A Song of Ice and Fire: Comorbid Diagnosis

*Shameless Game of Thrones reference*

I apologize for the recent lack of updates. Lately I’ve been working more hours at my job than I used to, and I still haven’t learned how to balance multiple projects at a time. I promise that I will eventually finish writing up my series on neurologically mixed relationships. For now, this shorter post on a different topic is all I can manage. Here’s hoping I’ll get be able to get back to my more in-depth series soon!

A major diagnosis like autism can sometimes feel like quite a burden. But, in many ways, having a label is a relief. With a label you have a frame of reference, a community of people like you, and decades of research to help guide your own personal journey of soul-searching and self-improvement.

But what if there’s more to the story? What happens when, as you work to navigate your road of self-discovery, you get slapped with even more labels—labels that also demand attention, exploration, and understanding?

Suddenly that road of self-discovery, already rough and uncharted, becomes a branching path of confusing, maybe even conflicting decisions.

It happens to many of us (arguably, to most of us).

It’s not easy to grow up autistic without developing a few other quirks along the way…

We’re square pegs in a world of round holes. Rare is the autistic who goes through life unburdened by so-called comorbidities—additional labels—like depression, anxiety, and other disorders.

Many of these comorbid diagnoses can even appear to conflict with the core traits of ASD. In fact, many mental health professionals will overlook problems that might otherwise be glaringly obvious if they’re seeing a patient through autism-tinted glasses. When that happens, how can we be sure which coping skills, therapies, and medications are the right ones?

For several years now I’ve known that I, like other autistics, have issues identifying and processing emotions (a trait known as alexithymia). I’d put in hundreds if not thousands of hours learning to recognize, label, and express my emotions. And yet, after all this work, my emotional challenges hadn’t lessened; if anything, they seemed to be getting worse.

With every emotional meltdown more intense than the last, I just kept trying harder. Eventually, episodes that once would have been hour-long cryfests of confusion and frustration became two- or three-day breakdowns of misguided certainty. I would recognize a feeling, label it, and then let it consume me, ruining otherwise pleasant conversations, outings, or entire vacations by expressing my emotions at the cost of all else.

What was I doing wrong? I thought expressing myself was supposed to solve problems, not create them!

My problem was in the label itself.

It wasn’t until I began branching out, researching my symptoms themselves on a stand-alone basis, that I found answers.

And when I did, I found I wasn’t alone. It seemed that many others in the autism community had similar struggles: autism alone wasn’t enough to explain what was going on, and following advice meant for autistics only made things harder.

My issue, it seemed, was one that countless others before me had battled with.

Namely, autism literature often tells us to trust in our feelings.

We’re taught that we must dig down deep to discover the truth masked by our emotion-blindness, and that once we can see our feelings clearly, they will serve as a bridge to the real world.

No one ever told me that when I finally managed to see my feelings clearly they might lie to me.

It turns out, my gut feelings are almost always wrong.

I know now that when I identify an emotion, the most valuable thing I can do—for the sake of myself and those around me—is to stay skeptical. There’s a fine line between the healthy expression of emotions and letting my emotional perceptions take over my life. Because nine times out of ten, my emotions aren’t telling me the truth.

This is surprisingly common in the autism world. Even more surprising is the fact that there’s so little written about it.

Since this discovery I’ve been hit with a heavy dose of the Baader-Meinhof phenomenon. It seems like everywhere I look I encounter autistics suffering with comorbid diagnoses like post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), bipolar disorder, and countless other labels and conditions.

And should it really be so surprising?

What happens when an autistic spends many of their formative years in an environment of social and emotional uncertainty? It’s pretty hard to be autistic and not have those kinds of experiences on some level. And, coincidentally, that type of formative environment is the perfect storm for developing a mood or personality disorder

Of course, not every autistic develops a pathological disorder. But many do. And so, an important question emerges: What do these disorders look like in autistics, and how can we identify and treat them?

For example, an autistic with borderline personality disorder is an empathy paradox. On the one hand, they struggle to notice and correctly identify the emotions of those around them. And yet they are also extremely sensitive and responsive to perceived emotions. Combine that with other BPD traits like an extreme fear of abandonment and an unstable sense of self—in addition to autistic traits like overly logical, black-and-white thinking—and you have a recipe for social and romantic disaster.

The autism treatment world often puts the cart before the horse. Many autism therapies focus on things like “social skills training,” and ABA behavior modification.

When we focus on symptoms instead of root causes, we might as well be treating lactose intolerance with Pepto-Bismol.

It’s hard to define the line between healthy neurodiversity and pathology. And dealing with seemingly paradoxical comorbidities is even harder still. How do we know which thoughts to indulge, which emotions to express?

All I know is that exploring this area has helped me, so I’m hoping it may help others.

This topic is both broad and mysterious. These are still mostly uncharted waters, and I hope to keep mapping them out in both my professional and personal life. For now, the least I can do is to bring the matter out into the open. If you have a label that hasn’t given you all the answers, perhaps there’s more to the story.

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