Hi, mdcastle-ga !
How very worrying for your family this must be. I have been able to
find quite a lot of information on both conditions, so here goes:
Starting with Avoidance Personality Disorder there is a good page
defining the disorder in simple terms on Top Condition's website:
http://topcondition.com/images/mymindfield/avoidance_personality_disorder.htm
They say:
"People with this disorder have feelings of inferiority, inadequacy
and sensitivity to how others view them. These people are extremely
sensitive, and anticipate failure or rejection, even if there is no
objective reason to sense impending loss."
They go on to say:
"Psychotherapy appears the most preferred treatment. Medication is
contraindicated for this condition. Individual therapy is preferred,
because the condition makes group scenarios difficult. ..... These
individuals often see only negative aspects of life and negative
potential. Their self evaluation is colored by these predispositions.
It is difficult to get a literal and accurate report, forcing the
clinician to read between the lines and look for subtle clues about
avenues of pursuit. "
Med Help's Mental Health Forum answered a patient's query on the
subject in May 1999 at:
http://www.medhelp.org/forums/mentalhealth/archive/667.html
HFHS.M.D.-D.E. wrote:
"Persons with this type of disorder show an extreme sensitivity to
rejection, which may lead to a socially withdrawn life. Such
individuals are not asocial and show a great desire for companionship
but are shy. They assume others will be critical: this affects
performance in school, work, and life in general. They are apt to
misinterpret other people's comments as derogatory and ridiculing.
When talking with someone, they express uncertainty and a lack of
self-confidence and may speak in a self-effacing manner. Persons with
this disorder are subject to depression and anxiety if their support
system fails. .... The good new is that it is possible to get help. A
good relationship with a therapist who can help you develop strategies
to enable you to express your needs more openly and improve your
self-esteem is a good way to start."
He indicates that medication may be needed to assist with any
associated depression.
A scholarly approach to the diagnosis of personality disorders is
taken at:
http://www.md.chula.ac.th/psychi/knowledge/gp/personality.html
"A personality Disorder is an enduring of the individual's culture, is
pervasive and inflexible, has an onset in adolescence or early
adulthood, is stable over time, and leads to distress or impairment."
It goes on to give diagnostic criteria for personality disorders, and
stresses the difference from personality traits, which are those
differenced between people that make us individuals.
"Personality traits are enduring patterns of perceiving, relating to,
and thinking about the environment and oneself that are exhibited in a
wide range of social and personal contexts. Only when personality
traits are inflexible and maladaptive and cause significant functional
impairment of subjective distress do they constitute Personality
Disorders. The essential feature of a Personality Disorder is an
enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the individual's culture and is
manifested in at least two of the following areas: cognition,
affectivity, interpersonal functioning, or impulse control (Criterion
A). This enduring pattern is inflexible and pervasive across a broad
range of personal and social situations (Criterion B) and leads to
clinically significant distress or impairment in social, occupational,
or other important areas of functioning (Criterion C). The pattern is
stable and of long duration, and its onset can be traced back at least
to adolescence or early adulthood (Criterion D). The pattern is not
better accounted for as a manifestation or consequence of another
mental disorder (Criterion E) and is not due to the direct
physiological effects of a substance (e.g., a drug of abuse, a
medication, exposure to a toxin) or a general medical condition (e.g.,
head trauma) (Criterion F). "
A long way down the page the disorder is discussed in more detail
giving examples of the Criteria listed above and goes on to say:
"Individuals with Avoidant Personality Disorder often vigilantly
appraise the movements and expressions of those with whom they come
into contact. Their fearful and tense demeanor may elicit ridicule and
derision from others, which in turn confirms their self-doubts. They
are very anxious about the possibility that they will react to
criticism with blushing or crying. They are described by others as
being "shy," "timid," "lonely," and "isolated." The major problems
associated with this disorder occur in social and occupational
functioning. The low self-esteem and hypersensitivity to rejection are
associated with restricted interpersonal contacts. These individuals
may become relatively isolated and usually do not have a large social
support network that can help them weather crises. They desire
affection and acceptance and may fantasize about idealized
relationships with others. The avoidant behaviors can also adversely
affect occupational functioning because these individuals try to avoid
the types of social situations that may be important for meeting the
basic demands of the job or for advancement. "
It also warns:
"There appears to be a great deal of overlap between Avoidant
Personality Disorder and Social Phobia, Generalized Type, so much so
that they may be alternative conceptualizations of the same or similar
conditions. "
Now moving on to Asperger Syndrome, OASIS (Online Asperger Syndrome
Information and Support) have an informative website at:
http://www.udel.edu/bkirby/asperger/
They have also published a guide for parents and teachers which is
available from amazon at US$19.95
Clicking on "What is AS?" in the left hand menu brings you to an
article by Barbara L. Kirby (you do not seem to be able to reach this
article independently of the menu).
She says: "Asperger Syndrome.... is a neurobiological disorder named
for a Viennese physician, Hans Asperger, who in 1944 published a paper
which described a pattern of behaviors in several young boys who had
normal intelligence and language development, but who also exhibited
autistic-like behaviors and marked deficiencies in social and
communication skills. "
The syndrome can be anywhere from mild to severe.
She goes on to describe the AS personality in detail. Among other
things:
"Persons with AS show marked deficiencies in social skills, have
difficulties with transitions or changes and prefer sameness. They
often have obsessive routines and may be preoccupied with a particular
subject of interest......
. It's important to remember that the person with AS perceives the
world very differently. Therefore, many behaviors that seem odd or
unusual are due to those neurological differences and not the result
of intentional rudeness or bad behavior, and most certainly not the
result of "improper parenting".....
By definition, those with AS have a normal IQ and many individuals
(although not all), exhibit exceptional skill or talent in a specific
area. Because of their high degree of functionality and their naiveté,
those with AS are often viewed as eccentric or odd ......
Vocabularies may be extraordinarily rich and some children sound like
"little professors." However, persons with AS can be extremely literal
and have difficulty using language in a social context. "
At the bottom of the page Kirby lists the official diagnostic criteria
for Aspergers, and a "layman's language" list by Lois Freisleben-Cook,
who points out:
"The children I have known do desire interaction with others but have
trouble knowing how to make it work. They are, however, able to learn
social skills much like you or I would learn to play the piano. "
and
"There is a general impression that Asperger's syndrome carries with
it superior intelligence and a tendency to become very interested in
and preoccupied with a particular subject. Often this preoccupation
leads to a specific career at which the adult is very successful."
There is a wealth of other material on the OASIS site - click on
"Papers and Articles". These include:
" Is Asperger's syndrome/High-Functioning Autism necessarily a
disability?" by Simon Baron-Cohen which summarises some of the
neuro-biological differences in the course of the discussion:
"AS/HFA involves a range of neural differences. ..... . In some
regions of the brain increased cell density has been found , - for
example, in the limbic system - whilst in other regions of the brain
structures are reported to be smaller. For example, the cerebellar
vermis lobule 7 and the posterior section of the corpus callosum have
both been reported to be reduced in size in autism. However, whilst
these neural abnormalities signal differences between brains of people
with and without AS/HFA, they cannot be taken as evidence that one
type of brain is better or worse than the other.
Similarly, AS/HFA appears to be strongly familial, implying a genetic
aetiology, and the first report from an international molecular
genetic consortium study reported a linkage on Chromosome 7 in
affected individuals . The molecular genetic basis of AS/HFA remains
to be worked out in detail, but again such findings are at best
evidence of difference and in no way implies that the genotype of
AS/HFA is deficient. "
The Asperger Syndrome Coalition of the US has a similar informative
site at:
http://www.asperger.org/asperger/asperger_main.html
Through them you can find a solid article by Dr. Stephen Bauer at:
http://www.asperger.org/asperger/asperger_bauer.htm
He writes:
"Asperger syndrome is the term applied to the mildest and highest
functioning end of what is known as the spectrum of pervasive
developmental disorders (or the Autism spectrum). Like other
conditions along that spectrum it is felt to represent a
neurologically-based disorder of development, most often of unknown
cause, in which there are deviations or abnormalities in three broad
aspects of development: social relatedness and social skills, the use
of language for communicative purposes, and certain behavioral and
stylistic characteristics involving repetitive or perseverative
features and a limited but intense range of interests."
Citing an article by Gilberg he comments:
"In fact, Gillberg has estimated that perhaps 30-50% of all adults
with AS are never evaluated or correctly diagnosed. These "normal
Aspergers" are viewed by others as "just different" or eccentric, or
perhaps they receive other psychiatric diagnoses. I have met a number
of individuals whom I believe fall into that category, and I am struck
by how many of them have been able to utilize their other skills,
often with support from loved ones, to achieve what I consider to be a
high level of function, personally and professionally. It has been
suggested that some of these highest functioning and brightest
individuals with AS represent a unique resource for society, having
the single mindedness and consuming interest to advance our knowledge
in various areas of science, math, etc. "
This is borne out a little by my own observation of encountering two
adults with AS at various times. One was an expert on all aspects of
Gilbert and Sullivan and was an active member of his local G&S
Operatic Society, although otherwise his social functioning was poor;
the other - married and with children - was obsessively knowledgeable
about steam trains. (My husband can bore the socks off you on the
subject of steam trains - this man was something else again.)
On medication Bauer comments - talking about children :
"Although most children with AS are managed without medication and
medication does not "cure" any of the core symptoms, there are
specific situations where medication can occasionally be useful.
Teachers should be alert to the potential for mood problems such as
anxiety or depression, particularly in the older child with AS. "
He goes on to discuss appropriate medications such as anti-depressants
like serotonergic drugs or clomipramine.
This site also has a good general article by Rosalyn Lord.
Dr. R. Kaan Ozbayrak, MD maintains the website:
http://www.aspergers.com
This includes some more information on brain differences and another
definition:
"In Asperger's Disorder, affected individuals are characterized by
social isolation and eccentric behavior in childhood. There are
impairments in two-sided social interaction and non-verbal
communication. Though grammatical, their speech is peculiar due to
abnormalities of inflection and a repetitive pattern. Clumsiness is
prominent both in their articulation and gross motor behavior. "
A really interesting support site for University students with AS can
be found at:
http://www.users.dircon.co.uk/~cns/
This includes personal stories including Chris Mitchell (diagnosed at
19) at:
http://www.users.dircon.co.uk/~cns/chris.html
Chris found the diagnosis a relief:
"I became someone to avoid because I too often tried to ram my own
opinions down people's throats. I began to suffer depression. It was
here that characteristics I had shown during this time suggested to my
doctor and psychologist that I had Asperger's Syndrome. I was relieved
to find out that there was a reason for why I am the way I am and when
I saw the advantages that the condition presents, I became more
confident about myself. The diagnosis also helped my colleagues to
understand me. "
Note his obsessive special interest that leads him to add cricket
statistics to his online account.
Paul Schwarz describes childhood symptoms that had gone unrecognised:
http://www.users.dircon.co.uk/~cns/phil.html
"That's what I'd been labeled, as a kid, gifted. Allowed to be odd (at
least by parents and teachers) because I was gifted. And I certainly
had that expectation of giftedness upon me going into Chicago, as a
University Scholar.
But then I found out that there were students way more brilliant than
me who weren't odd. Being odd was apparently _not_ "part of the deal"
for being gifted. My self-esteem crumpled under the weight of all
this."
Paul is a pure maths specialist. He goes on:
"My fragile emotional state marked the beginning of my 17-year slog
through talking therapy for depression and dysthymia that lasted until
our son Jeremy's atypical development (leading to a dx of
high-functioning autism, or, technically, according to the American
DSM-IV, PDD-NOS) caused us to discover that there were high
functioning forms of autism and that "mild" AS described what was
going on with me better than anything I'd seen in 17 almost-nonstop
years of therapy. There is a God, and Xe is what we call here in New
England a wicked good practical joker. "
So Paul's was a late diagnosis as an adult, but the symptoms were in
fact present from childhood.
Finally AS_IF is a site maintained by Suzie, herself with AS, at:
http://www.aspergerinformation.net
She lists the adult diagnostic criteria as well as those for children,
and has a very balanced view of the subject. Click on "Adult Diagnosis
Procedure" and then click on it again or scroll down a long way for a
good rundown, and some very useful phone numbers including The Centre
for Social and Communication Disorders on tel 020 8466 0098 and The
NAS Information Centre for Health Professionals on tel 020 7903 3599.
Note: These are UK numbers.
(This is another page which doesn't have its own URL and must be
reached through the menu system.)
About medication she says (under "treatment"):
"The class of drugs most commonly used to treat autism are known as
the serotonin reuptake inhibitors (Prozac is one of them). SRIs can
increase attention, decrease distractibility and hyperactivity, and
increase social interaction. They can also be used to treat
depression, anxiety disorders and obsessive-compulsive illness.
Certain hormones are sometimes prescribed for treatment too. There are
many types of drugs that have been or are being used, but I shall not
list them all here. Drugs for autism are not as widely prescribed in
the UK as they are in the USA. None of these drugs cure or prevent
autism, they just alter your behaviour for as long as you take them."
You can download a free leaflet from her site (top right).
It is evident that Asperger's shows up in childhood, and is considered
to be a lifelong neurobiological problem on the Autism spectrum with
its roots in the physical, whereas the personality disorder is a
psychological problem manifesting in adolescence or adulthood.and
developing over time.
So as a "tip-off" to the more likely diagnosis, look at your nephew's
childhood. If your nephew did not show these behaviour patterns in
childhood, he is unlikely to have AS. If he did, then APD is probably
a good diagnosis. You can also look at whether his withdrawal from
social interactions seems to be triggered by such things as fear of
failure or fear of rejection (APD), or whether there is a basic
inability to relate easily to other people in social situations (AS).
Drug therapy seems to be used in both cases to treat associated
problems such as depression, rather than the under-lying problem - as
you indicate above in the case of your nephew. Avoidance Personality
Disorder patients respond to conventional therapies; Asperger's
Syndrome people can consciously learn some of the social skills that
most people just pick up as they go along but psycho-therapy is
probably not appropriate unless there are other issues that they wish
to tackle with the help of a therapist.
A website dedicated to the side effects of Prozac is:
http://prozac-side-effects.com/prozac-side-effects.html
The third listed common side-effect is:
"Behavioral: Insomnia, Anxiety, Nervousness, Agitation, Abnormal
dreams, Drowsiness and fatigue " so if your nephew experiences any
increase in these - not everybody does, -he should talk to his doctor
regarding a possible cha nge in medication.
As an adult, if your nephew is happy with the diagnosis and feels the
treatment is helping him, then perhaps that's all that is necessary.
Of course his health professionals are in the best position to assess
his condition.
I do hope this information is useful and helpful for you . Good luck.
Search terms:
"Avoidance Personality Disorder"
"Aspergers"
Prozac side effects |
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