ASC… and some “Connected Conditions”

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) outlines specific criteria for various mental health conditions.

Autism, ADHD, BPD, AvPD, CFS, and bipolar disorder share overlapping symptoms and comorbidities, making differential diagnosis complex.

Below is a table reflecting the symptoms of Autism Spectrum Condition (ASC), Attention-Deficit/Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), Avoidant Personality Disorder (AvPD), Chronic Fatigue Syndrome (CFS), and Bipolar Disorder, based on the DSM-5-TR and related sources:

Here’s a summary of the research findings:

1. Autism and ADHD: These conditions frequently co-occur, with studies showing that between 18%-34% of adults with ADHD have co-occurring BPD, and ADHDers have 19.4 times higher odds of BPD than individuals not diagnosed with ADHD The DSM-5 allows for the co-diagnosis of ASD and ADHD, acknowledging the common comorbidity.
2. Autism and BPD: Research indicates significant overlaps between Autism Spectrum Disorder (ASD) and Borderline Personality Disorder (BPD). For instance, 15% of BPD subjects met the criteria for ASD, and there is an increased odds ratio in BPD patients for having ASD (OR = 10.0) Additionally, 45% of ASD females had a diagnosis of BPD.
3. ADHD and BPD: ADHD and BPD share several personality traits, particularly novelty seeking and harm avoidance. Studies have found that 33.7% of ADHDers had BPD compared to 5.2% in the general population.
4. Autism and AvPD: Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding or eating disorder with considerable overlap with autism, where 8% to 55% of children diagnosed with ARFID were autistic.
5. Autism and Bipolar Disorder: There is a noted overlap in symptoms between autism and bipolar disorder, which can lead to misdiagnosis. Bipolar disorder is often claimed to be comorbid with a number of conditions, including autism.
6. CFS (Chronic Fatigue Syndrome): While not directly discussed in the context provided, CFS can co-occur with various psychiatric and neurological conditions, and its symptoms can overlap with those of depression and anxiety, which are also common in autism and other neurodevelopmental disorders.

Below is a summary table of symptoms for the following disorders: Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), Avoidant Personality Disorder (AvPD), Conduct Disorder (CD), and Bipolar Disorder. These symptoms are derived from the DSM-5-TR and related sources.

Disorder	Key Symptoms
Autism Spectrum Disorder (ASD)	– Persistent deficits in social communication and interaction across multiple contexts – Restricted, repetitive patterns of behavior, interests, or activities – Symptoms must be present in the early developmental period (typically before age 3) – Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
Attention-Deficit/Hyperactivity Disorder (ADHD)	– Inattention: Six or more symptoms (e.g., difficulty sustaining attention, forgetfulness, easily distracted) – Hyperactivity and impulsivity: Six or more symptoms (e.g., fidgeting, interrupting others, difficulty waiting turns) – Symptoms must persist for at least 6 months and be inconsistent with developmental level – Onset before age 12
Borderline Personality Disorder (BPD)	– Frantic efforts to avoid real or imagined abandonment – Unstable and intense interpersonal relationships – Identity disturbance: markedly and persistently unstable self-image or sense of self – Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, reckless driving) – Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior – Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety) – Chronic feelings of emptiness – Inappropriate, intense anger or difficulty controlling anger – Transient, stress-related paranoid ideation or severe dissociative symptoms
Avoidant Personality Disorder (AvPD)	– Avoids occupational activities that involve significant interpersonal contact due to fears of criticism, disapproval, or rejection – Is unwilling to get involved with people unless certain of being liked – Shows restraint within intimate relationships due to fear of being shamed or ridiculed – Is preoccupied with being criticized or rejected in social situations – Is inhibited in new interpersonal situations due to feelings of inadequacy – Views self as socially inept, personally unappealing, or inferior to others – Is unusually reluctant to take personal risks or engage in any new activities because they may prove embarrassing
Conduct Disorder (CD)	– Aggression to people and animals: e.g., bullying, threatening, or intimidating others; initiating physical fights – Destruction of property: e.g., deliberate fire setting; deliberate destruction of others’ property – Deceitfulness or theft: e.g., breaking into someone’s house; lying to obtain goods or favors – Serious violations of rules: e.g., staying out at night despite parental prohibitions; running away from home overnight; truancy from school before age 13 – Onset before age 18; symptoms must persist for at least 12 months
Bipolar Disorder	– Manic episode: abnormally elevated, expansive, or irritable mood lasting at least 1 week; increased goal-directed activity or energy; inflated self-esteem; decreased need for sleep; more talkative than usual; flight of ideas; distractibility; excessive involvement in activities that have a high potential for painful consequences – Hypomanic episode: similar to manic episode but less severe, lasting at least 4 days – Major depressive episode: depressed mood most of the day, nearly every day; markedly diminished interest or pleasure in all, or almost all, activities; significant weight loss or gain; insomnia or hypersomnia; psychomotor agitation or retardation; feelings of worthlessness or excessive or inappropriate guilt; diminished ability to think or concentrate; recurrent thoughts of death or suicidal ideation

Notes:

• ASD: The DSM-5 eliminated the previous subcategories (e.g., Asperger’s syndrome) and now classifies all autism-related disorders under the umbrella term “Autism Spectrum Disorder”
• ADHD: The DSM-5 introduced more specific criteria for adults, requiring only five symptoms instead of six for diagnosis in individuals aged 17 or older
• BPD: BPD is often comorbid with other disorders, including depression, anxiety, and substance use disorders
• AvPD: AvPD shares similarities with Social Anxiety Disorder but is more pervasive and involves a broader pattern of social inhibition and feelings of inadequacy
• CD: CD is often a precursor to Antisocial Personality Disorder (ASPD) in adulthood, especially if symptoms begin before age 10
• Bipolar Disorder: The DSM-5 distinguishes between Bipolar I (at least one manic episode), Bipolar II (at least one hypomanic and one major depressive episode), and Cyclothymic Disorder (chronic, less severe mood swings)

The DSM-5-TR, a text revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, serves as a comprehensive guide for diagnosing mental health conditions and was published in 2022.

It includes updates and changes that reflect advancements in mental health practice since the original DSM-5 release in 2013. The DSM-5-TR is crucial for healthcare providers in making accurate diagnoses, which in turn influence treatment recommendations and healthcare payments.

Autism Spectrum Disorder (ASD) in the DSM-5-TR is characterized by a dimensional approach, allowing clinicians to assess symptom severity rather than categorizing patients into distinct subtypes. This change was made to address the inconsistencies in distinguishing Asperger’s syndrome from other autism-related conditions and to simplify diagnosis and improve access to services.

Attention Deficit Hyperactivity Disorder (ADHD) in the DSM-5-TR no longer excludes individuals with autism as a comorbid diagnosis, and the age of symptom onset for ADHD diagnosis has been extended from 7 to 12 years old.

Borderline Personality Disorder (BPD) is frequently comorbid with other conditions. Studies have shown that individuals with BPD often exhibit higher rates of other disorders, such as ASD and ADHD. In a sample of individuals with ASD, 7% were found to have BPD Additionally, research indicates that BPD is more common in individuals with ADHD compared to those without.

Avoidant Personality Disorder (AvPD), while not directly mentioned in the snippets, is known to have comorbidities with depression, bipolar disorder, and anxiety disorders, particularly social anxiety disorder, according to the DSM-5.

Chronic Fatigue Syndrome (CFS) was not discussed in the provided context, so no specific information can be relayed regarding its comorbidity with other disorders mentioned.

Bipolar Disorder comorbidity with BPD is noted, with studies showing that individuals with bipolar disorder can also exhibit traits of BPD, and vice versa The DSM-5-TR continues to provide the criteria for diagnosing bipolar disorder, which includes various specifiers to capture the complexity of the disorder.

The DSM-5-TR also introduced changes to the diagnostic criteria for personality disorders, including the Alternative DSM-5 Model for Personality Disorders, which uses a dimensional approach to assess impairments in personality functioning and pathological personality traits.

It is important to note that the DSM-5 and DSM-5-TR are intended for use by mental health professionals and should not be used for self-diagnosis.

If you or someone you know is experiencing symptoms of any of these conditions, it is recommended to seek the advice of a qualified healthcare provider.

For completeness:

Asperger’s syndrome and autism spectrum disorder (ASD) have undergone significant diagnostic changes over time, particularly in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Historically, Asperger’s syndrome was considered a distinct condition within the broader category of pervasive developmental disorders (PDD), which also included autism. The DSM-IV, published in 1994, formally recognized Asperger’s syndrome as a separate diagnosis characterized by difficulties in social interaction, communication, and restricted interests, but without significant delays in language or cognitive development.

In contrast, autism in the DSM-IV was diagnosed based on more generalized impairments, including language and cognitive delays. Asperger’s syndrome was often described as a “high-functioning” form of autism, though this distinction was debated among researchers and clinicians.

The DSM-5, published in 2013, eliminated the separate diagnosis of Asperger’s syndrome and integrated it into the broader category of autism spectrum disorder. This change was made to improve diagnostic consistency and reflect the spectrum nature of autism-related conditions Under the DSM-5, individuals previously diagnosed with Asperger’s syndrome are now classified under ASD, typically with a specification of “without intellectual or language impairment”.

A similar change occurred in the World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11), which also removed Asperger’s syndrome as a distinct diagnosis in 2022 These revisions have sparked debate, with some arguing that the loss of a specific Asperger’s diagnosis overlooks important differences in symptom presentation and personal identity for those affected.