Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 19, 2021; 11(12): 1366-1386
Published online Dec 19, 2021. doi: 10.5498/wjp.v11.i12.1366
Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis
Camilla Rinaldi, Margherita Attanasio, Marco Valenti, Monica Mazza, Roberto Keller
Camilla Rinaldi, Roberto Keller, Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
Margherita Attanasio, Marco Valenti, Monica Mazza, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
Margherita Attanasio, Marco Valenti, Monica Mazza, Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
Author contributions: Rinaldi C wrote the paper and collected and interpreted the data; Attanasio M incorporated changes during the course of review and edited the paper; Valenti M and Mazza M reviewed and critically revised the paper; Keller R conceived, supervised and reviewed the study and finalized the manuscript. All authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roberto Keller, MD, Chief Doctor, Adult Autism Center, Department of Mental Health, ASL Città di Torino, Local Health Unit, Cso Francia 73, Turin 10138, Italy. rokel2003@libero.it
Received: February 17, 2021
Peer-review started: February 17, 2021
First decision: May 13, 2021
Revised: May 26, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: December 19, 2021
Processing time: 292 Days and 16 Hours
Abstract
BACKGROUND

Differential diagnosis, comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder (ASD), but clinical assessments often omit screening for personality disorders (PD), which are especially common in individuals with high-functioning ASD where there is less need for support.

AIM

To summarize the research findings on PD in adults with ASD and without intellectual disability, focusing on comorbidity and differential diagnosis.

METHODS

PubMed searches were performed using the key words “Asperger’s Syndrome”, “Autism”, “Personality”, “Personality disorder” and “comorbidity” in order to identify relevant articles published in English. Grey literature was identified through searching Google Scholar. The literature reviews and reference sections of selected papers were also examined for additional potential studies. The search was restricted to studies published up to April 2020. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.

RESULTS

The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria: 16 evaluated personality profiles or PD in ASD (comorbidity), five compared ASD and PD (differential diagnosis) and one performed both tasks. There were significant differences in the methodological approaches, including the ASD diagnostic instruments and personality measures. Cluster A and cluster C PD are the most frequent co-occurring PD, but overlapping features should be considered. Data on differential diagnosis were only found with cluster A and cluster B PD.

CONCLUSION

ASD in high-functioning adults is associated with a distinct personality profile even if variability exists. Further studies are needed to explore the complex relationship between ASD and PD.

Keywords: Autism spectrum disorder; Asperger’s Syndrome; Personality disorder; Adulthood; Comorbidity; Differential diagnosis

Core Tip: Differential diagnosis, comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder (ASD). Findings of most studies support that ASD in high-functioning adults is associated with a distinct personality profile even if variability exists. Cluster A and cluster C personality disorders (PD) are the most frequent co-occurring PD in ASD, but overlapping features should be considered.