What misdiagnoses do women with autism spectrum disorder receive in the DSM-5?

Abstract

Recently increasing literature is focusing on sex differences in the manifestations of Autism spectrum disorder (ASD), highlighting the presence of several possible female-specific features of this condition. 1 Some authors also pointed out that ASD diagnostic criteria would be tailored on the typical male presentations of the disorder, leading to an under-recognition of ASD among females. Subsequently ASD females, in particular those without language or intellectual impairment, would likely receive other kinds of diagnoses, with a consequent negative impact on the course of the disease and on the treatment outcome. 1,2 One of the first line of investigations in this field focused on Anorexia nervosa (AN). Intriguingly, AN shows an opposite gender ratio when compared to ASD, featuring a strikingly higher prevalence among females but also a familiar aggregation with ASD. 3 Moreover, the strong interest in diet and weight, together with the ritualized behaviors related to food preparation and consumption typical of AN were noted to resemble an autistic-like pattern of stereotyped interests and behaviors, although focused on food. AN patients were also reported to share with ASD the presence of social difficulties, lack of socio-emotional reciprocity and an altered theory of mind. Several epidemiological studies, including longitudinal ones, highlighted significant overlaps between AN and ASD diagnoses, while more recently the presence of significant autistic traits was reported also in other Feeding and eating disorders (FED), such as Bulimia nervosa or the emerging condition of Orthorexia nervosa. 3 These findings progressively provided support to the possibility of a re-conceptualization of

Rumination and altered reactivity to sensory input as vulnerability factors for developing post-traumatic stress symptoms among adults with autistic traits

“…22,40,41,43,[45][46][47][48][49][50] In addition, subjects in the autism spectrum, even when having experienced major traumatic events, may not be able to properly report it due to their difficulties in processing and communicating life experiences. 5,7,31,48 According to our findings, autism spectrum subjects reported a strikingly higher rate of PTSD when compared with the HC group from our study (30% versus 0%). The reported prevalence was higher also when compared with ranges reported in the general population, which are around 3-4%.…”

“…As a consequence, autism spectrum among females may remain masked by other diagnosis, spanning from eating disorder to social anxiety, borderline personality disorders, and trauma and stress-related disorders. 7,14,[57][58][59] Other studies also stressed that individuals with AT after traumatic exposure may more likely develop mood disorders, enhanced by PTSD symptoms and altered circadian rhythms symptoms. This hypothesis is in line with previous researches that highlighted a role of trauma/stress-related symptoms in the relationship between autism spectrum and increased suicidal risk.…”

“…[4][5][6][7] In addition, the current scientific literature is also stressing the importance of identifying subthreshold manifestations of ASD, such as autistic traits (ATs), due to their possible impact on quality of life and their role as a vulnerability factor for the development of other psychiatric conditions. [5][6][7] This kind of subthreshold manifestations, such as impaired social and communication skills, unusual and aloof personality, and repetitive and stereotyped behaviors, was originally detected among first-degree relatives of ASD probands, where they have been labeled as "broad autism phenotype." 2,6,[8][9][10][11][12] However, further studies highlighted how AT seem to be continually distributed in the population, being particularly high in specific high-risk groups, such as university students of scientific courses [13][14][15][16][17][18] or clinical groups of psychiatric patients with other kinds of mental disorders.…”

Investigating the relationship between autistic traits and symptoms and Catatonia Spectrum

“…In the validation study [1], the AdAS Spectrum questionnaire demonstrated an excellent reliability and a strong convergent validity with other scales employed in this field, such as the Autism-Spectrum Quotient Test [22] and the e Ritvo Autism and Asperger Diagnostic Scale 14-item version [23]. The AdAS Spectrum has been used, in recent years, within numerous studies focusing on the autism spectrum both in clinical and in nonclinical settings [24][25][26][27][28][29][30][31][32][33].…”

Measuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review

“…Reaching a shared consensus on the theoretical conceptualization of social camouflaging—as a feature specific to, but possibly not exclusive of, people on the autism spectrum—should be considered as one of the next goals to aim for. Such a model should reflect the actual camouflaging experiences of people with ASD, taking into account the specific female presentations that often remain undetected due to the actual gender biased conceptualization of ASD [ 43 , 46 , 64 , 72 , 82 , 88 , 89 , 90 ].…”