It is well documented that, compared to the general population, some individuals with Asperger personalities respond differently to medication. It is commonplace to hear these individuals referred to as being ‘wired differently’.
Some of the medications prescribed to help with obsessions or perseveration, and/or with associated depression and anxiety, include SSRIs such as Paxil, Prozac or Zoloft. In individuals with stereotyped movements, agitation and idiosyncratic thinking, low dose antipsychotics such as risperidone are also frequently prescribed. But, for some individuals, these medications have been known to produce the complete opposite effects to those intended.
Bearing these uncommon responses in mind, when we consider AS personalities who have become addicted to drugs or alcohol, the question arises as to whether these personalities become chemically dependent or whether they are more locked in to the repetitive behaviour pattern. The obsessive characteristics linked with these personalities lend themselves very readily to repetitive cycles of behaviour which are also apparent in dependent behaviour.
If we assume that AS personalities are displaying cyclic behaviour rather than true chemical dependence, then it should prove relatively easy to support them into removing the dangerous substances eg alcohol or drugs from their systems, and without the same level of distress that someone dependent on the substance might experience. The remaining obsessive habit, however, then becomes a behaviour management issue. Of course, this may not be an either/or situation, as there may well be dependence combined with cyclic behaviour patterns.
Special interests are a recognised part of the AS personality, and where this interest is focused on a useful activity, this sometimes forms the basis of earning a living for that individual eg IT specialisms. When the special interest is self injurious or anti-social in some respect then the activity is viewed as requiring some sort of intervention – which may take the form of: medication; education; punishment; or rehabilitation.
When an AS personality becomes aggrieved about something, quite often, the focus of his/her complaints will be the person who is closest to her/him. This may be Mum, or the primary carer, or it may be a sibling. Whoever it is will bear the brunt of repeated tirades about the particular topic. This can become extremely distressing and also wearing, and, if there is no understanding of how the AS personality’s anxieties escalate, the situation will continue indefinitely.
Because of the tendency towards obsessive and ritualistic behaviours, when anyone engages with the AS personality to discuss their ‘problems’, the conversation inevitably becomes cyclic and as it does, with each cycle, the individual’s anxiety will get higher and higher. In this event, the cycling must be stopped, whether the problem is resolved or not, otherwise it just ends up with everyone feeling anxious and yet no further forward.
Having established all the above facts, the question then arises about support strategies that involve repeated self assessment in relation to: resentment towards others, disempowerment, physical well-being; mental well-being. The likelihood is that, at any one of these points, an AS personality may become fixated and engage in cyclic thought and conversation patterns which are difficult to shift, and which only serve to escalate the anxieties.
The introduction of set rules will suit the AS personality very well as they tend to work well within a structured environment, but these rules must be applicable in the long term as well as the short term. In addition, it is really important to ensure that the individual has heard and understands what is being asked of her/him. There is a tendency towards: literal interpretation of language; not always hearing the complete sentence (which may reverse the intended meaning); only seeing things from a personal perspective. Therefore, all these possibilities must be considered by the support services and double checked each time a directive is given.
Because AS personalities can experience behavioural difficulties that are also displayed in dependent behaviour, this can create confusion when attempting to use differential diagnosis, as one symptom may mask another. Unless the staff in rehabilitation centres have met an individual before s/he acquired their addiction, it is very unlikely that they will be able to discern what has produced the behaviours they are observing. The natural assumption would be that all the maladaptive behaviours are a result of the dependence. Only when the person is on the road to recovery ie clean for a period of time, will it become apparent that some behaviours have not reduced or vanished as might have been expected. Then it becomes necessary to look more closely. But if no-one knows what they are looking for then life can become very frustrating for everyone involved.
Personal Empowerment Therapy: Dr Dawn Heather
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