Autistic and Catatonic Spectrum Symptoms in Patients with Borderline Personality Disorder

Abstract

Background: Recent literature has shown that a considerable percentage of patients with severe mental disorders can develop, over time, full-blown or subthreshold catatonia. Some studies corroborate the model of an illness trajectory in which different mental disorders would be arranged along a continuum of severity until the development of catatonia. In such an illness pathway, autistic traits (AT) and borderline personality disorder (BPD) may represent important steps. In order to further explore the association between AT, BPD, and catatonia, the aim of this study was to compare catatonic spectrum symptoms and AT among patients with major depressive disorder (MDD), BPD, and healthy controls (CTL), also evaluating possible predictive dimensions of the different diagnoses. Methods: A total of 90 adults affected by BPD, 90 adults with a diagnosis of MDD, and 90 CTL, homogeneous in terms of gender and age, were recruited from six Italian university departments of psychiatry and assessed with the SCID-5-RV, the Catatonia Spectrum (CS), and the Adult Autism Subthreshold Autism Spectrum (AdAS Spectrum). Results: The total CS score was significantly higher in the BPD and MDD groups than in the CTL group, while the majority of CS domain scores were significantly higher in the BPD group than in the MDD group, which scored significantly higher than the CTL group. The total AdAS Spectrum score and the AdAS Spectrum domain scores were significantly higher in the BPD group than in the MDD group, which in turn scored significantly higher than the CTL group. The CS domains “psychomotor activity” and “impulsivity”, and AdAS Spectrum domains “verbal communication”, “empathy”, and “hyper-/hyporeactivity to sensory input” were associated with the risk of presenting a diagnosis of BPD.

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“…Catatonia is a complex neuropsychiatric syndrome, characterised by motor, affective and behavioural alterations. Even though for many years catatonia has been considered a psychiatric disorder on its way to extinction, in recent years it has benefitted from a renewed interest since it has now been discovered to occur in a wide range of diseases as a sort of ultimate common pathway for many severe mental disorders, including ASD [146][147][148][149][150][151][152]. While its exact prevalence in the general population is uncertain, in clinical settings, it is estimated to range from 3.3 to 8.9% [153][154][155] and, in acute psychiatric conditions, from 9% to 17% [156].…”

Autistic Traits as Predictors of Increased Obsessive–Compulsive Disorder Severity: The Role of Inflexibility and Communication Impairment

“…In particular, to this date, many studies have highlighted a higher prevalence of autistic traits among subjects with bipolar disorder (BD), where they have also been reported to be correlated with greater depressive symptoms and higher prevalence of suicidal thoughts or behaviors across the lifetime [34]. Similarly, subjects with borderline personality disorder (BPD) reported higher autistic traits than the general population, which also, in this case, are associated with suicidality and lifetime exposure to physical and/or sexual abuse [35,36]. Moreover, particularly timely is the hypothesis of a correlation between feeding and eating disorders (FED), in particular AN, and ASD.…”