Question:
Dear Dr. Heller,
I am in the process of becoming a LMHC. I have
had several clients and associations that have
Borderline that seem to also display
autistic/Aspergers as children and young adults which has led
me to wonder, could there be a connection? I
know and believe that Borderline is a biological
condition and given that autism is also biological
and those children are sensitive to sensory
overload, and react to stimulus in many of the
same ways that Borderlines do. What are the
chances that an autistic/Aspergers child who
does not get their needs met spirals into full blown
borderline? I would love to have a
conversation with you on this to find out what you know
about this.
My main consideration on this is my own child who
is now 25 and we have gone
through so much together. She had all the
features of Aspergers and was diagnosed as AD/HD
and dysthymia when she was 12 and bipolar when
she was 15 and hospitalized for self-mutilation
at that time. She was expelled from school
in 10th grade because she had a knife and a minute
amount of cannabis on her, but the real reason
is because she has always refused to conform,
dressing gothic and not paying attention to the
rules. The other kids thought she looked mad all
the time, when in reality, she was just shy
and had a low affect.
Substance abuse has been an
issue since she was 15 and by the time she
was 18 we put her in a reputable treatment center
which she didn't participate very well with.
Everywhere she goes, people always act like they
have never encountered anyone quite like my
daughter. In the meantime, she is witty, smart, and
intelligent and has a lot of insight into
everybody else’s issues but no clue for herself. Psyche
evaluations indicate that she has significant
issue with her executive functions and decision-making
capacities. She had a bad car accident when
she was 19 that complicated the problem
with brain injuries in addition to crushed bones
and a very long and painful recovery.
On at least 2 occasions she has been admitted in
the psychiatric ward for dysphoric episodes, self-mutilation
and suicide ideation. It was there that
she received the borderline diagnosis. She has also been
through an enormous amount of psychotropic
meds over the years.
Currently, at 25, she has an 8 month-old
baby boy who seems to have changed her life
immensely. Although, just until her
baby was born, she was still going through
intense dysphoric episodes causing her to break
windows, etc. She is now somehow better
able to control herself than she has ever been in her entire
life. Even though she still complains of feelings
of emptiness and hopelessness, she does care
about this baby above anything and wants to
give him a life better than her own.
In the meantime, I have a 15-year-old son
that displays many of the same symptoms for
Aspergers that my daughter did and many
of my aspergers clients. He too seems to go into
dysphoric episodes, as both have since they
were very young. We never supported this and made
them leave the room or left ourselves until
they were able to get hold of themselves. My son has
always been very apologetic for these episodes
once they pass, but there seems to be little to keep
them at bay once he falls into one.
I know this is a lot of information, and I am
not sure what, if anything, you could do to help me
with that. I just want to know if you have
seen similar issues with Aspergers and Borderline, or
am I mistaken and all of these individuals
were borderline from the start, or is it the other way
around and they are all suffering from untreated
autism.
Please let me know your thoughts and
any referrals you can give me for help.
Thank you so much for your time
Dr. Heller's Answer:
It sounds like you’ve had a very
rough time.
Substance abuse is frequently a mental illness
symptom (self-medicating) or a primary problem.
There’s no reason ADHD can’t co-exist with
multiple other diagnoses.
I’m a long way from being an expert on Aspergers
or autism, but I do believe they are very
different disorders from the BPD. Some
interesting studies from 5-10 years ago implied that
"oxytocin" may be low or deficient in
these individuals and high oxytocin is found in very
outgoing individuals. We need a
revolutionary medication for this neurotransmitter like Prozac
(fluoxetine) was for genetic depression and the BPD.
The BPD appears to be a malfunction of the glial
cells that support the nerve cells in the brain’s
"trapped, cornered, wounded" instinctual
areas of the limbic system. Prozac is far superior to
other SSRI’s primarily because of its effect on
glial cells. Serotonin deficiency may be part of the
problem, but low levels of serotonin metabolites
in the spinal fluid are only seen in completed
suicides (with or without the BPD) and impulsive
murderers, not just the BPD.
The BPD starts at puberty, when the limbic system
goes into hyperdrive. There are many
possible causes of the BPD including head trauma,
genetic predisposition combined with
emotional trauma, abuse, untreated or undertreated
ADHD or childhood onset bipolar, and
sometimes genetics alone is to blame.
Any psychological or physical trauma can cause
the release of pain oriented neurotransmitters
(such as substance P) which likely damage the
glial cells and possibly neurons and/or their
connections. From this perspective it’s
easy to see how both autism and Aspergers can result in
the BPD at puberty since they are both
painful conditions. Once someone with Aspergers and/or
autism reaches puberty however, if BPD symptoms
become present the BPD is now likely to be
an additional diagnosis, especially when
self-mutilation is present. Prior to
puberty, childhood onset bipolar would be a more
likely explanation for raging and out of control.
http://www.BiologicalUnhappiness.com/BiPlrKid.htm
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