Is There a Major Role for Undetected Autism Spectrum Disorder with Childhood Trauma in a Patient with a Diagnosis of Bipolar Disorder, Self-Injuring, and Multiple Comorbidities?

Abstract

This case report highlights the relevance of the consequences of trauma in a female patient with an undetected autism spectrum disorder (ASD) affected by bipolar disorder (BD) with multiple comorbidities. A 35-year-old woman with BD type II, binge eating disorder and panic disorder was admitted in the Inpatient Unit of the Psychiatric Clinic of the University of Pisa because of a recrudescence of depressive symptomatology, associated with increase of anxiety, noticeable ruminations, significant alteration in neurovegetative pattern, and serious suicide ideation. During the hospitalization, a diagnosis of ASD emerged besides a history of childhood trauma and affective dysregulation, marked impulsivity, feeling of emptiness, and self-harm behavior. The patient was assessed by the Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale (RAADS-R), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Trauma and Loss Spectrum (TALS-SR), and Ruminative Response Scale (RRS). Total scores of 38/50 in the AQ, 146/240 in the RAADS-R, 99/160 in the AdAS Spectrum emerged, compatible with ASD, 47/116 in the TALS-SR, and 64/88 in the RRS. We discuss the implications of the trauma she underwent during her childhood, in the sense that caused a complex posttraumatic disorder, a lifelong disease favored and boosted by the rumination tendency of high functioning ASD.

Sex Differences in the Relationship between PTSD Spectrum Symptoms and Autistic Traits in a Sample of University Students

“…Moreover, it can also be hypothesized that some subjects, and in particular those with AT, may fail in reporting, during the clinical interview, the presence of a major traumatic event in their clinical history, due to their difficulties in properly externalizing and in coping with the traumatic experiences. Consequently, in subjects with AT it is possible that a cPTSD symptomatology, or even a full-blown PTSD, would remain partially or entirely unrecognized, leading these patients to receive a diagnosis of a different mental illness [4-6, 33, 43]. This study should be considered in light of some important limitations.…”

“…A strong genetic component has been recognized in ASD, and generally, the disorder comes to clinical attention during childhood [2, 3]. However, recently an increasing number of studies is focusing on mild forms of ASD, or even on sub-threshold Autistic Traits (AT), which do not properly fulfill the Diagnostic and Statistical Manual of Mental Disorder (DSM) criteria: while milder forms of ASD may come to clinical attention only in adulthood, when patients develop other disorders in comorbidity, AT may remain entirely undiagnosed during lifetime [4-6]. AT can be usually found among first-degree relatives of ASD probands, where they are known with the label of “broad autism phenotype” [7-9], but they may also be found in some high-risk groups from the general population, such as university students, and in particular those enrolled in high-ranking universities [10-18].…”

“…In this framework, it is also noteworthy that, while ASD is a diagnosis with a higher prevalence among males [46, 47], results from literature generally show higher PTSD rates in women compared to men [48-51]. It should be noted that an increasing number of studies is stressing the necessity to pay more attention to female presentations of autism spectrum, which may be significantly different to those typically reported among males, remaining consequently undiagnosed, especially when hidden by other disorders in comorbidity, including stress-related disorders [6, 47, 52, 53]. In the light of reported data, the present study aims to investigate sex differences in the relationship between post-traumatic stress symptoms and autism spectrum in a sample of university students from high-ranking universities.…”

Risk and Protective Factors for PTSD in Caregivers of Adult Patients with Severe Medical Illnesses: A Systematic Review

“…Avoidant coping behaviors show significant overlap with PTSD symptoms and prevent recovery from the disorder, as they are associated with increased symptom severity over time [69][70][71]. This is likely because avoidant coping strategies prevent actions aimed at actively managing stressors, potentially resulting in a paradoxical increase in intrusive thoughts [72,73].…”

Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors

“…Current literature recognizes that women may have a twofold risk for PTSD, with respect to men exposed to the same traumatic event (6)(7)(8)(9). Again, increased evidence suggests the former to report more severe symptoms than the latter, with the only exception of reckless and self-destructive behaviors (10)(11)(12)(13)(14)(15), although a few studies have specifically focused on neurovegetative alterations in PTSD.…”