Autism Symptoms in Other Disorders

One of my clients, a young woman in her 20s, would come into session and sit for long periods in silence. She found it almost impossible to make eye contact. Later, I learned that she was mentally "singing" brief repetitive songs she herself had composed. Usually they were but a few bars repeated over and over. Or she might get a famous song "stuck in her head" and keep the loop running. The Beatles' "She's Got a Ticket to Ride" was a favorite. At those times, I felt as if she were shutting me out, almost as if I didn't exist.
At other times in our work, she would communicate with me and use words in a normal way, although she was quite troubled and in a great deal of obvious pain. She had a few stormy friendships; she mostly dated women and developed one intense, merged relationship that lasted more than a year. In terms of background, she came from a chaotic and emotionally violent family; she remembers as a small child regularly crouching behind a chair in the living room, intoning a single word over and over in a monotone way. She had other such repetitive rituals that soothed her. She also recalled an early childhood fascination with small hard objects and continually pressing them into her hands. She didn't like soft toys.
Although she thought of herself in some way as "autistic", this young woman would never have received a diagnosis of autism because she didn't come close to meeting the threshold for diagnosis, despite the fact that she displayed some autism symptoms. She most closely fit the diagnostic criteria for Borderline Personality Disorder, but over the years of our work together, an understanding of what she called her "autism" gave me the greatest insight into her difficulties.
If you look through the DSM-IV diagnostic criteria for the Pervasive Developmental Disorders, you'll see that they reflect an inability to make emotional contact with other people, whether through words, facial expressions, eye contact, etc. An apparent lack of empathy (at least toward human beings) is the most prominent of all the autism symptoms; current research holds that autistic individuals lack what is called a "theory of other mind" -- that is, they are unable to attribute independent mental states to self and others in order to predict or explain behavior.
My client was quite able to empathize, and I can't generalize from her experience to autism in general, especially as I've never worked with anyone who would have received a full diagnosis of an autism spectrum disorder. Still, I think her emotional difficulties and how she coped with them are revealing.
This young woman had extreme issues with separation and merger. She couldn't tolerate separateness, either in her relationships with other people or in our work together. While her mental songs appeared to shut me out, she was actually merged with me in fantasy. The breaks between our sessions, especially over the weekend, were felt as a traumatic kind of separation. Eventually, I realized that "She's Got a Ticket to Ride", made flat and unemotional through endless repetition, had once held meaning: the original feeling, now deadened, was that I indifferently "cut her loose" at the end of each session: "She's got a ticket to ride and she don't care."
Over those breaks, she kept me in her head, repeated words I'd said but with no meaning attached to them, much like her repetitive circular songs. She defended against awareness of a physical separation between us with what she herself described as autistic means, although no mental health professional would ever have given her a diagnosis of autism.
As always, when confronting these more extreme disorders, it may at first be difficult to relate or find a place within yourself that resonates. I'd focus on two areas: (1) deadening of emotion; and (2) issues of separation.
The wish to turn a full-bodied emotional experience (three-dimensional) into something flat (two-dimensional) and lifeless lay behind my client's autism symptoms. In contrast to using different emotional drugs to escape a feeling, this method focuses on mental repetition, through words and other sounds. Do you ever find yourself with songs stuck in your head like my client? I know that I do; with great difficulty, I can sometimes trace it back and connect it to an emotion I don't want to feel.
Do you have problems acknowledging separateness in your relationships? Control and manipulation are one means of expressing that difficulty, but taking your partner for granted might be another. Some people live in deadened relationships, marked by mindless routine and little emotional contact, not because they are indifferent but because they can't bear to feel alive to the relationship and all it entails, especially awareness of separateness and need. How alive are your relationships? If you make them flat and lifeless, you may be using a technique similar to my client's to ward off something unbearable.