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This article offers a systematic review of studies of personality and the dimensions of temperament and character, personality pathology, and personality disorders (PDs) in adults with autism spectrum disorder (ASD). Fifteen studies met the inclusion criteria for the review, from which seven studies were meta-analyzed. Results indicate that ASD is significantly and systematically associated with an introvert, rigid, passive-dependent temperament with low novelty seeking, high harm avoidance, low reward dependence and high persistence, and with an immature and poorly developed character with low self-directedness, low cooperativeness, and high self-transcendence. The review further finds a positive correlation between ASD (severity) and neuroticism and a negative correlation between ASD (severity) and extraversion, openness to experience, agreeableness, and conscientiousness. It also finds a positive correlation with paranoid, schizoid, schizotypal, avoidant, and obsessive-compulsive PDs. However, the far from perfect associations indicate there is considerable variation between people with ASD in their personality and personality pathology. In order to obtain a comprehensive picture of an individual with ASD and to implement the most effective intervention plans for and therapeutic relationship with adults with ASD, temperament, character, and comorbid personality pathology and PDs should be considered.

BackgroundTo our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD.Methods/designTwelve adult individuals (age > 18 years) with ASD and at least one PD are given a treatment protocol consisting of 30 weekly offered sessions. A concurrent multiple baseline design is used with baseline varying from 4 to 9 weeks, after which weekly supportive sessions varying from 1 to 6 weeks start with the study therapist. After baseline and 1 to 6 supportive sessions, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, and schema modes are explored, and information about the treatment is given. This is followed by 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions: patients are vice versa and randomly assigned to the interventions. Finally, there is a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and report weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs, and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after supportive sessions, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II is administered during screening procedure, at 5- and at 10-month follow-up.Trial registrationThe Netherlands National Trial Register NTR5788. Registered 01 April 2016.

Background To our knowledge, treatment of personality disorder (PD) comorbidity in autistic adults is understudied and is still in its infancy. We investigated the effectiveness of schema therapy (ST) for autistic adults with PD. Method A multiple case series design with 12 adults (aged 19–62 years) was used with baseline, exploration, ST (with cognitive behavioural and experiential techniques) and follow‐up conditions. Participants rated dysfunctional core beliefs (primary outcome) weekly during baseline and treatment and monthly during follow‐up. Schema modes, general mental health symptoms, social responsiveness, PD traits and common Axis‐I mental disorders were assessed. Results Mixed model analyses indicated significant effects of ST with medium to large effect sizes for dysfunctional core beliefs, functional schema modes, PD traits, general mental health symptoms and social responsiveness. Results remained stable during follow‐up. Conclusion The results of this study indicate that ST might be effective in decreasing dysfunctional core beliefs, PD traits and general mental health symptoms and in increasing functional schema modes and social responsiveness. Improvements persisted over time. ST seems effective in treating PD in autistic individuals.

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BackgroundInterest in autism spectrum disorders (ASD) in adulthood is increasing. Although a person may be diagnosed with ASD, the diagnosis reveals little about the individual's temperament, character, and personality. Also, relatively little is known about the personality of adults with ASD.MethodA reanalysis of scores on the Temperament and Character Inventory (TCI) administered to a group of 66 normally intelligent men aged 18–63 years, diagnosed with ASD, by individual case matching to a comparison group of 66 men from the general population drawn from the TCI manual.ResultsCompared to the comparison group, men with ASD scored significantly higher on the scale for Harm Avoidance, and lower on Novelty Seeking, Reward Dependence, Self-Directedness, and Cooperativeness.ConclusionsIn this study the score pattern for temperament and character found in men with ASD by individual case matching confirms and strengthens earlier general group matching findings emerging from our 2012 study and from studies from Sweden and the Netherlands.

This chapter outlines schema therapy (ST) as a treatment possibility for adults with autism spectrum disorder (ASD) and comorbid personality disorder (PD). The chapter begins with some key considerations concerning the therapeutic relationship and the differential diagnosis of ASD versus PD. ST is introduced, followed by a summary of empirical findings about personality characteristics in people with ASD including both weaknesses (i.e., pathology) and strengths. A summary is provided of the empirical studies examining ST concepts and treatment programs for adults with ASD (and comorbid PD). The chapter concludes with a case study exemplifying the ST approach.

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