Autism Spectrum Features and Personality Disorders: Overlap, Differentiation, and Developmental Trajectories

Autistic features and personality pathology have been entangled since both concepts entered clinical psychiatry. Adults with autism spectrum features and average or high intelligence — many previously described under Asperger's syndrome — are frequently diagnosed first with schizoid, avoidant, obsessive compulsive, borderline, narcissistic or unspecified personality disorder, and treated accordingly. Treatments developed for personality disorders often fail these patients, sometimes after years of unsuccessful therapy. In child and adolescent services, the pattern begins earlier: autistic traits go unrecognised in outpatient clinics even when kindergarten staff and siblings have long noticed differences in social communication, rigidity and sensory response. Diagnostic practice compounds the problem, because clinicians see what their training prepares them to look for, and mentalizing difficulties make standard diagnostic interviews unreliable without a parent or other informant. The result is a population diagnosed late, or not at all.This Research Topic addresses misdiagnosis and its consequences. When autistic features in intelligent, verbally able people are read as personality pathology, patients receive treatments designed for a different condition, and long courses of therapy fail in ways that are then attributed to the patient. Meanwhile, autistic features in children and adolescents go unrecognized in the very services meant to detect them. Recent work, including screening studies in psychiatric inpatients with severe self-harm, shows how much undetected autism sits within populations already carrying personality disorder diagnoses, and how routine screening changes that picture. We aim to bring together clinical, developmental and neurobiological evidence that clarifies where these conditions genuinely overlap, where they can be reliably distinguished, and what each distinction means for treatment. The intended outcome is practical: a clearer account of the developmental pathways involved, better use of childhood history and informant data, and guidance clinicians can apply when the two presentations are hard to tell apart.This Research Topic invites contributions on the overlap, differentiation and developmental relationship between autism spectrum features and personality disorders across the lifespan. Themes of particular interest include: -shared genetic and developmental vulnerability-systemizing, empathizing, mentalizing and social cognition as differentiating axes-executive function and emotion regulation-self-development and identity formation-social communication difficulties in childhood-rigidity, resistance to change and circumscribed interests-sensory sensitivity as an under-used diagnostic marker-comorbidity between autism and schizoid, avoidant, borderline, narcissistic and unspecified personality disorders. We especially welcome work on diagnostic methodology — childhood history-taking, informant-based assessment, screening instruments and clinician bias — and on treatment implications when autism is identified in patients already managed as personality disorder. Original research, systematic and narrative reviews, clinical trials, case reports, perspectives and opinion articles are all welcome.Bo Bach is a co-author of the DIPP-11, a diagnostic interview for ICD-11 personality disorders, and receives royalties from it. The other Topic Editors declare no competing interests with regard to the Research Topic subject. Topic editors: Øyvind Urnes, Bo Bach, Carla Sharp, Arvid Nikolai Kildahl Source: https://www.frontiersin.org/research-topics/86110/autism-spectrum-features-and-personality-disorders-overlap-differentiation-and-developmental-trajectories