Autism's Confusing Cousins

Summary

“I think that these days what we mean by “autism” is basically “weird person disease.””Sorbie Richner, Rich Girl Rehab“Accurate diagnosis requires consideration of multiple diagnoses. Sometimes, different diagnoses can overlap with one another and can only be differentiated in subtle and nuanced ways, but particular diagnoses vary considerably in levels of public awareness. As such, an individual may meet the diagnostic criteria for one diagnosis but self-diagnoses with a different diagnosis because it is better known.”Sam Fellowes, Self-Diagnosis in Psychiatry and the Distribution of Social ResourcesUnsurprisingly, these days I meet many people in the psychiatric clinic who are convinced that they have autism, or suspect (with various degrees of confidence) that they have autism, or report being diagnosed with autism at some point in their lives by some clinician. And for a fair number of such individuals, I cannot say with reasonable certitude that they have autism. The reasons they give for considering autism vary widely, but tend to be along the lines of…“Eye contact makes me very uncomfortable.”“I suck at small talk.”“I have rigid routines.”“I hyper-focus on my hobbies.”“I am always fidgeting.”“Social interaction exhausts me.”“I really bad at making friends.”“I don’t fit in; people find me weird.”What’s interesting about many of the items above is that the number one diagnostic possibility in my mind is an anxiety disorder of some sort. I remember seeing a woman who was a classic example of someone with high neuroticism, poor self-esteem, and severe social anxiety, and she had believed for much of her life that she was autistic because some random doctor somewhere at some point (she couldn’t even remember who or what sort of assessment this involved) had told her that she had autism, and she believed it because it fit in with her experience of being awkward-shy-weird.It is common for me to meet individuals who think they have autism and find myself thinking, “s...