One of the most controversial posts I have written here appeared on June 20, 2014. More than 60,000 people read it, and there were numerous comments, many heated, about whether autism and antisocial personality disorder are complementary, totally different, or overlap. For people on the “autism spectrum,” their families, and their friends, it is crucial that the public understand that these are two distinct conditions. Despite superficial similarities, they should not be equated.
The onset of autism occurs in early childhood in the form of developmental delays. Given that there are many individual differences in personality among people who have some degree of autism, it is important to bear in mind crucial defining features. According to the Diagnostic and Statistical Manual of the American Psychiatric Association, Fifth Edition, a hallmark of autism is “persistent impairment in reciprocal communication and social interaction.” More specifically, the APA specifies the following defining features of “Autism Spectrum Disorder (ASD)”: difficulty responding to or initiating social interactions, difficulty integrating verbal and nonverbal communication, and difficulty in developing, maintaining, and understanding relationships.
People with an antisocial personality disorder also have difficulty with reciprocity in relationships, but for an entirely different reason. Viewing the world as their personal chess board, they seldom care about the feelings of others and, instead, make choices (often calculated) to advance their agendas. They resort to any means to achieve their objectives with little consideration of the impact of their behavior. People with an antisocial personality disorder resort to deception, intimidation, or violence as they maneuver to gain power and control over other people. Relentless and cruel in their tactics, they “reciprocate” in self-serving ways, caring little about the welfare of others.
People with autism may experience difficulty in interpersonal relationships because they have trouble “reading other people.” This is different from the antisocial person who does not try to “read” others because he does not care about anyone but himself.
When a person with autism fails to understand the point of view of another, it is not due to choices but to a disability. The antisocial person seldom cares what another person thinks because he is focused entirely on himself. Due to his disability, a person with autism may have difficulty sharing. This is very different from the mean-spirited self-centeredness of the person with an antisocial personality.
A person with autism may become frustrated, then aggressive because he does not understand the behavior of another person. This is very different from the frustrated antisocial person who simmers with anger whenever others disagree with him, fail to do what he wants, or do not affirm his inflated view of himself.
A person may have two independent conditions. A person could have a broken wrist and the flu—one has nothing to do with the other. And so it is that a person may have characteristics of autism but also have features of a personality disorder. One does not “cause” the other.