Autism and dissociative processes Full paper Some people will have a greater tendency toward developing dissociative

disorders and if they then experience significant trauma may be more at risk of Post- Traumatic Stress Disorder (PTSD). In fact, having a pervasive developmental disorder may predispose children to dissociative disorders. Dissociative symptoms can coexist with other childhood psychiatric conditions (R1555256AA). In fact, an underlying mood disorder, cognitive disorder or pervasive developmental disorder may lower a child's threshold for coping with a traumatic environment and therefore make the child more vulnerable to the development of comorbid dissociative symptoms. ('Dissociative Symptoms in Children', Joyanna L. Silberg, Ph.D.; Elaine D. Nemzer, M.D. Am J Psychiatry 1998;155:708a-709. American Journal of Psychiatry 1998).

Dissociative identity disorder (DID) is one of the more severe dissociative disorders within a spectrum of dissociative disorders. This spectrum includes conditions such as general dissociation, Derealization and Depersonalization (DP)Dissociative Amnesia, Dissociative Fugue, PTSD, Complex PSTD (C-PTSD) DDNOSs , DID and Polyfragmented DID. The change from the now-defunct term of MPD to DID distinguished DID as part of a spectrum of dissociative disorders. This spectrum included general dissociation common to any and all human beings, standard in children before the age of 5 and possibly higher tendencies in some children on the autism spectrum.

PERSONALITY TRAITS AND PREDISPOSITION

Certain personality traits were also found commonly to overlap with DID and contrary to the general stereotype, BPD overlaps less with DID than several other personality disorders. *AvPD (Avoidant Personality Disorder) had a 76% crossover .* Self Defeating Personality Disorder had a 68% crossover .* Schizotypal Personality Disorder had a 58% crossover with dissociative tendencies.* BPD (Borderline) had a 53% crossover .* Passive Aggressive Personality Disorder had a 45% crossover .

DISSOCIATION AND AUTISM

There is a higher rate of Schizotypal and Avoidant Personality Disorders among the autistic population, who are already known commonly to over-employ dissociation. Anxiety disorders in autistic children thought to run as high as up to 85% co-morbidity and many children on the spectrum also have significant difficulty regulating emotions and some are treated from quite early for mood disorders.

Dissociative states are one of the results of chronic anxiety. Yet there is little literature about dissociative disorders and the autism spectrum. If a child already predisposed to dissociative tendencies is continually entrapped with traumatic experiences from infancy or very early childhood, he or she may be at risk of more severe dissociative disorders. But what constitutes such continual trauma for someone with autism? Could a combination of significant disabilities create a state of ongoing anxiety and stress so overwhelming as to lead to such over- employment of dissociative skills that a child with autism might risk becoming

comparatively more comfortable with dissociation, derealisation, depersonalisation than they are with non-dissociative communication, interaction and involvement? Take, for example, a common 'autism fruit salad' in which someone with autism might struggle to process sensory information (sensory integration disorder), have the inability to process nonverbal language (such as social emotional agnosia), be face-blind (prosopagnosia), be contextblind or object-blind and see their world bit by bit (simultagnosia), be meaning-deaf (language and auditory processing disorder), be entrapped in the helplessness, isolation, inequality and lack of choices that may come with having limited verbal or even augmented form of functional communication. Add to this the possibility they may have undiagnosed or unmanaged health conditions (gut, immune, metabolic, autonomic, connective tissue disorders or brain chemistry imbalances) which contribute to their challenges.

We know ongoing chronic stress will exaccerbate anyone's personality traits into what can potentially present as corresponding personality disorders (such as Dependent Personality Disorder in which the person avoids independence skills in monopolising their carer), even combining into 'mixed personality disorder' (where several of the person's personality traits are presenting in the personality disorder range).

A range of issues can contribute to identity, personality and dissociative disorders. Among these: Being developmentally out of sync with non-autistic peers, the challenges of being person versus case/cause/condition, being in an intensive programme that is out of sync with your own processing style or personality traits, being subject to extensive medical interventions whether required or not, the challenges of being someone with disabilities in a family of people who may not be on the autism spectrum at all, the challenges, being socially, educationally, intellectually measured against a nonautistic model of 'normality', feeling like the 'burden' to the family or sibling/s or in a family waiting for you to overcome your autism before being treated as a 'true' or fully fledged, equal member of the family, watching non-autistic people connect and gain opportunities you may never easily access, being subtly or overtly a focus of people's charity, pity, humour or self-inflatory bullying.

Enough of a combination of these things may predispose some autistic children to over-employ dissociative skills to the extent that, over years, these risk progressively developing into dissociative disorders.

When my first book, Nobody Nowhere, came out in 1991, it was as much about growing up with

autism as it was about dissociative processes as both skill and disorder. I wrote about dissociation, derealisation, depersonalisation but also about splitting, keeping company with the split-off parts of myself (alters) and how these helped me function as a person with autism. The models of autism at the time were simplistic, purist, two-dimensional, and static. It was all 'tidy boxes'. But human beings, autistic or not, are more complex, three-dimensional and dynamic than that.

Even amidst pressure in online forums to adhere to autism stereotypes based on this static model, others continued to discuss openly diversity among those with autism, to discuss their own 'autism fruit salads'.

Controversial at the time, we now understand autism is more than a two-dimensional model of a 'spectrum'. It is not only commonly more dynamic, but also a three- dimensional model of interacting and interconnecting layers, of 'autism fruit salad', which includes complications of cooccuring mental health issues, the over-employment of dissociative 'skills' or exaccerbation of personality traits into the personality disorder range, and complications of identity. We have begun to hear a range of accounts about some (perhaps more idiosyncratic/schizotypal) autistic children who will spend their day as a cat, dog, tiger, TV character. Some switch between identifying as one gender or the other (there is a higher rate of transgender people on the autism spectrum than the general population). Some self- isolate and self-chatter with 'characters' within their own world, about those who have developed a non autistic persona to cope in some environments whilst retaining one or more different autistic personas in others, about those who have changed identities insisting the old self is 'gone'. Research has also shown that female children with autism also commonly will have imaginary friends which live 'in their own world'. Yet we still have little or no cohesive literature or discussion on these issues and their management in a wider context of helping people developmentally reach their fullest potential.

In 2010, I was diagnosed with the dissociative disorder, DID. Any human being can develop an anxiety disorder, dissociative disorder, identity disorder or personality disorder. These are not exclusive to non-autistic people and having autism does not make one immune to having either great dissociative skills or over-employing these to the degree they present as dissociative disorders. I have since connected with a number of adults both on and off the autism spectrum who are also diagnosed with DID and used my skills as an autism consultant to begin to navigate the complexities of dissociative disorders. I have made a video over at Autism Hangout, where I discuss the connections between autism and dissociation. I hope you find it useful. You can also find more info at my website: http://www.donnawilliams.net

Donna Williams, Dip Ed, BA Hons Author, Autism consultant and public speaker. WEB: http://www.donnawilliams.net