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.
Highlights
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines autism spectrum disorder (ASD) on the basis of two major criteria: (A) persistent deficit in communication and social interaction and (B) narrow interests and repetitive behaviors
ASD prevalence varies across studies from 0.76% to 2.64% in the general population, while prevalence rates in adult psychiatric inpatients vary from 2.4% to 9.9% [2]
We present the case of a patient with bipolar disorder, binge eating disorder, self-harm behaviors, impulsivity, affective dysregulation, self-devaluation, and feeling of emptiness and instability in the relationships, hospitalized at the Inpatient Unit of the Psychiatric Clinic of the University of Pisa, in which an undetected diagnosis of ASD, without language or intellectual impairment, with childhood trauma emerged
Summary
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines autism spectrum disorder (ASD) on the basis of two major criteria: (A) persistent deficit in communication and social interaction and (B) narrow interests and repetitive behaviors. We present the case of a patient with bipolar disorder, binge eating disorder, self-harm behaviors, impulsivity, affective dysregulation, self-devaluation, and feeling of emptiness and instability in the relationships, hospitalized at the Inpatient Unit of the Psychiatric Clinic of the University of Pisa, in which an undetected diagnosis of ASD, without language or intellectual impairment, with childhood trauma emerged. This suggested a possible major role of these conditions as a vulnerability factor for the following development of severe multiple psychopathologies
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