September 9, 2025 • 37 mins
In this episode of The Personality Couch, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack the differences and similarities between schizoid personality disorder and autism spectrum disorder, and whether you can be diagnosed with both. We start by discussing the limitations of current research before investigating the underlying causes of social withdrawal seen in both conditions. We conclude by emphasizing that while they may share observable traits, their origins and implications are fundamentally different.
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Chapters 00:00 Introduction to Schizoid & Autism 00:58 Problems with ASD & SzPD research 04:42 Autistic Thinking Defined 05:26 Autistic Fantasy Defined 05:54 Autism Name Origins 06:25 Autistic Contiguous Position Defined 08:22 Similarities b/w Autism & Schizoid 10:54 Genetics & Etiological Differences 11:40 Schizophrenia’s Genetics 12:37 Autism Genetics 14:50 Can Schizoid and Autism Co-Occur? 17:58 Development of ASD vs SzPD 18:46 Imagination in Schizoid vs ASD 19:08 Late Diagnosing of ASD + Cultural Trends 21:24 Viewer Question: Phantasy of the Schizoid 25:18 Mirror Neurons in ASD vs SzPD 28:05 Our Thoughts About Dual ASD & SzPD Diagnoses 36:05 Summary & Conclusion
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Personality Couch podcast,
where we discuss all thingspersonality and clinical practice.
I'm your host, Doc Bok, and I'm herewith my co-host, Doc Fish.
We are both licensed clinical psychologistsand private practice.
And y'all, we have had a lively discussionon YouTube with our Schizoid series.
(00:22):
I know that we've received a lot of
questions about today's topic,and I am thrilled to
be able to talk about it.
In today's episode, our resident research
ninja, Doc Fish, is goingto help us unpack
the differences between autismand Schizoid personality.
And we're also going to answer some
listener viewer questions aboutthese diagnoses.
(00:45):
Today we'll also get intoa really thought
provoking question that we received about
Schizoid fantasies.
So let's keep this lively discussiongoing as we dive in.
Doc Fish, you have spent a lot of time
researching Schizoid and autism andcame across some really
interesting and disheartening things.
(01:06):
So I want to hear more about thisresearch that you found.
Sure.
So firstly, our terminologyof what Schizoid
is versus what autism is,it's just horrible.
Specifically for this episode,I want to set
the frame by saying there'sa lot of limitations
to this research, like a lot,a lot of limitations.
The terminology in the research,like across
(01:29):
different researchers, acrossdifferent disciplines,
and even across history isabsolutely terrible.
Like the worst I've seenthus far, honestly.
My goodness.
Okay.
This doesn't surprise me because
historically we have been so badabout naming things as
(01:49):
shrinks like so bad.
Like we historically call things the samename that are different things.
And I just think back toall the different
DSM diagnoses that we'vealready done this.
And I'm going to guess that we're callingSchizoids autistic, among other things.
You got it.
It's really frustrating.
(02:09):
So we're trying to compareand contrast Schizoid
personality disorder and autismspectrum disorder
today.
So we do have to look at bothconstructs terminology.
So first, researchers lookingat Schizoid and
autism are comparing samples,including like
the DSM influenced Schizoidpersonality disorder.
Fine.
(02:29):
Good.
Okay.
But they also include other labels and
criteria of like, Skizotypyas a trace, Skizotypal
personality disorder, and schizophrenia.
So like, for example, one study sample of
Schizoid included individualsacross the Schizoid
Skizotypal spectrum.
(02:50):
So we're not like actuallylooking at pure
Schizoid, but a range of Schizoidlike symptoms.
Right.
Yeah.
This is not helpful.
Like we can't just lump it all together
when we're comparing and contrastingdiagnoses,
because Schizoid does exist at differentseverity levels.
And then when we compareit to autism, also
(03:11):
happening at different severitylevels, like
we need to know which end of thecontinuum we're working with.
Like for Schizoid, is it mild?
Is it personality disordered?
Has it disintegrated into schizophrenia?
That's important to know.
Absolutely.
So that's like one flaw and limitation.
Another is the operational definitionof autism spectrum disorder.
(03:34):
So obviously this is influenced byhistorical changes, right?
So early research often comparesSchizoid and
Asperger's disorder, separatingit from autism.
Then there's different levels offunctioning in autism.
Well, now it's like a spectrum disorder.
So some articles use samples of like high functioningautism, but then like where's
(03:57):
the cutoff?
It's unclear.
That's a research limitation as well.
Right.
So our classification system has evolvedover time, but it still has flaws.
Like, and we're not quitesure what is being
studied in this research thatyou found because
our definition and severity cutoffshave changed over the decades.
(04:18):
Exactly.
So that in particular makes it difficultto generalize the findings.
Okay.
So here is another extra confusing part.
Schizoid phenomena was historically, and
sometimes still is, intertwinedwith the terms autistic
thinking and autistic fantasy.
Oh, great.
Yeah.
So I'm thinking we need to definethese terms too, right?
(04:41):
So, all right, let's go tothe APA dictionary.
APA dictionary of psychology defines
autistic thinking as an outdatedterm for egocentric
thought processes, suchas fantasizing and
daydreaming that have littleor no relation
to reality.
So autistic thinking focuses on self
(05:01):
absorption into the thoughts, butnot to the point that
someone is disconnected from reality.
Exactly.
Yep.
Yep.
And I want to say that the term is highly
inaccurate and misleading regardingthe thinking
styles of individuals with autismspectrum disorder.
So it's called autistic, but it's not autisticas we know by today's terms.
(05:25):
Lovely.
Yeah.
Okay.
So then they define autistic fantasy as
quote, a defense mechanism inwhich a person deals
with emotional conflict and stressors by
indulging in excessive daydreamingas a substitute for
active problem solving, whichis essentially
what we mean when we describethe schizoids
tendency to defend themselves by withdrawinginto fantasy, right?
(05:49):
Exactly.
Exactly.
And then we have the dictionary definitionof autism to consider too.
Of course.
Yep.
Let's bring that in here.
So when looking at autism, it comes fromthe Greek root auto, meaning self.
And then the Greek suffix ismmeans a state of being.
So basically being within oneself, whichsounds a bit schizoidy, right?
(06:14):
It totally does.
Oh my goodness.
And I do want to throw in onemore term because
it has to do with schizoidand object relations,
which we talked about last episode.
So a psychoanalyst named Thomas Ogden coinedthe term autistic contiguous position.
Basically what that is sayingis like there's
(06:35):
a spectrum of moving awayor towards an object
depending on how comforting ordangerous the object is.
Okay.
So if it's not a safe relationship, thenmove away and inside the self.
Right.
And then this can becomepathological later
if it turns into like arigid and flexible
defense.
(06:55):
Of course.
Yeah.
Yeah.
This is really interestingbecause this is
describing the schizoid,like not the neuro
developmental disorder of autism,like really not at all.
So the schizoid fears being overwhelmedby or consumed by others.
So they retreat into the mind goingdeeper and deeper into themselves.
(07:17):
And then that rigidity is what leads to a
personality disorder andspecifically here
schizoid or schizoid personalitydisorder.
Exactly.
So the literature on the connections, the
overlaps and the differencesof schizoid personality
disorder and autism spectrumdisorders, like
ridiculously hindered by terminologyand definitions.
(07:39):
The two are very intertwined and that'swhy we're trying to tackle it today.
Yep.
So with all this, it sounds likeresearch is quite muddy.
And what we talk about here is indesperate need of more research.
Exactly.
So autism could be on theline of schizoid,
but research doesn't reallysupport it, but
(08:01):
it's still a possibility.
But like McWilliams doesn't rule it out.
But Milan kind of infers that it is.
And the DSM says no, but otherresearchers say yes.
And it's just a mess.
Lovely.
So why don't we start unpacking this messa little bit, starting with the overlap.
Okay.
So I think some of these similarities go
(08:23):
without saying, so we won't camphere long, but the
observable things are thesocial component
or lack thereof with bothautism and schizoid.
Sure.
Okay.
So briefly, several overlappingcriteria include
like solitary activity, apparentlack of empathy,
(08:43):
emotional detachment, increased
sensitivity, unusual styles ofcommunication and being
cognitively rigid.
So we see the outside observable stuff
like maybe chilliness or socialawkwardness or
even like lack of social reciprocity or
like volleying a conversationback and forth.
(09:04):
Also solitary play or activities being a
social or sometimes not respondingto social cues.
And even fixed interest could be interpretedeither as skis or as autism.
Now there's been a little research aboutearly communication problems.
(09:26):
So Wolf 1998 investigated schizoid and
autism dynamics and apparentschizoid children.
I think this is fascinating.
So they had three schizoid boys and three
schizoid girls and they wereelectively mute
in contrast to language delays.
Okay.
This is another piece.
(09:46):
Yes.
Is the person nonverbal because of
developmental delays or is thisselective mutism where a
person doesn't talk in certain settingsdue to extreme anxiety?
It's similar observable behavior, butvery different root causes.
And for the schizoid child,I do wonder if
(10:07):
it's extreme anxiety andor maybe just, you
know, a choice to not spend the social energytalking to people who don't get them.
This is where it gets tricky when we startmaking diagnoses without a thorough look
at someone's history and theirbehavior across contexts.
So for both autism and schizoid, we can't
(10:29):
just look at the social stuffor the observable
stuff.
Like we have to know wherethe behavior is
coming from in order tomake the diagnosis
and that takes time and often involves
information from caregivers andspouses and other people
in their circles, etc.
Yeah, we need to take the time to look insideand see what's actually going on.
(10:52):
Yeah.
Okay.
So now let's take a peek at genetics tosee how these conditions develop.
See if this can help us out at all.
Okay.
Research has connected schizoid personalitywith schizophrenia.
The schizoid is still in reality versus
schizophrenia is the decompensatedschizoid or schizotypic
(11:15):
schizotypal personality that isout of touch with reality.
Yes.
So it is common in the literatureto refer to
the continuum of like schizoidto schizotypal
to schizophrenia, schizoids in reality,
schizotypal is like towing theline of reality and then
schizophrenia is kind of falling outof reality into psychosis.
(11:37):
Indeed.
Yeah.
So we know that schizophrenia hasa strong genetic loading.
Like research tells us that the risk of
schizophrenia increases eight to11 fold if a first degree
relative had it.
That is substantial.
Oh yeah.
So Wolf basically kind of asked the same
(11:59):
question regarding genetic linesand like skeez and
autism.
So in the DSM, it notes that genetically,
schizotypal personality disorderoccurs more
in first degree relativesof schizophrenia
and then schizoid personalitydisorder quote,
may have increased prevalencein the relatives
(12:20):
of individuals with schizophreniaor schizotypal
personality disorder.
This is really interesting.
So there is the clear genetic connection amongthe three skis or skits conditions.
However, okay.
In regard to the heredibilityof autism, the
DSM estimates have rangedfrom 37% to higher
(12:44):
than 90% based on twin concordancerates and
a more recent five countrycohort estimated
heredibility at like 80%.
So this is significant heredibilityfor autism.
So the autism and skis development seemto have different genetic loadings.
(13:05):
Like they're not overlapping here.
It doesn't appear to be thesame gene line.
Right, right.
Each has that substantialgenetic loading in
their own lane, but those lanesdon't necessarily
cross.
Mm hmm.
So with autism, research tells us that we
have comorbidity with otherneuro diagnoses
or developmental diagnoses,things like ADHD,
(13:28):
Tourette's, learning and intellectualdisabilities,
treatment disorders, eating disorders likeARFID, sleep issues, and even epilepsy.
So these often are occurringin the same person
and they give us clues thatthese are foundational
issues, right?
Like neuro issues tellingus that there may
(13:50):
be something in the hardwiring or the genes
that is contributing to thisautism development.
Right.
And studies have even found that autism
correlates in families with aspecific gene mutation.
Mm hmm.
Yep.
Yep.
So again, we have the skisoidrelated genetics
and then we have the autismrelated genetics.
(14:11):
They don't appear to overlap yet the
external observable characteristicsoverlap and even
look the same.
So ah, help.
Right.
Oh my goodness.
Oh my goodness.
We're trying to compare two presentations
where we have difficultyseeing what's going
on inside.
So there's an overlap of those observable
(14:33):
characteristics, but not necessarilythe individual's
internal experiences.
Always always what is under that observablebehavior that we're seeing?
Yeah.
Okay.
So there's separate conditions thatlook similar externally.
For the DSM, you can't have both autism
(14:54):
spectrum disorder and skisoidpersonality disorder.
Like they're not comorbid.
In fact, they can't be.
Yes.
So criterion B of skisoid personality
disorder specifically says thatit quote, does not
occur exclusively during the courseof autism spectrum disorder.
Then in the differentialdiagnosis section
(15:15):
of skisoid personality disorder in regard
to autism spectrum disorder,it highlights
that there can be great difficultydifferentiating
those from skisoid fromthose with autism,
especially if there are symptomsor more mild
because both disorders include a quote,
seeming indifference to companionshipwith others.
(15:35):
Mm hmm.
So we're comparing applesto oranges here.
Autism is a neurodevelopmental condition.
Skisoid is a personality style ordisorder as in the DSM.
So I like to think of it like this.
The personality is like the walls of a housethat encapsulate all our psych stuff.
(15:57):
So things like disorders, thoughts,and fantasies, et cetera.
So the personality walls can be made from
all kinds of materials anddefenses and serve
to either keep people inor keep people out.
Okay.
Makes sense.
But with autism, it'sneurodevelopmentally
(16:17):
based, which is like thefoundation of the
house.
So everything in the house relies on that
stable foundation, like ourability to meet
developmental milestones,to learn, to walk,
to talk, to sit up, to imagineand play with
other children and to have healthysocial interactions.
(16:40):
Okay.
So autism is a social hardwiring issue.
So something in the foundationalDNA is like incomplete.
Then for a skisoid personality disorder,the social hardwiring is intact.
However, it might fry easilyor shut down or...
Yeah, that's exactly it.
(17:00):
Yep.
Yeah.
So said a different way.
Autism is deficit based versus skisoid
personality disorder is defensemechanism based as with
all personality disorders.
I like that.
Yeah.
So I will also say thatwhile we generally
have a negative opinion ofhow the DSM describes
(17:23):
skisoid, the DSM does seem to getthe categories correct.
So there's a reason that autism spectrum
disorder is in the neurodevelopmentaldisorder section.
It's in the intersection of the DSM while
skisoid personality disorderis in the personality
disorder section, like two different things,which is also what research tells us.
(17:44):
So I do think that the DSM isgetting this part right.
Right.
Right.
And I can see how they canlook very similar
on the outside, but comefrom very different
places.
So the origin is the key.
Absolutely.
Oh yeah.
Okay.
So then that takes me to like thedevelopment of autism.
So as we stated previously, you often see
(18:06):
these foundational issuesreally early on,
like with the development of motor skills
and speech, reciprocal socialimitation or
imaginative play with other children.
Okay.
Exactly.
Autism is seen in the developmental
milestones anywhere from infancyto age two, three, and
(18:26):
it includes a lack of imaginative play.
When skisoid infants, theycan be difficult
to soothe, highly sensitive,but we really
don't see the pathological traits emerge
until about middle childhoodwhen they're facing
more social developmental milestones.
And also super important.
(18:47):
Skisoid children don't lack imagination.
The opposite really, likethey can actually
have trouble figuring outmake believe from
reality.
Yes.
Yes.
This is key.
This is key.
This is lack of imaginationin autism versus
too much of it as in skisoidpersonality disorder.
(19:07):
Yeah.
Okay.
I will say too that though there can be a
later diagnosis of autism,it's pretty rare.
Like it's the exception and not the rule
for it to be diagnosed muchlater, like teens
into adulthood, but it can happen.
But the important piece here is there isa developmental component to autism.
(19:31):
It's not a social diagnosis and it's notjust measuring social awkwardness.
Yeah.
Culturally, I think we're seeinga shift towards
people seeking autism diagnoseswithout concrete
symptoms other than, I mean,feeling different,
being socially awkward, engagingin self soothing
(19:51):
behavior for anxiety.
Social hardwiring is actuallystill intact.
Exactly.
It sure is.
Yeah.
It's a concerning trend that seems in
large part fueled by socialmedia and a need to
fit in with peers, but itis not autism, which
then it makes me wonder ifwe have like other
(20:12):
personality styles that are seeking an
autism diagnosis for some typeof gain, whatever
the reason is social or otherwise.
But I will say it is a concerning trend thatmany of us professionals are noticing.
That's very, very true.
But also talk, Brock, let'sget back on track
with the development and theski, sweet child's
(20:35):
imagination.
Yes.
You better stop me now so I don'tgo down that rabbit hole.
But that is something thatwe've talked about
in previous episodes on likewhat's trending
and what's happening.
So we'll shelf that, bring it backdown for another day.
But yes, as you said, DocFish, those with
autism don't have much abilityfor fantasy
(20:57):
or imagination.
Yes.
So those with autism areoften very rich and
in concrete versus a ski suedewho has a rich
and vibrant fantasy world filledwith imaginations.
But they might not tell youabout it, obviously.
Yes.
Yes.
Because that's their gold stash.
They're not going to give you themap to their treasure.
Are you kidding?
(21:17):
Oh, my gosh.
Exactly.
They have to protect their fantasy.
Yes.
Yes.
And this here is a greatplace to answer the
thought provoking questionthat we received
from a viewer about fantasyin the ski suede.
So essentially this person'shypothesis was
that for the ski suede, anattachment figure
(21:38):
is replaced by fantasy interaction with
the real world means lettinggo of fantasy to
interact socially.
So then in their words, realitybecomes like a
controlling lover, keepingyou from everything
that makes you feel a sense of selfbecause it's all buried within.
It's real deep.
(21:59):
What are your thoughts, Doc Fish?
Yes, I love the depth of this hypothesis.
So whether it's correct or incorrectdoesn't really matter here.
But it made me think about the antisocial
or psychopathic individuals,object relations
where they don't have an internalattachment object.
Instead they attach to or alignwith a stranger
(22:21):
object or like an archetypalobject from society.
But oppositely, I think it'stotally possible
that a ski suede could replacehuman attachment
with their own internal fantasythat serves
to house the development ofone sense of self.
But then to interact with others, they're
going to inherently representreality since
(22:42):
they're not part of the fantasy.
And that would be really intrusive.
It would have to involve atleast some level of
disconnection from fantasy andthus disconnection
from the sense of self.
So maybe at more mild levels,this dynamic
could just be exhaustingmaybe or annoying.
But at more severe levels, I imagine it
(23:03):
could be like seriously distressing,like making
me think of a turtle running aroundwithout its shell.
Oh, oh no.
Gosh, I have my own hypothesisabout this.
So most ski zoids that I know prefer theirown company to the company of others.
So I would imagine that there's something alluringabout that fantasy world because
(23:26):
it's serving a purpose and possiblyas an attachment substitute.
And it actually reminds meof a conversation
that we had last episode aboutski zoids intensely
pursuing a passion or a job like Sherlock
Holmes or composers, almostlike it's a substitute
for a lover.
Yeah.
So their fantasies provide stimulation,
(23:49):
companionship, intrigue, safety,and a way to get out any
socially inappropriate frustrationslike in
their mind where it's safein their minds.
They can tell that person off in theirhead or flip them the bird.
Like and it makes me wantto ask our skis,
listeners and viewers, like, do you think
(24:11):
there's a re-parenting that's happeningthrough fantasy?
And if so, like, what makesyou think that?
Let us know in the comments.
Yeah, it makes me think oflike the fantasies
that they may have of likeworld domination,
but like they're not going to be theperson that goes for that.
Right.
So it houses that unconscioussexual and aggressive
(24:32):
drives that we detach from asa ski zoid personality.
Right.
And they're not going to show you the
treasure map either of like, here'sall my fantasies.
Exactly.
Super deep stuff.
I also do have a random, but it's actuallya relevant question for the ski zoids.
How do you feel about reasons?
(24:52):
Like genuinely, like, please, please letme know how you feel about reasons.
Yeah, there's a method tothe madness here.
Yeah, we have some interesting, just some
interesting things that we'relooking into.
So curious about that.
Let us know in the comments.
But bringing this back around, I do think
(25:13):
there's another piece of researchthat's worth
noting here.
Doc Fish, do you want to tell us a littlebit more about mirror neurons?
Yes, I love this.
Okay.
Findings on mirror neurons andfacial expressions.
I find this super duper fascinating.
And I think it's extremely important toknow at least two specific studies.
(25:34):
Ring and Marie in 2008 found that those
with schizophrenia were foundto have deficits
in observable facial expressions, but not
micro expressions, whichothers didn't pick
up on.
Oh, okay.
So schizophrenic participants had micro
expressions that other people couldn'tdetect, but a computer
(25:55):
could.
Is that right?
Correct.
Okay.
Emotional physio stuff underthe surface was
normal in comparison to thecontrol sample.
In other words, schizophrenicsexperience emotions.
Normally, they just don't express it.
(26:15):
And because they don't express it, people
interacting with the schizophrenicpatients
decreased their own expressiveness and
reported they felt more negativeexperiences, which
is perhaps why we may overpathologize them.
Uh-huh.
I think you're onto something there.
Yeah.
So under the surface, schizophrenics are
(26:37):
having the exact same emotionalexperiences as you
and I now.
They're just not telling you about it.
And then we as a society feel a way about theirlack of expression and then project
our own negative feelings andthings onto them.
Exactly.
Yes.
I have more though.
Okay.
Okay.
So the
whole world described thatactively psychotic
(26:58):
individuals had increased mirrorneuron activity.
Schizophrenic individualshad average mirror
neuron activity and thenindividuals on the
autism spectrum were found to have little
to no mirror neuron activitywhen observing
others.
Okay.
Hold up.
Hold up.
So with active psychosis where the
(27:19):
individual is responding to theirown internal stimuli
plus the external stimuli.
So their system is basicallyover activated, right?
So then in schizophrenia, it was normal,not over activated, normal.
We just, and not under activatedeither, but
even still we aren't privyto their emotions
(27:42):
or their responses.
In contrast with autism, the socialhardwiring is not intact.
The mirror neurons don't even fire becausethey can't detect those social cues.
Science.
Yes.
It's so fascinating.
This is so interesting.
(28:02):
Wow.
Okay.
So Doc Bok, we should actuallytalk about
our thoughts because reallywe want to kind
of explore the question of can autism
spectrum disorder and schizoidpersonality disorder
occur in the same person?
Yes.
Yep.
We need to get into that.
Okay.
So I'll go first.
(28:23):
So for the DSM, which is disorderbased, the answer is no.
You can't have both disordersat the same time.
If you do have both, one is probablya misdiagnosis.
That's my opinion.
Okay.
So then if there's evidence of
developmental stuff, fixed interestand social deficits,
autism is likely.
(28:45):
If it's just the social odditiesor withdrawal,
you're probably looking atschizoid personality
disorder.
And of course, this is a gross
oversimplification, of course, butteasing these out takes lots
and lots of time.
Consultation with otherprofessionals too,
of course, an extensive social history of
the individual.
(29:05):
Like you need to look at all of that.
Yeah.
Yes.
Yes.
But that's what the DSM says autism
spectrum disorder and schizoidpersonality disorder
cannot be diagnosed at the same time.
And you're right.
In cases we've seen that couldgo either way.
We've really had to look close at history
and if possible, even hearfrom other people
(29:27):
in the individual's life.
Yeah, it confuses even us andwe study this stuff.
Like my goodness.
All right.
So if the person truly hasautism spectrum
disorder, schizoid personalitydisorder is
moot.
Because if the social hardwiring is not intact,it can't be a personality disorder.
(29:49):
So with autism, the foundationalsocial circuit
is missing pieces versus inschizoid personality
disorder.
They're using defenses to keep thesocial circuit from frying.
Right?
So personality disorderscan't be diagnosed
if the reason for socialpathology is based
on a developmental deficit.
(30:10):
Like that just doesn't even make sense.
Okay, I see what you're saying here.
So if you have a diagnosis of schizoid
personality disorder, you're notgoing to automatically
be on the autism spectrum.
But if you are on the autismspectrum, you
still have a personality whichmay be schizoid.
Mm hmm.
I actually have a hypothesisthat autism spectrum
(30:33):
disorder can come in all packagesof personality,
but it's not going to be a disorderlevel because it can't be.
Like you could possibly have a
schiz-oriented temperament and someonewho's autistic, but
that schiz would not beat disorder level.
Okay, I really like that hypothesisthat autism
(30:55):
can come in all packages ofpersonality because
they have personalities.
Yeah.
Okay, so then in my opinionas well, someone
with autism should not be diagnosedwith disorder
level personality.
I think that's simply not fairand it's redundant
because the difficulties stemfrom neurodevelopmental
(31:15):
stuff.
Yeah, yeah.
So I think of it like this.
Individuals with autism don't comewith a full social toolbox.
Their tools are missing.
Individuals with personality disorders
have the social tools in thetoolbox, but they
either misuse them or don'tuse them at all.
So it's unfair and just notcorrect to call
(31:38):
someone with autism who doesn'thave the tools,
personality disordered.
I can totally agree with that.
That does make sense.
Now for funsies, another studywith another perspective.
Oh, okay.
Nerdy stuff.
So we ignore that autism and schizoid
personality disorder cannot be diagnosedin the same person
(32:00):
according to the DSM.
One study took a group ofpeople diagnosed
with Asperger's disorderbecause it was 2012
and they investigated which personalitydisorders overlapped.
So from greatest to least, Asperger's
overlapped with schizoid 26%,obsessive compulsive at
(32:22):
19%, avoidant at 13% andschizotypal at 2%.
My favorite point in thisparticular study
is that there's no overlapwith any cluster
B personality disorders.
Thanks, zero.
Not a sip.
Oh boy.
Okay.
This, this is actually reallyinteresting.
(32:43):
So I would imagine that cluster B leaning
types are the least likelyto overlap with
autism, but sometimes they seem tobe seeking out the diagnosis.
I didn't say that.
You didn't hear that.
Okay.
So cluster Bs are dramatic and socially
engaged in illicit reactionsfrom others versus with
(33:04):
clusters A and C, like they couldgo either way socially.
Right.
Dramatic and erratic is kind of oppositeof the skis skits dynamics.
So one viewer even stated that schizoidsare the opposite of cluster Bs.
Yeah.
And I agree with that.
I totally agree.
(33:24):
Yep.
So regarding the clusterC overlap, I think
it's interesting that psychodynamicperspectives
often include avoidant personalitydisorder
into like schizoid conceptualization,which
I don't necessarily agree with, but it is
one perspective and then obsessivecompulsive
personality disorders.
(33:45):
The only differential diagnosis for
schizoid listed in McWilliamsbook, which makes me
think maybe there's likean overlap with a
hard outside shell and compulsivelike behaviors
to protect it.
Ooh, yes.
Yeah.
That compulsive shell comesup in a lot of
different personality stylesand even personality
disorders, which is where it gets tricky
(34:06):
because you have to look at what'sbeyond that shell
and what's really at the core.
But unfortunately we don't have timeto get into all of that today.
I wish we did, but there'sso many different
flavors of personality andpossibilities that
can pop up.
And that's even true with schizoid.
It can come in different shades and hues,which is really interesting.
(34:28):
Yeah.
And I will say too, we have had a lot of
viewer and listener questionson schizoid versus
avoidant personality disorder,which is also
kind of hotly debated inour field as well.
But we will have to get tothat in a separate
episode because there's alot to unpack with
that too, of course.
(34:49):
My last thoughts on thisthough, is that we
are mere humans, we're imperfectand complex.
Even though autism and schizoid genetic
lines are separate, accordingto imperfect human
researchers, there's nothingsaying that it
can't intersect in a familyor an individual
at some point.
(35:10):
I don't think there's any use making
concrete facts about these questionsbecause we're
simply too vast and complex to be put in
like a box or a label or categoryindividually.
Like we're all unique as it should be.
Yeah.
I love that perspective, Doc Fish.
Yeah.
And I think it's importantto note that as
(35:32):
science advances, like ourunderstanding of
humans deepens and then research gets
updated and then our opinionschange and they could
change here too, based on new informationand new research that we have.
So boxes and categories aside, like weare all human at the end of the day.
(35:53):
Fortunately or unfortunately, yes.
Maybe some of us are wishingwe were computers.
I don't know.
Maybe not.
Maybe.
Anyway, so in some, we hopethat you've learned
something about the differencesbetween schizoid
personality disorder and autismspectrum disorder.
(36:14):
They're two different diagnoses measuring
two very different partsof the psyche, the
foundational neurodevelopmental stuff andthe protective walls of the personality.
And this is also supportedby genetic studies
looking at her readabilitythat found autism
and skis to be two separate tracks.
(36:34):
It's complicated.
We know that.
And our research about thisis grossly incomplete
and confusing and we could usemore help understanding
if there is overlap beyond this socialawkwardness that we see in both.
And on that note, that's a wrap.
Thank you for joining us today on thisepisode of the personality couch.
(36:56):
Make sure to check out ourblogs that coincide
with these episodes at www.personalitycouch.com.
And as always, don't forget to give us a
thumbs up, subscribe, orrate and review us
on your favorite podcast app.
And on YouTube, hit thatbell so you don't
miss a single episode of ourschizoid personality
series.
Be well, be kind, and we'll see you nexttime on the personality couch.
(37:23):
This podcast is for informationalpurposes
only and does not constitutea professional
relationship.
If you're in need of professional help,
please seek out appropriate resourcesin your area.
Information about clinical trends or
diagnoses are discussed in broadand universal terms
and do not refer to any specificperson or case.
Welcome to the Personality Couch podcast,
where we discuss all thingspersonality and clinical practice.
I'm your host, Doc Bok, and I'm herewith my co-host, Doc Fish.
We are both licensed clinical psychologistsand private practice.
And y'all, we have had a lively discussionon YouTube with our Schizoid series.
(00:22):
I know that we've received a lot of
questions about today's topic,and I am thrilled to
be able to talk about it.
In today's episode, our resident research
ninja, Doc Fish, is goingto help us unpack
the differences between autismand Schizoid personality.
And we're also going to answer some
listener viewer questions aboutthese diagnoses.
(00:45):
Today we'll also get intoa really thought
provoking question that we received about
Schizoid fantasies.
So let's keep this lively discussiongoing as we dive in.
Doc Fish, you have spent a lot of time
researching Schizoid and autism andcame across some really
interesting and disheartening things.
(01:06):
So I want to hear more about thisresearch that you found.
Sure.
So firstly, our terminologyof what Schizoid
is versus what autism is,it's just horrible.
Specifically for this episode,I want to set
the frame by saying there'sa lot of limitations
to this research, like a lot,a lot of limitations.
The terminology in the research,like across
(01:29):
different researchers, acrossdifferent disciplines,
and even across history isabsolutely terrible.
Like the worst I've seenthus far, honestly.
My goodness.
Okay.
This doesn't surprise me because
historically we have been so badabout naming things as
(01:49):
shrinks like so bad.
Like we historically call things the samename that are different things.
And I just think back toall the different
DSM diagnoses that we'vealready done this.
And I'm going to guess that we're callingSchizoids autistic, among other things.
You got it.
It's really frustrating.
(02:09):
So we're trying to compareand contrast Schizoid
personality disorder and autismspectrum disorder
today.
So we do have to look at bothconstructs terminology.
So first, researchers lookingat Schizoid and
autism are comparing samples,including like
the DSM influenced Schizoidpersonality disorder.
Fine.
(02:29):
Good.
Okay.
But they also include other labels and
criteria of like, Skizotypyas a trace, Skizotypal
personality disorder, and schizophrenia.
So like, for example, one study sample of
Schizoid included individualsacross the Schizoid
Skizotypal spectrum.
(02:50):
So we're not like actuallylooking at pure
Schizoid, but a range of Schizoidlike symptoms.
Right.
Yeah.
This is not helpful.
Like we can't just lump it all together
when we're comparing and contrastingdiagnoses,
because Schizoid does exist at differentseverity levels.
And then when we compareit to autism, also
(03:11):
happening at different severitylevels, like
we need to know which end of thecontinuum we're working with.
Like for Schizoid, is it mild?
Is it personality disordered?
Has it disintegrated into schizophrenia?
That's important to know.
Absolutely.
So that's like one flaw and limitation.
Another is the operational definitionof autism spectrum disorder.
(03:34):
So obviously this is influenced byhistorical changes, right?
So early research often comparesSchizoid and
Asperger's disorder, separatingit from autism.
Then there's different levels offunctioning in autism.
Well, now it's like a spectrum disorder.
So some articles use samples of like high functioningautism, but then like where's
(03:57):
the cutoff?
It's unclear.
That's a research limitation as well.
Right.
So our classification system has evolvedover time, but it still has flaws.
Like, and we're not quitesure what is being
studied in this research thatyou found because
our definition and severity cutoffshave changed over the decades.
(04:18):
Exactly.
So that in particular makes it difficultto generalize the findings.
Okay.
So here is another extra confusing part.
Schizoid phenomena was historically, and
sometimes still is, intertwinedwith the terms autistic
thinking and autistic fantasy.
Oh, great.
Yeah.
So I'm thinking we need to definethese terms too, right?
(04:41):
So, all right, let's go tothe APA dictionary.
APA dictionary of psychology defines
autistic thinking as an outdatedterm for egocentric
thought processes, suchas fantasizing and
daydreaming that have littleor no relation
to reality.
So autistic thinking focuses on self
(05:01):
absorption into the thoughts, butnot to the point that
someone is disconnected from reality.
Exactly.
Yep.
Yep.
And I want to say that the term is highly
inaccurate and misleading regardingthe thinking
styles of individuals with autismspectrum disorder.
So it's called autistic, but it's not autisticas we know by today's terms.
(05:25):
Lovely.
Yeah.
Okay.
So then they define autistic fantasy as
quote, a defense mechanism inwhich a person deals
with emotional conflict and stressors by
indulging in excessive daydreamingas a substitute for
active problem solving, whichis essentially
what we mean when we describethe schizoids
tendency to defend themselves by withdrawinginto fantasy, right?
(05:49):
Exactly.
Exactly.
And then we have the dictionary definitionof autism to consider too.
Of course.
Yep.
Let's bring that in here.
So when looking at autism, it comes fromthe Greek root auto, meaning self.
And then the Greek suffix ismmeans a state of being.
So basically being within oneself, whichsounds a bit schizoidy, right?
(06:14):
It totally does.
Oh my goodness.
And I do want to throw in onemore term because
it has to do with schizoidand object relations,
which we talked about last episode.
So a psychoanalyst named Thomas Ogden coinedthe term autistic contiguous position.
Basically what that is sayingis like there's
(06:35):
a spectrum of moving awayor towards an object
depending on how comforting ordangerous the object is.
Okay.
So if it's not a safe relationship, thenmove away and inside the self.
Right.
And then this can becomepathological later
if it turns into like arigid and flexible
defense.
(06:55):
Of course.
Yeah.
Yeah.
This is really interestingbecause this is
describing the schizoid,like not the neuro
developmental disorder of autism,like really not at all.
So the schizoid fears being overwhelmedby or consumed by others.
So they retreat into the mind goingdeeper and deeper into themselves.
(07:17):
And then that rigidity is what leads to a
personality disorder andspecifically here
schizoid or schizoid personalitydisorder.
Exactly.
So the literature on the connections, the
overlaps and the differencesof schizoid personality
disorder and autism spectrumdisorders, like
ridiculously hindered by terminologyand definitions.
(07:39):
The two are very intertwined and that'swhy we're trying to tackle it today.
Yep.
So with all this, it sounds likeresearch is quite muddy.
And what we talk about here is indesperate need of more research.
Exactly.
So autism could be on theline of schizoid,
but research doesn't reallysupport it, but
(08:01):
it's still a possibility.
But like McWilliams doesn't rule it out.
But Milan kind of infers that it is.
And the DSM says no, but otherresearchers say yes.
And it's just a mess.
Lovely.
So why don't we start unpacking this messa little bit, starting with the overlap.
Okay.
So I think some of these similarities go
(08:23):
without saying, so we won't camphere long, but the
observable things are thesocial component
or lack thereof with bothautism and schizoid.
Sure.
Okay.
So briefly, several overlappingcriteria include
like solitary activity, apparentlack of empathy,
(08:43):
emotional detachment, increased
sensitivity, unusual styles ofcommunication and being
cognitively rigid.
So we see the outside observable stuff
like maybe chilliness or socialawkwardness or
even like lack of social reciprocity or
like volleying a conversationback and forth.
(09:04):
Also solitary play or activities being a
social or sometimes not respondingto social cues.
And even fixed interest could be interpretedeither as skis or as autism.
Now there's been a little research aboutearly communication problems.
(09:26):
So Wolf 1998 investigated schizoid and
autism dynamics and apparentschizoid children.
I think this is fascinating.
So they had three schizoid boys and three
schizoid girls and they wereelectively mute
in contrast to language delays.
Okay.
This is another piece.
(09:46):
Yes.
Is the person nonverbal because of
developmental delays or is thisselective mutism where a
person doesn't talk in certain settingsdue to extreme anxiety?
It's similar observable behavior, butvery different root causes.
And for the schizoid child,I do wonder if
(10:07):
it's extreme anxiety andor maybe just, you
know, a choice to not spend the social energytalking to people who don't get them.
This is where it gets tricky when we startmaking diagnoses without a thorough look
at someone's history and theirbehavior across contexts.
So for both autism and schizoid, we can't
(10:29):
just look at the social stuffor the observable
stuff.
Like we have to know wherethe behavior is
coming from in order tomake the diagnosis
and that takes time and often involves
information from caregivers andspouses and other people
in their circles, etc.
Yeah, we need to take the time to look insideand see what's actually going on.
(10:52):
Yeah.
Okay.
So now let's take a peek at genetics tosee how these conditions develop.
See if this can help us out at all.
Okay.
Research has connected schizoid personalitywith schizophrenia.
The schizoid is still in reality versus
schizophrenia is the decompensatedschizoid or schizotypic
(11:15):
schizotypal personality that isout of touch with reality.
Yes.
So it is common in the literatureto refer to
the continuum of like schizoidto schizotypal
to schizophrenia, schizoids in reality,
schizotypal is like towing theline of reality and then
schizophrenia is kind of falling outof reality into psychosis.
(11:37):
Indeed.
Yeah.
So we know that schizophrenia hasa strong genetic loading.
Like research tells us that the risk of
schizophrenia increases eight to11 fold if a first degree
relative had it.
That is substantial.
Oh yeah.
So Wolf basically kind of asked the same
(11:59):
question regarding genetic linesand like skeez and
autism.
So in the DSM, it notes that genetically,
schizotypal personality disorderoccurs more
in first degree relativesof schizophrenia
and then schizoid personalitydisorder quote,
may have increased prevalencein the relatives
(12:20):
of individuals with schizophreniaor schizotypal
personality disorder.
This is really interesting.
So there is the clear genetic connection amongthe three skis or skits conditions.
However, okay.
In regard to the heredibilityof autism, the
DSM estimates have rangedfrom 37% to higher
(12:44):
than 90% based on twin concordancerates and
a more recent five countrycohort estimated
heredibility at like 80%.
So this is significant heredibilityfor autism.
So the autism and skis development seemto have different genetic loadings.
(13:05):
Like they're not overlapping here.
It doesn't appear to be thesame gene line.
Right, right.
Each has that substantialgenetic loading in
their own lane, but those lanesdon't necessarily
cross.
Mm hmm.
So with autism, research tells us that we
have comorbidity with otherneuro diagnoses
or developmental diagnoses,things like ADHD,
(13:28):
Tourette's, learning and intellectualdisabilities,
treatment disorders, eating disorders likeARFID, sleep issues, and even epilepsy.
So these often are occurringin the same person
and they give us clues thatthese are foundational
issues, right?
Like neuro issues tellingus that there may
(13:50):
be something in the hardwiring or the genes
that is contributing to thisautism development.
Right.
And studies have even found that autism
correlates in families with aspecific gene mutation.
Mm hmm.
Yep.
Yep.
So again, we have the skisoidrelated genetics
and then we have the autismrelated genetics.
(14:11):
They don't appear to overlap yet the
external observable characteristicsoverlap and even
look the same.
So ah, help.
Right.
Oh my goodness.
Oh my goodness.
We're trying to compare two presentations
where we have difficultyseeing what's going
on inside.
So there's an overlap of those observable
(14:33):
characteristics, but not necessarilythe individual's
internal experiences.
Always always what is under that observablebehavior that we're seeing?
Yeah.
Okay.
So there's separate conditions thatlook similar externally.
For the DSM, you can't have both autism
(14:54):
spectrum disorder and skisoidpersonality disorder.
Like they're not comorbid.
In fact, they can't be.
Yes.
So criterion B of skisoid personality
disorder specifically says thatit quote, does not
occur exclusively during the courseof autism spectrum disorder.
Then in the differentialdiagnosis section
(15:15):
of skisoid personality disorder in regard
to autism spectrum disorder,it highlights
that there can be great difficultydifferentiating
those from skisoid fromthose with autism,
especially if there are symptomsor more mild
because both disorders include a quote,
seeming indifference to companionshipwith others.
(15:35):
Mm hmm.
So we're comparing applesto oranges here.
Autism is a neurodevelopmental condition.
Skisoid is a personality style ordisorder as in the DSM.
So I like to think of it like this.
The personality is like the walls of a housethat encapsulate all our psych stuff.
(15:57):
So things like disorders, thoughts,and fantasies, et cetera.
So the personality walls can be made from
all kinds of materials anddefenses and serve
to either keep people inor keep people out.
Okay.
Makes sense.
But with autism, it'sneurodevelopmentally
(16:17):
based, which is like thefoundation of the
house.
So everything in the house relies on that
stable foundation, like ourability to meet
developmental milestones,to learn, to walk,
to talk, to sit up, to imagineand play with
other children and to have healthysocial interactions.
(16:40):
Okay.
So autism is a social hardwiring issue.
So something in the foundationalDNA is like incomplete.
Then for a skisoid personality disorder,the social hardwiring is intact.
However, it might fry easilyor shut down or...
Yeah, that's exactly it.
(17:00):
Yep.
Yeah.
So said a different way.
Autism is deficit based versus skisoid
personality disorder is defensemechanism based as with
all personality disorders.
I like that.
Yeah.
So I will also say thatwhile we generally
have a negative opinion ofhow the DSM describes
(17:23):
skisoid, the DSM does seem to getthe categories correct.
So there's a reason that autism spectrum
disorder is in the neurodevelopmentaldisorder section.
It's in the intersection of the DSM while
skisoid personality disorderis in the personality
disorder section, like two different things,which is also what research tells us.
(17:44):
So I do think that the DSM isgetting this part right.
Right.
Right.
And I can see how they canlook very similar
on the outside, but comefrom very different
places.
So the origin is the key.
Absolutely.
Oh yeah.
Okay.
So then that takes me to like thedevelopment of autism.
So as we stated previously, you often see
(18:06):
these foundational issuesreally early on,
like with the development of motor skills
and speech, reciprocal socialimitation or
imaginative play with other children.
Okay.
Exactly.
Autism is seen in the developmental
milestones anywhere from infancyto age two, three, and
(18:26):
it includes a lack of imaginative play.
When skisoid infants, theycan be difficult
to soothe, highly sensitive,but we really
don't see the pathological traits emerge
until about middle childhoodwhen they're facing
more social developmental milestones.
And also super important.
(18:47):
Skisoid children don't lack imagination.
The opposite really, likethey can actually
have trouble figuring outmake believe from
reality.
Yes.
Yes.
This is key.
This is key.
This is lack of imaginationin autism versus
too much of it as in skisoidpersonality disorder.
(19:07):
Yeah.
Okay.
I will say too that though there can be a
later diagnosis of autism,it's pretty rare.
Like it's the exception and not the rule
for it to be diagnosed muchlater, like teens
into adulthood, but it can happen.
But the important piece here is there isa developmental component to autism.
(19:31):
It's not a social diagnosis and it's notjust measuring social awkwardness.
Yeah.
Culturally, I think we're seeinga shift towards
people seeking autism diagnoseswithout concrete
symptoms other than, I mean,feeling different,
being socially awkward, engagingin self soothing
(19:51):
behavior for anxiety.
Social hardwiring is actuallystill intact.
Exactly.
It sure is.
Yeah.
It's a concerning trend that seems in
large part fueled by socialmedia and a need to
fit in with peers, but itis not autism, which
then it makes me wonder ifwe have like other
(20:12):
personality styles that are seeking an
autism diagnosis for some typeof gain, whatever
the reason is social or otherwise.
But I will say it is a concerning trend thatmany of us professionals are noticing.
That's very, very true.
But also talk, Brock, let'sget back on track
with the development and theski, sweet child's
(20:35):
imagination.
Yes.
You better stop me now so I don'tgo down that rabbit hole.
But that is something thatwe've talked about
in previous episodes on likewhat's trending
and what's happening.
So we'll shelf that, bring it backdown for another day.
But yes, as you said, DocFish, those with
autism don't have much abilityfor fantasy
(20:57):
or imagination.
Yes.
So those with autism areoften very rich and
in concrete versus a ski suedewho has a rich
and vibrant fantasy world filledwith imaginations.
But they might not tell youabout it, obviously.
Yes.
Yes.
Because that's their gold stash.
They're not going to give you themap to their treasure.
Are you kidding?
(21:17):
Oh, my gosh.
Exactly.
They have to protect their fantasy.
Yes.
Yes.
And this here is a greatplace to answer the
thought provoking questionthat we received
from a viewer about fantasyin the ski suede.
So essentially this person'shypothesis was
that for the ski suede, anattachment figure
(21:38):
is replaced by fantasy interaction with
the real world means lettinggo of fantasy to
interact socially.
So then in their words, realitybecomes like a
controlling lover, keepingyou from everything
that makes you feel a sense of selfbecause it's all buried within.
It's real deep.
(21:59):
What are your thoughts, Doc Fish?
Yes, I love the depth of this hypothesis.
So whether it's correct or incorrectdoesn't really matter here.
But it made me think about the antisocial
or psychopathic individuals,object relations
where they don't have an internalattachment object.
Instead they attach to or alignwith a stranger
(22:21):
object or like an archetypalobject from society.
But oppositely, I think it'stotally possible
that a ski suede could replacehuman attachment
with their own internal fantasythat serves
to house the development ofone sense of self.
But then to interact with others, they're
going to inherently representreality since
(22:42):
they're not part of the fantasy.
And that would be really intrusive.
It would have to involve atleast some level of
disconnection from fantasy andthus disconnection
from the sense of self.
So maybe at more mild levels,this dynamic
could just be exhaustingmaybe or annoying.
But at more severe levels, I imagine it
(23:03):
could be like seriously distressing,like making
me think of a turtle running aroundwithout its shell.
Oh, oh no.
Gosh, I have my own hypothesisabout this.
So most ski zoids that I know prefer theirown company to the company of others.
So I would imagine that there's something alluringabout that fantasy world because
(23:26):
it's serving a purpose and possiblyas an attachment substitute.
And it actually reminds meof a conversation
that we had last episode aboutski zoids intensely
pursuing a passion or a job like Sherlock
Holmes or composers, almostlike it's a substitute
for a lover.
Yeah.
So their fantasies provide stimulation,
(23:49):
companionship, intrigue, safety,and a way to get out any
socially inappropriate frustrationslike in
their mind where it's safein their minds.
They can tell that person off in theirhead or flip them the bird.
Like and it makes me wantto ask our skis,
listeners and viewers, like, do you think
(24:11):
there's a re-parenting that's happeningthrough fantasy?
And if so, like, what makesyou think that?
Let us know in the comments.
Yeah, it makes me think oflike the fantasies
that they may have of likeworld domination,
but like they're not going to be theperson that goes for that.
Right.
So it houses that unconscioussexual and aggressive
(24:32):
drives that we detach from asa ski zoid personality.
Right.
And they're not going to show you the
treasure map either of like, here'sall my fantasies.
Exactly.
Super deep stuff.
I also do have a random, but it's actuallya relevant question for the ski zoids.
How do you feel about reasons?
(24:52):
Like genuinely, like, please, please letme know how you feel about reasons.
Yeah, there's a method tothe madness here.
Yeah, we have some interesting, just some
interesting things that we'relooking into.
So curious about that.
Let us know in the comments.
But bringing this back around, I do think
(25:13):
there's another piece of researchthat's worth
noting here.
Doc Fish, do you want to tell us a littlebit more about mirror neurons?
Yes, I love this.
Okay.
Findings on mirror neurons andfacial expressions.
I find this super duper fascinating.
And I think it's extremely important toknow at least two specific studies.
(25:34):
Ring and Marie in 2008 found that those
with schizophrenia were foundto have deficits
in observable facial expressions, but not
micro expressions, whichothers didn't pick
up on.
Oh, okay.
So schizophrenic participants had micro
expressions that other people couldn'tdetect, but a computer
(25:55):
could.
Is that right?
Correct.
Okay.
Emotional physio stuff underthe surface was
normal in comparison to thecontrol sample.
In other words, schizophrenicsexperience emotions.
Normally, they just don't express it.
(26:15):
And because they don't express it, people
interacting with the schizophrenicpatients
decreased their own expressiveness and
reported they felt more negativeexperiences, which
is perhaps why we may overpathologize them.
Uh-huh.
I think you're onto something there.
Yeah.
So under the surface, schizophrenics are
(26:37):
having the exact same emotionalexperiences as you
and I now.
They're just not telling you about it.
And then we as a society feel a way about theirlack of expression and then project
our own negative feelings andthings onto them.
Exactly.
Yes.
I have more though.
Okay.
Okay.
So the
whole world described thatactively psychotic
(26:58):
individuals had increased mirrorneuron activity.
Schizophrenic individualshad average mirror
neuron activity and thenindividuals on the
autism spectrum were found to have little
to no mirror neuron activitywhen observing
others.
Okay.
Hold up.
Hold up.
So with active psychosis where the
(27:19):
individual is responding to theirown internal stimuli
plus the external stimuli.
So their system is basicallyover activated, right?
So then in schizophrenia, it was normal,not over activated, normal.
We just, and not under activatedeither, but
even still we aren't privyto their emotions
(27:42):
or their responses.
In contrast with autism, the socialhardwiring is not intact.
The mirror neurons don't even fire becausethey can't detect those social cues.
Science.
Yes.
It's so fascinating.
This is so interesting.
(28:02):
Wow.
Okay.
So Doc Bok, we should actuallytalk about
our thoughts because reallywe want to kind
of explore the question of can autism
spectrum disorder and schizoidpersonality disorder
occur in the same person?
Yes.
Yep.
We need to get into that.
Okay.
So I'll go first.
(28:23):
So for the DSM, which is disorderbased, the answer is no.
You can't have both disordersat the same time.
If you do have both, one is probablya misdiagnosis.
That's my opinion.
Okay.
So then if there's evidence of
developmental stuff, fixed interestand social deficits,
autism is likely.
(28:45):
If it's just the social odditiesor withdrawal,
you're probably looking atschizoid personality
disorder.
And of course, this is a gross
oversimplification, of course, butteasing these out takes lots
and lots of time.
Consultation with otherprofessionals too,
of course, an extensive social history of
the individual.
(29:05):
Like you need to look at all of that.
Yeah.
Yes.
Yes.
But that's what the DSM says autism
spectrum disorder and schizoidpersonality disorder
cannot be diagnosed at the same time.
And you're right.
In cases we've seen that couldgo either way.
We've really had to look close at history
and if possible, even hearfrom other people
(29:27):
in the individual's life.
Yeah, it confuses even us andwe study this stuff.
Like my goodness.
All right.
So if the person truly hasautism spectrum
disorder, schizoid personalitydisorder is
moot.
Because if the social hardwiring is not intact,it can't be a personality disorder.
(29:49):
So with autism, the foundationalsocial circuit
is missing pieces versus inschizoid personality
disorder.
They're using defenses to keep thesocial circuit from frying.
Right?
So personality disorderscan't be diagnosed
if the reason for socialpathology is based
on a developmental deficit.
(30:10):
Like that just doesn't even make sense.
Okay, I see what you're saying here.
So if you have a diagnosis of schizoid
personality disorder, you're notgoing to automatically
be on the autism spectrum.
But if you are on the autismspectrum, you
still have a personality whichmay be schizoid.
Mm hmm.
I actually have a hypothesisthat autism spectrum
(30:33):
disorder can come in all packagesof personality,
but it's not going to be a disorderlevel because it can't be.
Like you could possibly have a
schiz-oriented temperament and someonewho's autistic, but
that schiz would not beat disorder level.
Okay, I really like that hypothesisthat autism
(30:55):
can come in all packages ofpersonality because
they have personalities.
Yeah.
Okay, so then in my opinionas well, someone
with autism should not be diagnosedwith disorder
level personality.
I think that's simply not fairand it's redundant
because the difficulties stemfrom neurodevelopmental
(31:15):
stuff.
Yeah, yeah.
So I think of it like this.
Individuals with autism don't comewith a full social toolbox.
Their tools are missing.
Individuals with personality disorders
have the social tools in thetoolbox, but they
either misuse them or don'tuse them at all.
So it's unfair and just notcorrect to call
(31:38):
someone with autism who doesn'thave the tools,
personality disordered.
I can totally agree with that.
That does make sense.
Now for funsies, another studywith another perspective.
Oh, okay.
Nerdy stuff.
So we ignore that autism and schizoid
personality disorder cannot be diagnosedin the same person
(32:00):
according to the DSM.
One study took a group ofpeople diagnosed
with Asperger's disorderbecause it was 2012
and they investigated which personalitydisorders overlapped.
So from greatest to least, Asperger's
overlapped with schizoid 26%,obsessive compulsive at
(32:22):
19%, avoidant at 13% andschizotypal at 2%.
My favorite point in thisparticular study
is that there's no overlapwith any cluster
B personality disorders.
Thanks, zero.
Not a sip.
Oh boy.
Okay.
This, this is actually reallyinteresting.
(32:43):
So I would imagine that cluster B leaning
types are the least likelyto overlap with
autism, but sometimes they seem tobe seeking out the diagnosis.
I didn't say that.
You didn't hear that.
Okay.
So cluster Bs are dramatic and socially
engaged in illicit reactionsfrom others versus with
(33:04):
clusters A and C, like they couldgo either way socially.
Right.
Dramatic and erratic is kind of oppositeof the skis skits dynamics.
So one viewer even stated that schizoidsare the opposite of cluster Bs.
Yeah.
And I agree with that.
I totally agree.
(33:24):
Yep.
So regarding the clusterC overlap, I think
it's interesting that psychodynamicperspectives
often include avoidant personalitydisorder
into like schizoid conceptualization,which
I don't necessarily agree with, but it is
one perspective and then obsessivecompulsive
personality disorders.
(33:45):
The only differential diagnosis for
schizoid listed in McWilliamsbook, which makes me
think maybe there's likean overlap with a
hard outside shell and compulsivelike behaviors
to protect it.
Ooh, yes.
Yeah.
That compulsive shell comesup in a lot of
different personality stylesand even personality
disorders, which is where it gets tricky
(34:06):
because you have to look at what'sbeyond that shell
and what's really at the core.
But unfortunately we don't have timeto get into all of that today.
I wish we did, but there'sso many different
flavors of personality andpossibilities that
can pop up.
And that's even true with schizoid.
It can come in different shades and hues,which is really interesting.
(34:28):
Yeah.
And I will say too, we have had a lot of
viewer and listener questionson schizoid versus
avoidant personality disorder,which is also
kind of hotly debated inour field as well.
But we will have to get tothat in a separate
episode because there's alot to unpack with
that too, of course.
(34:49):
My last thoughts on thisthough, is that we
are mere humans, we're imperfectand complex.
Even though autism and schizoid genetic
lines are separate, accordingto imperfect human
researchers, there's nothingsaying that it
can't intersect in a familyor an individual
at some point.
(35:10):
I don't think there's any use making
concrete facts about these questionsbecause we're
simply too vast and complex to be put in
like a box or a label or categoryindividually.
Like we're all unique as it should be.
Yeah.
I love that perspective, Doc Fish.
Yeah.
And I think it's importantto note that as
(35:32):
science advances, like ourunderstanding of
humans deepens and then research gets
updated and then our opinionschange and they could
change here too, based on new informationand new research that we have.
So boxes and categories aside, like weare all human at the end of the day.
(35:53):
Fortunately or unfortunately, yes.
Maybe some of us are wishingwe were computers.
I don't know.
Maybe not.
Maybe.
Anyway, so in some, we hopethat you've learned
something about the differencesbetween schizoid
personality disorder and autismspectrum disorder.
(36:14):
They're two different diagnoses measuring
two very different partsof the psyche, the
foundational neurodevelopmental stuff andthe protective walls of the personality.
And this is also supportedby genetic studies
looking at her readabilitythat found autism
and skis to be two separate tracks.
(36:34):
It's complicated.
We know that.
And our research about thisis grossly incomplete
and confusing and we could usemore help understanding
if there is overlap beyond this socialawkwardness that we see in both.
And on that note, that's a wrap.
Thank you for joining us today on thisepisode of the personality couch.
(36:56):
Make sure to check out ourblogs that coincide
with these episodes at www.personalitycouch.com.
And as always, don't forget to give us a
thumbs up, subscribe, orrate and review us
on your favorite podcast app.
And on YouTube, hit thatbell so you don't
miss a single episode of ourschizoid personality
series.
Be well, be kind, and we'll see you nexttime on the personality couch.
(37:23):
This podcast is for informationalpurposes
only and does not constitutea professional
relationship.
If you're in need of professional help,
please seek out appropriate resourcesin your area.
Information about clinical trends or
diagnoses are discussed in broadand universal terms
and do not refer to any specificperson or case.
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