The Complex Relationship between ADHD, Autism, and Personality Disorders like as Narcissism

😵‍💫 Autism is often confused with personality disorders like narcissism, which is problematic.

In recent years, there has been a growing concern about late and incorrect diagnoses in our society, and autism and ADHD are no exception. These developmental conditions are often overlooked and confused with personality disorders like narcissism, which is problematic.

Developmental & personality disorders are not the same

First, let's examine the difference between neurodevelopmental conditions like ADHD and a personality disorder like narcissism. The DSM-5 defines neurodevelopmental conditions as a group of conditions that arise in early childhood and affect a person's development and functioning in multiple areas, such as social interaction, communication, and behavior. Autism is characterized by challenges in social interaction, (non-)verbal communication, and a limited, repetitive, or stereotyped pattern of behavior, while ADHD consists of symptoms such as inattention, hyperactivity, and impulsivity that often begin in childhood and can persist into adulthood.

In a personality disorder, there is a long-term pattern of, among other things, rigid and negative traits, intense emotions, and problems maintaining social relationships. The characteristics are often expressed in cognition, affect, impulse control, and overall functioning.

A personality disorder is not innate, but the predisposition to develop it can be. The reason someone develops a personality disorder is usually due to a combination of biological and upbringing factors that influence each other.

Understanding narcissism and its confusion with AuDHD

Of the various personality disorders, I believe narcissistic personality disorder stands out for its striking similarities with AuDHD. All three conditions involve disrupted attachment, identity issues, impulsivity, poor decision-making, and difficulty expressing empathy.

Narcissistic personality disorder (NPD) comes in two forms: overt and covert. The first kind of NPD is all about flaunting oneself and craving attention and admiration by boasting about one's achievements. The latter type is more sly and manipulative.

Sometimes, people with covert narcissism may get misidentified as autistic. This is because of the commonalities in the social interaction and communication issues that exist in both conditions. But, there is one fundamental difference - unlike people with autism, those with covert narcissism want attention and admiration, rather than simply lacking social skills.

As for overt narcissism, it may be mistakenly assumed as ADHD. Both conditions can lead to hyperactivity, impulsivity, and distractibility. Instead, with overt narcissism, the behavior is driven by a craving for attention and validation rather than being caused by a neurological condition such as ADHD. Additionally, ADHD-related social issues usually result from attention and executive function problems, whereas in overt narcissism, the desire for attention is the primary motivator.

What's more is that studies have shown a higher likelihood of people with autism and ADHD meeting the criteria for one or more personality disorders, including narcissistic personality disorder. In fact, the chance of developing a personality disorder is more than three times higher¹ for people with autism spectrum condition. Another study found² that patients with ADHD have a high risk of developing DSM cluster B personality disorders, including borderline, antisocial, and narcissistic personality disorders. This is likely due to the fact that individuals with ADHD and autism may be more sensitive to trauma, which can contribute to the development of narcissistic behavior as a coping mechanism. Traumatic events in childhood, such as abuse, can cause high levels of stress and a child may develop a narcissistic self-image as a way to cope with these painful emotions.

The complexity does not stop there: it is sometimes unclear whether someone's behavior is due to trauma or AuDHD. Black-and-white thinking, sensitivity to change or certain stimuli and impulsivity occurs in all cases. Additionally, it is worth noting that someone can exhibit narcissistic, ADHD or autistic traits without qualifying for the full diagnosis.

The difference lies in intention

I think it’s of immense importance to view these diagnoses as conditions on a different level. The symptoms of autisme and ADHD are typically present from a young age, as they are developmental conditions that have a neurobiological basis. This contrasts sharply with a personality disorder such as narcissism, which develops throughout childhood in response to various detrimental conditions. The revelation of narcissism usually only comes at sixteen years or later.

The cause of the behavior is also important. With narcissism, there is almost always a higher purpose: people are used to feed the sense of self-worth. Often there is a malignancy and indifference to the fact that they harm others. Someone with a narcissistic personality usually has cognitive empathy, and is capable of recognizing others' emotions and behaving accordingly. Affective empathy, the ability to take on others' feelings when they show those emotions, is then feigned with the aim of manipulating.

Someone with AuDHD will rarely consciously hurt others. On an affective or emotional level, we are hyper-empathic, but cognitive processing can sometimes lag behind. We don’t always know how to adjust our behavior based on emotion. Oh, and we might also experience problems with non-verbal communication, behavioral routines, and fixed interests. Structure in the mind often leads to peace, while those with narcissism enjoy causing chaos and disruption.

People who have AuDHD are also more likely to seek psychological help in the hope of navigating life more easily. If someone with a narcissistic personality does seek psychological counseling, it is usually to gain better insight into how to manipulate and control others, rather than to address and overcome their harmful behavior.

It becomes particularly challenging when narcissism and AuDHD co-occur. Some narcissistic individuals mislead healthcare professionals in order to obtain a misdiagnosis of autism spectrum disorder as an explanation for their behavior. This further darkens the societal perception of autism and ADHD.

Personally, I have had an experience with an ex-partner who was diagnosed with autism but showed clear traits of narcissistic personality disorder. She would deliberately try to bring me down, gaslight me, and triangulate situations, but then attribute it to her autism. This was a very difficult and damaging experience for me but it also drove me to seek a better understanding of the complex relationship between AuDHD and personality disorders.

1. https://pubmed.ncbi.nlm.nih.gov/26861713/

2. https://www.cambridge.org/core/journals/european-psychiatry/article/personality-traits-and-disorders-among-adult-adhd-patients-is-borderline-personality-disorder-as-common-as-we-expect/8BFBC8070BBEC4C24DA42510EA0AACD7