHD having autism.
So then you grow up as autistic and/or ADHD person which creates a lot of social friction and conflict in your life, you're called lazy, careless, difficult, overly sensitive, and this is particularly bad if you're undiagnosed. You don't fit in socially so you develop social anxiety (this is par for the course), and after a while that can spiral into depression or even a personality disorder, you might start to self-medicate which can turn into a substance use disorder, and ultimately people afflicted by these disorders are taking their own lives at alarming rates. You should look up statistics for suicidal ideation among children and adults with autism for a reality check.
Most of this can be prevented if those affected were diagnosed and offered support as early in life as possible.
So no, having ADHD and autism, two very closely related neurodiversities, and then developing anxiety as a result of that is not at all unusual.
Do you think neurotypical people often go, "I would like to spend significant time and money to get an autism diagnosis"?
I don't think it's particularly common. When I went through my dx, I was really hoping for adhd because then I could get meds, but my doc and all my screenings were like, "definitely not adhd, definitely autism".
So, maybe you are seeing rising diagnosis rates and considering that too easy? If encourage you to think about why you feel this way.
Readit News
For some people these diagnoses will be a very good fit with clear predictive outcomes. But many of us have a grab-bag of traits from several categories and still mostly get along in life, maybe with some assistance particular to one of these diagnosis but no more help overall than anyone else needs otherwise.
The diagnostic models suck. They are too broad here, too narrow there, misunderstood by professionals. I had a psychiatrist (mis)diagnose me as bipolar based on a 45 minute appointment when I was in some sort of crisis in my early 30s and that ended up haunting me years later when applying for a job with a security clearance. I didn’t even know about it at the time. This was one of the top rated doctors in a major metro area. What a sham.
The field is a mess. It has a terrible history of horrific abuse. Some autistic children still receive involuntary-to-them ECT. I think we should be supportive of research into these topics while also being critical of the very obvious problems with them.
I think the most important part of what you wrote is that you changed over time. Whether that improvement came from meditation, therapy, maturity, trauma processing, or simply growing into yourself, it challenges the idea that autism is a static essence. Development, coping skills, neurology, and environment interact in ways the current diagnostic boundaries don’t fully capture.
Where I push back slightly is on the conclusion that self-diagnosis can automatically fill the gaps. For some people it’s deeply accurate and validating, for others it may explain one part of their experience but obscure another. As you said, many people carry a “grab-bag” of traits, and a single label can illuminate or compress that complexity depending on how it’s used.
You’re right that the field has a painful history and uneven present. Misdiagnosis is real. Forced treatment is real. Diagnostic tools are blunt instruments for a very diverse human reality. Supporting research while staying critical of the system makes sense, not because autism isn’t real, but because the categories we have are still evolving. Your story is a perfect example of why humility in diagnosis matters, whether it’s done by a psychiatrist or by oneself.
Edit:typo
Dead Comment
Mental healthcare in-general tends to suck. I went for years to a boutique psych that had suspect people working for them and that would just increase dose until prescribing the max allowed of various meds.
What I’ve noticed is that if a doctor’s or dentist office looks stylish, consider moving to a different one. It’s not worth ruining your life, health, teeth, etc.
Did your sporting team have success on the weekend? Wonderful, direct eye contact, smile, mirror. Ok, now, to business:
There are some clinicians and unfortunately now many patients and caregivers that nonetheless take an essentialist view of diagnosis and come to identify their patient/self/child/peer with what's really just meant to be a guideline for support with ongoing dysfunctions.
In reality, most people face some fluctuating bag of dysfunctions over the course of their life, with fluctuating intensity, with contributing causes too diffuse and numerous to identify. They might be diagnosed squarely by one clinician with one thing thing at one time, then see some other clinician the same day who thinks the diagnosis was overstated or preposterous. Or they might find that a qualifying symptom that seemed very salient at one time of their life hasn't been an issue for them for a long time because of some new learned behavior, some change of circumstance, etc. Likewise, they may even find themselves facing new or greater dysfunctions compared to what they'd experienced or noticed before, precipitated through known or unknown reasons.
For people most intensely disabled by mental health dysfunction, they often can't escape that dysfunction entirely without the discovery and resolution of some kind of radical physiological or environmental issue.
But for the majority of people who just found that they had a hard time with their daily life, but were otherwise independent, and received a diagnosis that helped them see some constellation of related factors and opportunities for accommodation or treatment, things are hardly so static.
For most of early psychology, this marked the distinction between "psychotic" and "neurotic" presentations. The former represented a disruption so severe that escaping disability and achieving independence were largely out of reach, whereas the latter were understood to be real but fluctuating or even ephemeral disturbances.
It's not really until very recently, when so many people started to obsess with "identifying" themselves with this thing or that thing in some kind of permanent way, that this distinction began to fall out of mind.
In the case of those diagnosed with autism as part of generally independent and functional lives, it's not hard to find people who have experienced changes to the symptoms that originally qualified them for the diagnosis -- sometimes positively, sometimes negatively; sometimes during certain times, sometimes permanently. It's also not hard to find people who received such a diagnosis at one time and either felt comfortable fully rejecting that diagnosis at some later time or had a clinician who strongly questioned it or refused to confirm it. None of this stuff is static and much of it is subjective.
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Adults too; ask me how I know.
I am doing better these days but I sometimes wonder how I would have turned out if I got help sooner, instead of spending years and years searching for the wrong kind of help. It doesn't help that society is talking more about this and inadvertently leading people to believe that these problems are just the way things are, without considering upbringing and environmental factors.
At the same time, blaming the wrong problem is different then spending all one's time blaming the right problem, which is different than letting go of the past and doing the best one can with one's life. It is nearly insurmountable for me but I try to put forth an effort each day.
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And I disagree with that. There is a wide overlap of symptoms in all mood disorders. People with ASD show many traits of the negative symptoms of schizophrenia. This paper might change your mind:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8931527/
I would only add that ASDs do not have "real" negative symptoms of schizophrenia, but what they do have can look a bit similar. The research on anti-correlation was using questionnaires and binned the social questions taking that into account.
Unfortunately this view is a little ahead of technical capability to observe and intervene at that level so it's more of a clarifying viewpoint than a predictive tool
Openness (to experience) in the Five Factor Model is quite strongly correlated to IQ, so I'd rather expect that highly intelligent autistic people would score much higher regarding openness.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6982569/
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IMHO schizophrenia is a breakdown in the barrier between imagination and processing of reality.
Autism and the like is an inability to process social cues like a blind person might have a damaged visual cortex.
But the effects of autism are visible outside of social interaction too, with repetitive behaviors, intense focused interests, trouble with adapting to change, rigidity in lifestyle, etc.
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You're saying that relative to the 'typical individual', autistic brains weigh sensory inputs more heavily than their internal model. And that in schizotypal brains, relative to the 'typical individual', the internal model is weighed more heavily than the sensory input, right?
I don't know much about this area, so I can't comment on the correctness. However, I think we should be cautious in saying 'over-weigh' and 'under-weigh' because I really do think that there may be a real normative undertone when we say 'over-weigh'. I think it needlessly elevates what the typical individual experiences into what we should consider to be the norm and, by implicit extension, the 'correct way' of doing cognition.
I don't say this to try to undermine the challenges by people with autism or schizotypy. However, I think it's also fair to say that if we consider what the 'typical' person really is and how the 'typical' person really acts, they frequently do a lot of illogical and --- simply-put --- 'crazy' things.
No biggie, there's a real normative undertone to the world in general too.
Norm itself means "what the majority does" or the socially (i.e. majority) accepted yardstick ("norma" in latin was a literal yardstick-like tool).
It's not about the typical person _always_ doing things in a better way, or the autistic person always doing things differently. It's about the distribution of typical vs atypical behavior. So, it's not very useful to characterize such atypical behavior better or worse based on absolute moral or technical judgement. Morality changes over time, cultures, and even social groups, to a bigger or smaller degree.
If, however, we use "degree of comformity with majority behaviors/expectations" as the measurement, autistics do perform worse on that.
It’s like saying we shouldn’t call immigrants “aliens” because that conjures images of space. Where do you think the term comes from?
Whether "normal" is also "correct" is a completely separate question. There are plenty of fields where the behavior of the typical person is also widely perceived to be incorrect, like personal finance or exercise routines.
I figured that this is probably something Scott Alexander has written about, and lo and behold: https://slatestarcodex.com/2018/12/11/diametrical-model-of-a...
To be sure, clinically, thresholds are useful because services, insurance, and research all rely on clear binary classifications, in our current society. But outside that context, it isn’t obvious that everyday language needs to mirror that line. Self-identification can be a way of making sense of one’s life, not an attempt to claim a clinical label.
But at the same time, the spectrum includes people with very high support needs, and there’s understandable concern that broad or casual uses of the term can hide those realities in ways that impact care.
To me, none of this means people are wrong for wondering about autism. And I do not have the experience to advocate for or against "anxiety disorders" being weighted more heavily in clinicians' priors than they currently are (as the OP article heavily implies with its length). I mean only to highlight the mismatch between a binary diagnostic system and a very heterogeneous spectrum, and the need for language that acknowledges self-understanding without flattening anyone’s experience.
It seems in the DSM 5 the definition was narrowed specifically to focus on two performance deficits: 1) immediate harms either to the inflicted or to those they interact with due to social interactions, 2) catastrophic academic failures due strictly to input/output perception irregularities not otherwise explained by neuro-transmission disorders (things that can be treated with drugs) or low intelligence measures.
That excludes a massive host of social and perception abnormalities that do result in less immediate social rejection and abstract reasoning failures.
We know autism affects all sorts of long term outcomes, but if you tried to split it into actual diagnoses, you end up with insurance companies dividing and conquering approvals.
So instead of having several definitions, we put them all behind autism because that has already received appreopiate laws that establish requirements to treat both at school and in healthcare settings.
So basically, once it breached the "we need to address this", rather than every new diagnosis having to struggle to say "look, this problem effects society", it just grows offshoots and spectrum status.
Because it's definitely not a physically identifiable disability. It's all behavioral and that will always have more coincidences.
I think it may have been narrowed in theory, but often not in practice.
Here in Australia, making DSM-5 ASD a shortcut to getting funded by our national disability insurance scheme (NDIS) caused a lot of pressure to broaden the diagnosis in practice - if clinicians have to stretch the diagnosis to get someone the support they need, they feel ethically obliged to engage in that stretching, since it is in the best interests of their client (who are experiencing real challenges, even if those challenges map poorly to the official diagnostic criteria).
And Australia is not unique in providing funding pressures for ASD diagnosis, although NDIS is arguably a global outlier in the scale of that pressure. Apart from funding, growing popular and clinical mindshare of the diagnosis creates independent pressure to broaden its definition.
So a theoretical narrowing coexists with a practical broadening - and the latter is arguably what really counts
Yeah, as the old adage goes: with an ADH?D diagnosis you get to try drugs like lisdex or methylphenidate (or the non-stim options if those aren't suitable), but with an Autism/ASD diagnosis you get some pamphlets, coffee morning invites and a reading list.
I don't have a formal diagnosis but my child does and that made me read lots on the subject. Authors like Eliza Fricker, Ellie Middleton, Pete Wharmby amongst others.
It's opened my eyes to many other related aspects, specifically Rejection Sensitivity Dysphoria (RSD) and Pathalogical Demand Avoidance (PDA) and how those play into both ADH?D and ASD. In reading about them I've worked out just how much they apply to my-undiagnosed-self and how understanding the triggers and recognising the early behaviour has allowed me to adapt to minimise their impact.
(Note, the guy with the blog is a doctor, but he specifically recommends certain medications for this that I don't think anyone else who discusses RSD online would agree with if they knew this.)
Personally, I think it just sounds like a description of anxiety.
Anyway I have it and it's crippling.
Don't underestimate TikTok. You can find all sorts of weird fad mental illness there. For a while tourette syndrome was all the rage and the platform was filled with kids faking tics. There are fake epileptics faking seizures too. OCD is another common "cool" self-diagnosis and there are online quizzes to tell you how OCD, or ADHD or bipolar you are. It wouldn't surprise me at all if schizoid or schizotypal caught on.
I think some people are looking for the self-validation that can come with a diagnoses, an explanation for why they are the way the are, feel the way they do, or why they struggle with certain things. Others are just looking for views, attention, or a community to belong to.
While it can be fairly harmless the ability for mass sociogenic illness to spread via social media is interesting and a bit frightening.
Kind of like all those kids in Le Roy, NY who began experiencing involuntary tics. IIRC, it was interesting that it was mostly girls who were affected by the "craze".
https://www.npr.org/2012/03/10/148372536/the-curious-case-of...
Also see specialisms WITHIN Autism that are different to the mainstream Autism
The one I know most about is
PDA: Pathological Demand Avoidance [1]
PDA presents differently and needs very different strategies to mainstream Autism.
Main signs… kids under 12 attend school. However they explode at home or in private. At school the PDAers are masking (pretending to fit in) which is draining. When they get home the pent up frustration is released (explosively). So the family at home see a very different kid to the one that school/extended family witness. If this is an A-Ha! lightbulb moment for you or your child, see the questionnaire at the PDA Society[1]
[1] https://www.pdasociety.org.uk/what-is-pda/
Is it due to stimulous overload or anxiety? I think that's the difference.
The point being misdiagnosis ocd as pda is a risk if autism is the only thing people consider. Maybe not a a huge deal since realistically a misdiagnosis often means you get a pamphlet with broadly similar advice and maybe and cbt anyway ... but maybe I'm being overly cycnical.
At a bare minimum, it will give you a fresh perspective on things you already knew. In my experiences, there will be things you didn't realize about yourself.
They aren't going to tell you what the solution is to all your problems; that's for you and your doctor to figure out. They will give you everything you need to make well-informed decisions, and that's priceless.
Throughout my entire interaction with psychiatry (years, on and off) I never figured this is a thing. Go figure.
Regardless of whether the conclusion is "yes you have x" or "no you don't have x" the diagnosis will be accompanied by a detailed analysis of your psychological condition. Whether or not you are diagnosed, that analysis will cover the issues that led you to believe you may have that condition.
>> I never understood why ... americans ... wear their pseudoscientific bullshit diagnoses like medals.
> Borderline Personality Borderline personality disorder involves intense emotional instability, ... and devaluation of others.
>Social Communication Disorder ... knowing how much detail to give, adjusting their speaking style for different situations, understanding implied meanings or hints,
> B5: Antisocial personality disorder (ASPD): People diagnosed with ASPD show a lack of respect toward others. They generally don’t follow socially accepted rules.
> B5: Narcissistic personality disorder (NPD): People diagnosed with NPD have a sense of being better than others... They lack empathy for others
---
> I agree that there is a small fraction of people
What exactly makes you believe the fraction is small?
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Western culture is a mental issue beyond repair. It will soon be gone and it will not be missed.
So then you grow up as autistic and/or ADHD person which creates a lot of social friction and conflict in your life, you're called lazy, careless, difficult, overly sensitive, and this is particularly bad if you're undiagnosed. You don't fit in socially so you develop social anxiety (this is par for the course), and after a while that can spiral into depression or even a personality disorder, you might start to self-medicate which can turn into a substance use disorder, and ultimately people afflicted by these disorders are taking their own lives at alarming rates. You should look up statistics for suicidal ideation among children and adults with autism for a reality check.
Most of this can be prevented if those affected were diagnosed and offered support as early in life as possible.
So no, having ADHD and autism, two very closely related neurodiversities, and then developing anxiety as a result of that is not at all unusual.
I don't think it's particularly common. When I went through my dx, I was really hoping for adhd because then I could get meds, but my doc and all my screenings were like, "definitely not adhd, definitely autism".
So, maybe you are seeing rising diagnosis rates and considering that too easy? If encourage you to think about why you feel this way.