Narcissistic Personality Disorder is a spectrum disorder

The Asperger's Personality - Psychopathology, Personality Structure, and Differential Diagnosis in Non-Intelligent Adults with Autism Spectrum Disorder

Introduction: Autism spectrum disorders (ASD) belong to the profound developmental disorders and are characterized by qualitative impairments in social interaction and communication and by repetitive stereotypical behaviors and restrictive interests. Individuals with ASD without intellectual disability are often only diagnosed in adulthood. However, the diagnosis of ASA in adults is challenging, especially due to the difficult differential diagnostic differentiation from personality disorders. An evaluation of the diagnostic results of the Autism Outpatient Clinic of the Charité, Campus Benjamin Franklin (CBF) showed that narcissistic personality disorder (NPS) was one of the most common differential diagnoses in patients in whom the suspicion of ASD could not be confirmed . Symptoms overlap with ASD for borderline personality disorder (BPD), which is the most relevant personality disorder in the clinical context. By identifying personality traits and pathological manifestations of personality traits that are specific for people with ASD, differential diagnosis and thus the diagnostic process could be supported. METHODS: A group of 59 non-intelligence-impaired adults with ASD was recruited via the Charité's autism outpatient clinic for adults, CBF. The ASD diagnosis was made as part of a detailed diagnostic process using autism-specific diagnostic instruments (diagnostic observation scale for autistic disorders, diagnostic interview for autism - revised and clinical interview according to DSM-IV criteria) and differential diagnostic work-up (MINI International Neuropsychiatric Interview and Structured Clinical Interview for DSM-IV axis II). The group of adults with ASA was compared with a group of 62 patients with NPS, a group of 80 patients with BPS and 106 healthy control persons with regard to personality traits and pathology. For this purpose, personality traits were recorded using the NEO Personality Inventory Revised (NEO-PI-R) and personality pathology using the Dimensional Assessment of Personality Pathology (DAPP-BQ). Results: Compared to all other groups, individuals with ASA achieved significantly lower scores on the NEO-PI-R scales of extraversion and openness to experience and significantly higher scores on the DAPP-BQ scales of inhibition and compulsiveness. Individuals with ASA differed from patients with BPS and NPS in that they were significantly more conscientious (NEO-PI-R scale) and significantly lower scores for dissocial behavior (DAPP-BQ scale). Conclusion: In this study, personality traits and pathological expressions of personality traits were determined for the first time in adults with ASD and the results were compared with those of adults with personality disorders and healthy control persons. Personality traits and pathology specific to ASA could be identified. The personality of individuals with ASD can be described as sincere, orderly and conscientious, with clear introversion and little openness to experience. The results can contribute to improving the diagnostic process of people with ASD and could provide the basis for the development of measuring instruments for more precise diagnosis and differential diagnosis.


Introduction: Autism Spectrum Disorders (ASD) are classified as pervasive developmental disorders and are characterized by impairments in social interaction and communication and by repetitive stereotyped patterns of behavior and restricted interests. Individuals with ASD without accompanying intellectual impairment often already reached adulthood before an ASD diagnosis is made. Diagnosing ASD in adults is challenging, especially because of difficulties in differentiating ASD from personality disorders. An analysis of the diagnostic results of the outpatient's clinic for autism diagnostics of Charité, Campus Benjamin Franklin (CBF), showed that in the area of ​​personality disorders the Narcissistic Personality Disorder (NPD) was one of the most prevalent differential diagnoses in patients in whom autism could be excluded. For the Borderline Personality Disorder (BPD), which represents the most prevalent personality disorder in clinical settings, symptom overlap to ASD could be identified, too. Identifying personality traits and personality pathology specific to ASD might facilitate differential diagnosis and therefore the diagnostic procedure. Methods: We recruited a sample of 59 adults with ASD without accompanying intellectual impairment via the outpatient’s clinic for autism diagnostics of Charité, CBF. ASD patients were diagnosed by an extensive diagnostic procedure with autism specific diagnostic instruments (Autism Diagnostic Observation Schedule, Autism Diagnostic Interview - Revised, and clinical interview based on DSM-IV diagnostic criteria) and instruments for differential diagnosis (MINI International Neuropsychiatric Interview and Structured Clinical Interview for DSM-IV personality disorders). The sample of adults with ASD was compared to a sample of 62 individuals with NPD, a sample of 80 individuals with BPD, and to 106 nonclinical controls. Personality traits, measured with the NEO Personality Inventory-Revised (NEO-PI-R), and personality pathology, measured with the Dimensional Assessment of Personality Pathology (DAPP-BQ), were assessed. Results: ASD individuals scored significantly lower on the NEO-PI-R scales Extraversion and Openness to Experience and significantly higher on the DAPP- BQ scales Inhibitedness and Compulsivity relative to all other groups. Compared to patients with BPD and NPD, individuals with ASD scored significantly higher on Conscientiousness (NEO-PI-R scale) and significantly lower on Dissocial Behavior (DAPP-BQ scale). Conclusion: This study identified for the first time personality traits and personality pathology in adults with ASD and compared the results to those of adults with personality disorders and to nonclinical controls. Personality traits and personality pathology specific to ASD could be identified. The personality of individuals with ASD can be described as very straightforward, orderly and conscientious by considerable introversion and low openness for experience. The results of this study could improve the diagnostic procedure and may function as the basis for the development of more accurate diagnosis and differential diagnosis measures.