"Having a dash of autism," is how author Uta Frith describes individuals with Asperger's Syndrome (AS)

Today this very morning I have had what can only be described as a eureka moment; a moment or a series of moments when suddenly all has been revealed and some of the problems, frustrations and confusions of years has been cast aside. No sadly it is not a positive event inasmuch as I have overcome any of my difficulties, however I have gained what can only be described as an enlightening moment concerning the conditions from which I suffer, most particularly my OCD and why I experience difficulties communicating with other people. I need of course to get a diagnosis or a confirmation from a doctor. I anticipate difficulties here as it appears to me that in general with this kind of condition, and this includes anxiety disorders,  that mental health professionals think the only thing that matters is addressing the symptoms and that precise diagnosis really is not  important. In fact it was not until I was as admitted to hospital that I formally received the diagnosis of OCD despite having spent the previous 10 years from the time of it’s full blown manifestation thinking that my problems, as bizarre as they are, where the result of anxiety. Consequently much time and energy was wasted reading material and so on which was totally irrelevant to my condition with the added result of feeling incredibly lonely and isolated as there appeared to be no one similar to myself. And that is the result of not having anything upon which to base my research. So yes it matters to me and one of my favourite quotations sums it all up for me: When the disease is known it is half cured, Erasmus Colloquies. The “disease” in question is Aspergers syndrome AS

In 2005 I wrote the above in my journal: I have never posted this entry on my blog because at that time there were still doubts but many of these doubts are being dispelled the more and more I look into this possibility.

I now give a great deal of consideration that I may also be on the autism spectrum as a duel diagnosis to my OCD, OCD being the primary condition, by primary condition I mean the condition that is of greatest detriment to your life . At least that is how I define the term primary condition and how I will use the term here and elsewhere in my writings on my website. I now consider that in addition to OCD I may also have Asperger Syndrome AS (a variant of autism) , or high functioning autism, often the two are used interchangeably however there are some differences concerning the symptoms presented in the first few years of life. I am at the very least effected by significant autistic traits enough to have a profound effect upon my life in general and my OCD. I believe that it is the addition of AS that has made it difficult for me to cope with my OCD or to sustain any improvements that I have made. I believe that the addition of AS has compounded my OCD and made it more difficult for me to cope with this incapacitating disorder. There are a small number of people with OCD for whom it appears no amount of therapy brings any lasting relief from the torment, and I now consider that I am one of these unfortunate few. Moreover I now believe that the possibility of AS and other significant co-existing or co-morbid disorders may have a role to play in such intractability. Even if this is not the case in an obvious proven way it cannot be denied surely that the presence of any co-existing conditions results in complications and impedes the sufferer’s ability to cope with or improve the primary condition. Furthermore I believe that there is a relationship between OCD and autism.

My doctor asked recently if it was important for me to have an assessment to ascertain if indeed I do have AS. I had consulted her about my migraine and had mentioned that I thought that I may have AS. I had previously spent the last two weeks prior to this appointment writing in detail why I think that I qualified for a diagnosis of AS. The first draft was thirty pages long the second was twelve and with some editing from my son we got it down to nine pages, still rather long to expect ones GP to read. I had wanted to ask her to read at least the first three pages and thereafter to browse the headings and I worried about this for days rehearsing over and over how I would present his request. I knew that I had to write it all down as I would never manage to explain verbally because of my social interaction difficulties which I will describe in due course. Despite such rehearsal I never got to give her these papers and instead attempted to explain the situation which is always a dismal failure as I get tongue-tied, muddled and appear socially inept. As is always the case when talking to others I experienced communication difficulties both with initiating a conversation and responding, it is as though I process information at a different speed and as a result I failed to explain why I need to know one way or another. I found it difficult to articulate as though the words would not form in my mind in order to clearly make this request in any coherent manner.  However after a somewhat garbled attempt my doctor has agreed to look into this although there may be no one locally who can undertake such an assessment, and I am too anxious to travel any distance to do so. I will include more here as the outcome of my request progresses.

So why do I need a diagnosis of Asperger syndrome ? In the next few pages I hope to answer some of these questions for you. I hope that my comments and observations may be of help to those of you who may be considering similar possibilities and to help gain more understanding concerning the complex natures of such conditions as AS, OCD and many similar conditions and their interconnectedness.

The following quotation perhaps describes the need for a diagnosis perhaps better than I am able

Knowing that I have AS, if appropriate, will help me make sense of my difficult life , why I have always felt different. Sufferers of any condition find comfort and a sense of belonging when they are diagnosed, most people need to identify with others who are experiencing similar difficulties or circumstances. Most people need to put a label on why this or that is happening to them, why they feel alienated and different from others, why life does not seem to unfold the way it does for other people. Without a formal diagnosis you are simply not confident enough to present yourself for instance at support groups or even on-line groups. I find it disappointing that still after so many years mental health professionals just do not understand this. Concerning therapy if I do have AS therapy needs to be adjusted to accommodate the presence of AS , for instance according to Temple Grandin, a high functioning autistic, medication needs to be administered in lower doses:

 "People with autism have very sensitive nervous systems. Some individuals may require much lower doses of medications than people with a normal nervous system. This will vary from individual to individual. If some individuals are given too high a dose of either an older tricyclic antidepressant or one of the newer medications, such as Prozac or Zoloft, there may be side effects."
Evaluating the Effects of Medication
Temple Grandin, Ph.D.
 

For me personally concerning AS; if appropriate this diagnosis will help me to understand why I have experienced difficulties with relationships and social interactions that have left me feeling as though I am on the periphery of society, like an outsider looking in but never participating, isolated, alone and why I have had great difficulty in coping with my OCD despite therapy. The last consideration I will explain in more detail later in this article . I like to label and categorise things - I understand this in itself is an AS trait - and this is yet another reason I need a diagnosis. I need to know if I have AS without a formal diagnosis there will always be doubt. I need a diagnosis to see my situation in a complete perspective in order to have understanding concerning the difficult life I have had and it addresses questions about my behaviours and attitudes and so on that are not answered fully by OCD. Most particularly social interaction difficulties, generally speaking people with OCD do not have this problem, it is not a part of the diagnostic criteria for OCD. If it is present, as is the case for myself, it is the result of another condtion such as AS, social phobia or avoidant personality disorder. Last but not least I plan and simply wish to know if I have an ASD in order to then use this knowledge to find out about the condition in order hopefully to improve the quality of my life.

It is important that I point out that OCD is my primary condition which exists as a separate diagnosis rather than part of AS. Obsessions and compulsions present as part of the symptomatic criteria for many people on the autism spectrum but usually not in quite such a disabling way and indeed if such obsessions and compulsions present significantly often the separate diagnosis of OCD is given.

I consider that the possibility of AS may explain not only why it has been so difficult to explain my situation to get effective treatment or to have friends or other relationships and so on but it also explains why I have sensitivity problems such as sensitivity to noise, (often hearing noise that others are unable to hear) bright lights, rough cloths and a whole range of other considerations which I will explain in due course. These difficulties are not part of OCD and indicate another disorder which I believe may be AS.

So why do I believe that the presence of Aspergers has made my OCD more difficult to treat.

It is my opinion that the existence of co morbid or coexisting conditions greatly effects the primary condition. It would seem obvious that the presence of
co-morbid or co-existing conditions will have an effect upon the primary condition or indeed upon one another, yet little has ever been done to treat some of these co morbid or co-existing problems, clearly identify them or diagnose them. Other disorders have greatly effected my OCD and have also had an added impact upon other areas of my life which in turn also indirectly effect my OCD. Such as in the case of AS my inability to interact socially and make myself understood in order to receive effective therapy. I believe that it may be because of AS, particularly my social interaction problems which cause significant anxiety in any social situation, that my OCD is intractable. I think one of the greatest difficulties that I have in getting help concerns my inability to effectively relate my problems; difficulties expressing myself have hindered my progress. Especially when talking about health or emotional problems, I am unable to think fast enough to form the words to convey my symptoms quickly or clearly. I can explain such issues more easily in writing. Moreover my social ineptitude means that I cannot do things which distract from my OCD which require social interaction such as join clubs or associations, make friends and so on. Moreover people on the autism spectrum experience a general anxiety which adds to the anxiety created by OCD. In short I have more to contend with, more conditions that create anxiety which in turn increase my OCD because OCD breeds on anxiety and stress and the more of either in your life will result in an increase in OCD. OCD is rather a cyclical condtion and while I believe that CD is neurological rather than purely psychological OCD is nevertheless made worse by the presence of anxiety, stress and depression while it itself creates these condtions.

There are additional symptoms other than social interaction which lead me to strongly believe that the problem is due to an AS rather than the other conditions such as social phobia or avoidant personality disorder. These symptoms I once put down to my OCD such as sensory problems being the result of anxiety but now in light of recent events and much research on the net I now consider otherwise. I have some doubts though as some of the diagnostic criteria doesn’t fit. However my son having recently had a diagnosis of AS, which I understand may be genetic, adds weight to the possibility that I may have AS. In many families of a person with autism there will be a family member with OCD. The possibilty of some form of ASD or significant traits thereof may be present in people with OCD.  It is something that medical professionals need to take into consideration when making an assessment a consideration which in all fairness would not have been a available when I was assessed when I went into a psychiatric hospital in the early eighties.

I will first list the symptoms which I manifest and than the symptoms which I do not.

The following symptoms lead me to consider the possibility that I may have Asperger syndrome in addition to my OCD.

To begin with here are the results of on-line tests.

These test are available on-line and may be taken by anyone.

"Psychologist Simon Baron-Cohen and his colleagues at Cambridge's Autism Research Centre have created the Autism-Spectrum Quotient, or AQ, as a measure of the extent of autistic traits in adults."

To take the AQ test go to Wired magazine's website where you can take the test and calculate your results.

Wired 9.12: Take The AQ Test

I scored 35 the last time I took this test.

The Geek Syndrome The Aspergers Syndrome Test.

To take the test go to the left hand column and click Geek test

I scoured 32

Difficulties with social interaction

The title of Robert Heinlein’s science fiction novel “A Stranger in a Strange Land” nicely describes how I feel for most of the time.

I have difficulties initiating, maintaining and ending a conversation.

For as long as I can remember I have experienced hampered conversational ability. I do not fit in socially. I am unable to think fast enough to form the words to communicate quickly or clearly, neither can I think or process information quickly enough to respond in the way people expect. I am often therefore unable to express my thoughts, or say what I wish to say or even to formulate thoughts quickly enough to respond. I cannot think of anything to say, sometimes there are no thoughts there no matter how much time I have to respond. I find speaking to anyone difficult. I find it very difficult to express myself verbally and this is especially so if I need to discuss health issues or emotional problems as already described. However any type of verbal communication does not come naturally, even the most simple of social interaction is difficult. I am hopeless at small talk. I have difficulties communicating, not knowing what to say, the words often coming out all jumbled and inarticulate. In a group of people I will remain silent feeling awkward, conspicuous, tongue-tied. I become quietly panicky, wanting to say something but not able to do so. I invariably feel awkward not just because of my inability to participate or initiate conversation but also in a way not easy to describe as though I feel physically out of place, clumsy and awkward with unnatural movements, and I feel as though this is noticeable. It is as though there is an barrier between me and others, as though there is no connection with others. As already described these communication difficulties I believe, have been a detriment in getting mental health professionals to understand my OCD problems, particularly now that they are so complicated and interwoven. Although I find it easier to write than talk there is still a problem with writing. I do write prolifically but it does take inordinate lengths of time not only because of the OCD checking and rumination problems but also because it is difficult for me to find the correct words to express myself.

I rehearse expected conversations, impromptu conversations leave me tongue-tied. I do not know how to interact with others; I am socially inept and don’t fit in.

With very few exceptions I have had few close relationships. At the present time I have no friends. Childhood was a lonely experience of social isolation, I avoided unnecessary contact with other children. 

Now in adulthood I have no idea whatsoever how to speak with a child. With my own son it was less difficult however I tended to talk with him in much the same way as I would with an adult and in some ways of course this meant that I did not talk to him enough due to my own inabilities over which I felt guilty not of course realising that I may AS or other condition. Yes social phobia explained why I was anxious in social circumstances but it did not explain the more complex issues such as my inability to know what to say in any situation. Baby talk was impossible, it was something I just could not do as I had no idea how to do this. To compensate, when he was a baby and a toddler I read to him nursery rhymes and children's stories very frequently. It is of interest to note that this was done following the advice of my health visitor and the paediatrician at the hospital because there was concern that my son who had been premature might as a result be delayed in his development. Therefore when he appeared not to be the same as other babies it was concluded that this was due to a developmental delay as a consequence of his premature birth. I had no experience with other people’s babies as indeed until I had my son I had never even picked up a baby. It was only the expertise of the health care visitor that alerted me to these differences which we hoped he would grow out of and indeed as time went on he appeared to catch up but was still nonetheless somehow not quite the same as the other kids. And it would not be for many years until we found out that he had AS. In fact my son discovered this quite by accident whilst studying for A level psychology when he recognised himself in a case study of AS. This answered a lot of questions that had been troubling him concerning his relationships with other people and other issues relating to AS.

Internet forums are not that easy either and I always have difficulties knowing when to end the conversation so to speak , when the thread is finished, when to reply to someone who has responded to me and when it is not necessary to do so. I have had to abandon two forums in recent times because somehow or other I managed to cause upsets, not of course intentionally it was a misunderstanding amongst the group concerning forum protocol . It is a long story and not that interesting. Suffice it to say I just could not articulate even in writing what I was trying to say and thought it best in everyone interest if I stopped participating. There was no unpleasantness and really I still do not understand what all the fuss was about obviously I missed something. But these things which may seem to others of no consequence can be very depressing and one can feel lonely and isolated as though I don’t fit in anywhere.

I lost a job many years ago; I was told that because I did not join in conversations that I made the atmosphere uncomfortable for my
co workers. There are so many similar examples which have occurred throughout my life.

During conversations I cannot process information fast enough to respond. To use computer analogy: It is as though I am working with Pentium 1 while everyone else is on Pentium 4 sometimes I just freeze and cant think of any response.

I used to desire social interaction with others but have trouble knowing how to make it work. At the present time I now seem less keen to do this as it is exhausting and anxiety provoking to such a degree that my ability to converse with others has deteriorated, the ordeal of social interaction is stressful to the extreme.

I once belonged to a computer club, my husband had to go with me even though he has no interest in computers. The other members where of similar age most older than I. But I could simply not fit in. I felt conspicuous awkward and for most part both of us where excluded, left out. I know enough about computers to join in intelligently, even enough to perhaps help others with their problems but no I simply do not know how to integrate, social interaction does not come naturally at all not like it appears to do for many others who mix and converse without a thought as naturally as the way that we breathe, without any forethought or anxiety. Part of the problem lies in the fact that I do not share with others my interests. For instance I could have mentioned my son’s website which I created for him in the beginning. I could not of course mention this one they simply would not understand. But no there is something that prevents me from doing so, something I cannot quite put my finger on. I find it difficult to tell people much of anything perhaps I simply do not know how. I see a situation that allows for an opening but often I let such situations pass overcome by a hesitancy, the reason for which is often very difficult to define. Mostly I am lost for words. For instance one day another member was sitting there looking at a front-page manual, the same software I have used to create both websites. Now I could have said to him something like: Have you created a website? Are you in the process of creating a website. I have used front page to create my website... There are any number of things I could have said to initiate conversation yet I did not as at the time I could not think how to say these things and the moment passed as so often it does. Maybe it is that I have to organise what I say and even after doing so when I open my mouth to speak it is unnatural and comes out muddled and I often stammer and than the eye contact problems adds even more difficulties. Yes there is no doubt that others can tell that I have a problem with eye contact.

In recent years my inability to interact with others has increased quite dramatically. I no longer answer the telephone leaving this task to my husband. I will use the telephone to make a call if absolutely necessary as I know the person whom I am telephoning and have some idea what to say having rehearsed this and I sometimes I write it all down first. Nonetheless I am anxious when making a phone call and often procrastinate until I really am compelled to do so, often until it is too late. For instance the insurance ran out on my computer before I made the phone call concerning a fault with my monitor now I will have to buy a new one.

Other social interaction difficulties include difficulties in accepting criticism feeling this is a personal attack.

I am naïve and tend to trust others and often miss their devious intentions. This has resulted in a certain level of paranoia inasmuch as I trust no one.

I have difficulty with reciprocal displays of pleasantries and greetings and congratulatory responses, feeling awkward not knowing quite how to go about this in particular expressing congratulations or enthusiasm that people expect, for instance when they announce the birth of a baby. This frankly leaves me cold and I am thinking so what I am not really interested or have any emotion one way or another but will for the sake of the another perosn try to feign such interest and the expected enthusiasm and sometimes my clumsy attempts are often ignored. The only exception to this concerns the announcement of a new baby and took place when a neighbour told me that their new baby had been born by a surrogate mother not for money but simply done so as an act of friendship. I was bowled over that someone should have such a close friendship with another to be prepared to the child of another couple. I was amazed to have or be such a friend to someone, such intense feelings towards a friend are beyond my comprehension.

Failure to develop peer relationships appropriate to developmental level

I have throughout my life virtually found it impossible to form relationships with people of my own peer group. With very a small number of exceptions I have had few close relationships; I could count the number of friends upon one hand and still have fingers remaining. Childhood was a lonely experience of alienation. I always preferred the company of much older people, both my sister and I avoided unnecessary contact with other children. Neither she nor I could fit in. This was particularly the case at puberty, the interest in boys ,pop music and the usual teenage preoccupations were absent particularly interest in boys. I tried to have interest in other things and for a time vaguely likely the current pop music but it was never with the same fervour as my contemporaries and was perhaps mostly to appear similar to others. If I consider my behaviour in those days I really had no interests appropriate for the typical teenager and had no real friends for any length of time after leaving infant school. I could not interact with other children at all to play imaginary games or to become part of any group. I could just about manage ball games and that was about it and that was only casual games in the playground. I could not participate in team sports or any other kind of sport for that matter. Doing things in groups was impossible for me. I recall with some horror having to play housewife for a week with another girl in the forth year at secondary school. This was a requirement for pupils in the final year of school. Two girls would get together and be housewives for a week sharing the duties of such in an apartment set aside for this purpose. This would also include having two teachers of ones choice for dinner. What a nightmare! I recall this so vividly, the fear, anxiety and awkwardness experienced by my social ineptitude. I simply could not participate and interact with this girl whom I barely knew and who had only selected me because there was simply no one else. No one ever selected me as a partner for anything and I had no friends at this time in my life. It is a long time ago now but I recall this particular incident which was one of many, I was and still am simply incapable of any kind of co-operative teamwork. I should point out with family members my husband and son such coordinated endeavours are not such a problem.

Anything that required team work found me left out as I simply could not interact with others and this of course continues today in adulthood, Groups of people are more difficult to interact with than individuals and I am always the quiet one who invariably feels left out and conspicuous by my silence. In heated discussions I get really confused, such rapid conversations and the need to think quickly cause more difficulties and my conversation becomes mixed up and muddled and it is difficult for me to get the other person to understand. I get angry and frustrated my voice raising and it often appears that I am becoming verbally aggressive and the other person senses this and feels they ‘re being attacked and it than becomes personal. Moreover it is frustrating and anxiety provoking. Also during conversations my mind seems to go blank even with rehearsed conversations. I tend to talk about such things as politics and religion, the type of conversations upon matters of which I am interested but which often cause discord with others. Even when talking about such matters it can be difficult. I often repeat myself in conversions covering the same ground two or three times but I have noticed others tend to do this also

Difficulty with eye contact

The DMS criterion A (1) states : 'Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.'

The word marked might be the key here in deciding if I have the degree of eye contact difficulties that constitutes AS.

Eye contact is for me a significant problem I find eye contact difficult even with my husband and son. Eye contact or lack thereof is one the most prominent features of my inability to interact socially as such is sometimes very significant and people I know feel considerable discomfort when speaking with me. I simply have no idea when to look someone in the eye; for how long and when it is appropriate to look away. Most of the time I either look away repeatedly or whilst trying to be normal stare into someone’s eyes for too long resulting in an obvious discomfort as the person with whom I am conversing turns their gaze a way with marked uneasiness.

Difficulty with physical contact

I tend to shy away from physical contact and if it does happen I do not know how to reciprocate. For example my mother in law would embrace and kiss me and I could never return the affection particularly when we first met. I never know how to react in such situations particularly when this happens with people I am not comfortable with, which is just about everyone except my husband and son and than at times that also feels unnatural as if it is a learned response. I would always stiffen if my sister embraced me and my mother claims that whenever she picked me up for cuddle as a baby and later as a child I would push her away and become stiff and rigid. I recall no physical contact ever with my mother until I left home at twenty one. I can only assume that she grew cold towards a child who could not reciprocate affection. This is not to say I do not love or care for anyone it is simply I cannot display such physical emotions. I am able to cuddle my husband and indeed clung to him during times of intense fear due to OCD but otherwise just lately I am finding it difficult to be touched by anyone and this makes me depressed. The problem with physical contact is caused by the effect of overwhelming sensory feelings whenever I am touched and more so of course If I am hugged or cuddled. Most bizarre of all is now as I'm thinking about it the sensations are there now, right now precipitated by merely the thought of being hugged. These overwhelming sensations when anyone touches me are difficult to describe . Today I still stiffen and become rigid whenever I am hugged.

Inability to share achievements

This has always been a problem and my hesitancy to share achievements, as described in the previous example concerning the computer club, I have previously put down to modesty and lack of self esteem thinking that no one will be interested. I do however try to at least pretend to be interested in other peoples interests but at times I overdo this and it then can seem obviously insincere.

Sharing interests and pointing out things of interest to other people is difficult and in fact after so long of never doing this it has become a habit not to do so and I tend not to think about it. I will sometimes point out things of interest to my husband and son but with others, acquaintances and strangers, I would never point out anything of interest even if I knew that the person concerned was interested. Why I do not know, I simply feel uncomfortable or I simply cannot express myself articulately to do so and often in many conversations I can’t get a word in sometimes, and I do not know how to interrupt other than abruptly. It appears to me that with very few exceptions most people talk and talk. My brain gets overloaded I can’t focus on what they‘re saying, particularly if the conversation is mundane or trivial. This is one of the most difficult problems I have conversing with others other than actually not knowing what to say, most times in situations were the other person is talking incessantly I either never say a word or I have to blurt out what I am going to say and the person than seems surprised.

I understand that many people with AS will talk incessantly about their interests but more like a monologue rather than a proper conversation. For me with anyone other than my husband or son this is something I never do as I cannot communicate sufficiently well enough to do so. Even with my husband and son I really do not talk much about my interests.

Moreover I most likely fail to notice things in my environment that are of interest to others as I am usually absorbed in my own interests and preoccupations. Also OCD plays a role here and often the task of trying to cope with it's pervasive intrusion absorbs my focus to a huge extent along with my preservative thinking where I am mentally still concentrating on my interests even though for all intents and purposes I am otherwise occupied. To say I do not give anyone my undivided attention would be very very accurate indeed.

This is a diagnostic criterion from the DSM the meaning of which is unclear the following is my interpretation which I feel is perhaps incorrect but which nonetheless expounds my difficulties further. And part of this criterion has been covered earlier concerning social etiquette.

I realise when someone is attempting to socialise however I am unable to respond particularly if the situation arises spontaneously and I have not had time to rehearse and consider what I will say and how I will react. For example if a stranger or even an acquaintance or relative initiates a conversation for which I am not prepared I become tongue-tied. Mostly this is of course much worse if the person is a stranger and it is a conversation which has been forced upon me unexpectedly. Mostly I barely respond and if I do my comments are brief and uncoordinated and inarticulate. For example recently a little girl whom I actually suspect as having some problem or other herself suddenly appeared and said to me: “ It is uncomfortable walking upon the stones?” We were in the ruins of an old abbey and the floor was paved with cobbles. I could think of nothing to say and responded with “yes yes” and walked on. I felt just awful but I simply was unable to respond quickly without preparation. This has been the way all my life and has caused much loneliness and pain. Incidentally I have always had difficulty speaking to children. I managed with my son’s few friends but it was always when and only as necessary. I had no idea about baby talk and do not in any case approve of talking down to children . I spoke to his friends the same way as speaking to an adult

Concerning Emotional responses, these are often out of proportion to the situation, they are basically more intense and mostly negative.

Concerning other people’s feelings and my attempts at responding to such: I believe I have some empathy - at least what I assume is empathy and not some kind of emotional transference. My emotions and empathy it seems are all or nothing. It appears that I have only empathy for people whom I consider are experiencing the same emotions as myself :unhappiness, pain, stress and other negative emotions . Indeed I am very sensitive to negative emotions and feel profoundly the sorrow and misery of others even those I do not know, in fact more often than not when the person is known to me such emotions tend to diminish with the exception of my son and husband, Also the pain and misery of animals whose suffering causes me immense sadness.

I do have empathy and this was one of the reasons that I doubted I had AS. However I think that with AS one has emotions but perhaps they are not the same as for NTs ( neurotypicals people not on the autism spectrum) or are more exaggerated or intense, but only in certain situations whilst remaining cold and aloof in other circumstances where everyone else's emotions are intense . For instance the the day whilst visiting a website someone had the most endearing Avatar of the cutest sweetest creature you can imagine. I am not even sure what kind of animal it was but it had just the loveliest innocent face and I was overwhelmed with such emotions for this creature which I would describe as love.

I once saw a homeless person in the street crying. I offered help but my inarticulate manner made matters worse, I then cried myself. Often I am overwhelmed completely by the sorrow of the entire world - at least my perceived sorrow of the entire world. However, and this is the crux of the matter, I have no empathy for the more joyful emotions of others. For instance as I have already explained I cannot get all excited if someone announces a wedding or pregnancy the way other people do, such events leave me cold. I just don’t have the emotions and find it hard to fake them for the benefit of others. Furthermore I cannot express what empathy I do have (or perhaps it’s my transferred misery which I think is empathy) to another. Someone I once knew, a former friend (I use the term here loosely as in reality I had no real emotions towards this person she was someone I tried to relate to but as usual failed miserable to do so) whom I no longer see now because friendships do not last, was very distressed. I could see her tears but could not feel her pain and I did not know how to respond. She asked me:” can you not see how upset I am?” Yes I could and indeed I wanted to reach out to her but I did not know how. I think she thought that I did not care perhaps in this instance this was true I cannot recal, but yet in other instances I care deeply and the pain of others effects me profoundly, yet I cannot express this and reach out to another to share my empathy or comfort them as I do not know what to say or how to react.

Touching people except my husband and son seems totally alien and I rarely know when it is appropriate to do so and I experience such awkwardness if I attempt to do this. Even if I care to admit it the same feelings occasionally occur with both my son and husband and contact feels strange and unnatural even though I love both deeply. It is important to note that I would like to be able to socialise in a normal way, I am not reclusive, the problem simply lies in the fact that I cannot interact with others in the usual way.

To reiterate: It is important to note that I do have emotions, rather an abundance in fact I am an extremely hypersensitive person and feel the pain of others, but not universally in any situation and at times I can be very cold and emotionless for reasons not easy to understand. I also feel the pain of other animals more keenly right down to the lowliest of creatures. Yes I even feel sorrow if a plant dies or a tree is cut down . However I have difficulties expressing and showing such emotion and empathy to most people as in the aforementioned example. My empathy or emotions are simply not the same as other people’s appear to be, mine are perhaps inappropriate, for instance I recall many years ago during a bad time with my OCD how I genuinely cried when hearing a commentary on the radio about Robbie Burns, who died in his thirties and how on the day of his funeral his wife gave birth. I recall actually crying, I mean seriously crying, as it felt so sad.

It has to be said if I am to be entirely honest, there are times when my emotions towards others seem dead as though they have been turned off and I feel cold and indifferent. I feel ashamed for on a different level, a non emotional level, I do care about this person and what happens to them and should they be in dire straits I often go out of my way often at detriment to myself to offer help, yet the actual emotions are non existent.

I prefer animals to most people, at least I have stronger feelings towards animals. In the same way as I have more feelings towards disadvantage people.

Concerning sensitivity: I feel more empathy for people or other creatures who are suffering. I have no empathy whatsoever for happiness or positive emotions of any kind. I feel a more keen empathy for the suffering of people I do not know, as for instance the starving in Africa. Individual people well ... when I see an individual who is clearly suffering such as a disabled person I feel profound sorrow and I really feel very depressed and hopeless that my son is depressed and his life is a misery and I always sense straight the way any change in his mood. The same applies also to my husband and recently I can sense a very significant change in his mood as he becomes more withdrawn. However displaying emotions borne of empathy is difficult for me and I come over as uncaring and rather cold.

The only emotion I can display is anger and than it can take a while to erupt but when it does I most certainly let go. In adulthood apart from throwing things usually at the door , walls and so on I have not physically attacked another. Although at school I did so if sufficiently provoked. Having said all that I do admit that it does take a lot to cause real anger or should I say in all honesty I do well in suppressing this emotion for in truth my anger is easily provoked. I should not confuse this with a tempter tantrum borne of OCD frustrations, irritability or heightened stress levels. In recent years this anger is there like a kettle ready to boil, often I seethe with overwhelming anger difficult to control. I feel as though I am becoming like my mother who always exhibited an underlying aggression which with increasing age become more palpable.

Perserverations and repetitive behaviours

The DSM Criterion B states Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

Well as a sufferer of OCD there is of course some overlap however the preoccupations, in other words obsessions that I refer to here are intense and addictive like interests and they are not the same as the OCD obsessions, and I do know the difference. Although OCD rituals and obsessive behaviours interfere with my interests as they do with every other aspect my life. For me there has always been some intense and obsessive preoccupation with some interest, idea or activity. Right now in the last few yeas it has been the computer including this website site, graphics programs, the internet and so on. I have other interests such as art but this is not such an obsession and quite often a good deal of my art work has something to do with the computer anyway, such as my attempts to make hand drawn clip art. I often resent having to do other things to the extent that my depression becomes more profound and I become irritated. I am up and on my computer as soon as I wake between 4 and 5am. Yes I have insomnia and this is how this routine came about but there are times when perhaps I do get up early just to work on my computer. It has taken on the quality of an addition and I have to really force myself to do other things and sometimes it is only the OCD rituals, the needs of others and pressures of society that one should not indulge ones time in such things so intensively that I turn often reluctantly to other pursuits. I have a long deep and abiding religious preoccupation however this may have more to do with the OCD part of my personality. Nonetheless religion as a comprehensive interest in all religious belief is indeed one of my interests and you would be hard pressed to find a book in my home which belonged to me that was not about religion, philosophy, metaphysics or esoterica.

I can’t recall the unusual collections of odd items associated with sufferers of AS in childhood but in recent years I have collected huge numbers of stuffed sheep, ornamental sheep, pictures of sheep and after buying a digital camera well I of course take endless photographs of sheep. I do seem to be rather be obsessed with sheep not in an OCD way as I have said before I do most certainly know the difference. However my husband does likewise hence all the sheep photographs in the gallery section on his page. However since giving all this thought to whether of not I have Asperger syndrome I now consider that my husband indeed has some form of autism himself! Well of as unlikely as that may seem it is of course not impossible and as the saying goes like attracts like and this may be the reason that unlike many who have been married for over thirty years we are still together.

The DSM Critrion b (2) : apparently inflexible adherence to specific, nonfunctional routines or rituals

Well I had plenty of these as a child however this is really where there is rather a grey dividing line between routines and rituals connected with OCD. I recall having such routines as a child and will mention those which have no fear as such attached to them and where not motivated by intrusive thoughts of an OCD nature. For instance in the bath if I washed one leg I immediately had to wash the other in exactly the same way immediately afterwards in a routine way. If I scratched one part of my body I had to immediately scratch the opposite site in the same place. I had set routines in my everyday life such as going to go to bed at exactly the same time. I had hand washing rituals before going to bed and these had to be done . No in retrospect these were not OCD rituals and had no connection with either germs or something bad happening however there was some anxiety if this ritual was not performed so there may be some cross over there with my OCD. Most daily activities were undertaken in a routine manner and although there was no fear attached if such was not possible, nonetheless I did not like changes to my habits and would become stressed or agitated if I was unable to abide by these routines. If major and irreversible changes did occur I would adapt other routines to take their place. This area is very confusing to separate from my OCD and I had numerous religious rituals which were more of an OCD nature. And now after all this time it is of course not easy to recall which were which as of course at the time no distinctions were made although there was obviously problems , problems which were noticed at school and for which I was referred to a psychiatrist from the age of three and again at eight. I have no personal recollections. I recall the sedative which I later learned tasted like gin and looked like gin, ummmm I wonder..... Interestingly gin was used in the eighteenth century as a sedative. My mother told me the sedative was advised because I would scream in the street and was generally disposed to crying and moaning all day and generally being a misery. I do recall screaming whenever confronted with a turnstile and this may have been one of the reasons my parents stopped going to football matches. Crowds also caused problems although for the most part I have no other clear recollections of screaming in the street. I do have the vague feeling that I was terrified of passing building sites the noise and the equipment producing feelings of being overwhelmed as did steam trains, also escalators caused problems and I do recall anxieties about using them. I recall screaming whenever I had to have my hair washed. I can recall my mother trying to wash my hair, my reluctance to lean my head back, the ceramic sink seeming hugely scary . I recall screaming when confronted with a turnstile at football matches and this may have been the reason my parents stopped attending. Moreover my mother said that the school were concerned as I did not play with my toys in the normal way. I have no idea what this period in my life was really all about my mother claimed to have few memories. However as social services were involved I find it very difficult to believe that she could not recall much other than what I have told you above.

I do not like changes in routine and changes in plans really upset and confuse me. After five years I am still not settled in my new home and I have not completely recovered from the shock of this huge change in routine. I do not like changing immediate plans. This however is two fold first because it simply makes me uneasy and anxious for reasons not easy to define. However plans which involve travelling have an extra OCD component concerning my fears that changing plans may change circumstances with dire consequences. I like to know each day what I am doing and when. I am not at all spontaneous and cannot cope with ambiguity.

I have the involuntary compulsion to rock backwards and forwards without realising this and was teased for this at work in my late teens where it was first bought to my attention. I continue to do this today. Other less noticed mannerisms include swinging my leg or foot when sitting cross legged and also swaying from side to side.

This criterion below is described in detail in the explanations above and therefore need no further elaboration.

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

DSM Criterion D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

At my age now it is impossible to recall if I had cognitive abilities suitable for my age I have no recollection as to whether or not there were any delays in self help abilities, such as dressing myself, feeding myself, and so on or my curiosity about my environment. There where delays in reading and I have never been able to spell. The only problem I recall clearly relating to the possibility of AS for as long as I can remember is my social integration difficulties. There were some problems at school with play and other matters indicating a rebellion against authority at the age of eight, at least according to a couple of letters in my medical files. And also the problem with screaming in the street referred to earlier .

Following is list of other diagnostic criteria associated with Asperger syndrome or other ASD which seem not to be included in the DSM but which many people with AS seem to have.

The following are characteristics of AS or other ASDs which do not appear in the DSM but are nevertheless experienced by many on the autism spectrum

Sound for me is greatly amplified at least by comparison to the reactions of others. I am overwhelmed by noise and often hear noises or am disturbed by noise that is either not heard by others or does not effect others. With the occurrence of music just about anywhere and everywhere in virtually every public building, I can barely cope I sometimes feel like a child once again and there are times when I reach up to cover my ears and feel like screaming. My sensitivity to noise seems to becoming more enhanced. Sudden noise is anathema and brings about an almost phobic reaction if I suspect such is likely to occur. For instance if I see a child with a balloon I immediately become tense should the balloon burst suddenly. I react by covering my ears even now in adulthood when really loud noises occur suddenly, such as fire alarms, fireworks, low flying air craft and the like. Noises such as people eating, swallowing and sniffing drive me crazy and even the noise of people moving about, fidgeting is extremely irritating jarring my nerves, for instance my husband fidgeting with his glasses or licking his fingers to turn a page which I don’t like anyway because of my OCD anxiety about salvia and contamination. I don’t like the sound of appliances such as vacuum cleaners and the washing machine. I am significantly disturbed by a constant low frequency hum from the local factory.

Clothing irritates me particularly underwear, bras and pants. Anything tight or made of rough material is impossible for me to wear. I can’t wear wool next to my skin or even synthetic knitted garments. I am sensitive to cloths labels and seams which are bulky and crinkly materials. I change very early in the evening into loose flowing night clothes, I can’t stand my day clothes and can’t wait to discard them. Sometimes I can’t sleep even with these lose fitting clothes as such irritate when I become entangled in them such as a nightdress wrapping round my legs.

This problem could also be related to my chronic daily headaches and migraine. Brilliant sunshine during the summer months seems now far too bright. I am more comfortable with sunglasses. I can’t cope with fluorescent lights.

A mixture of all the above such as in a cafe where there is music, bright lights, background noise - such as from coffee machines, the rattle of cutlery, the babble of background conversations, children yelling or crying and the pressure to make conversation is overwhelming. In such conditions I can barely think, my nerves are heightened, my stress levels rise and difficulties with conversation are more accentuated and I can barely hear or concentrate on what the other person is saying. I can become completely overwhelmed.

I don’t like crowds. Particularly when mixed with noise, bright lights. For instance a shopping trip is nightmare of misery screaming children, thumping music florescent lights and the hustle and bustle of crowds is overwhelming

Outburst of anger

I am prone to tantrums for want of a better word such as, screaming, throwing things, yelling, ranting and raving, sometimes over a small issue others would not be so angst about. Shouting at the TV mostly about social injustice, politics, animal rights and so on is a regular occurrence I am constantly angry for reasons both personal and non personal.

I rarely if ever understand another’s point of view although I attempt to tolerate such opposing opinions no one will ever change my mind and I appear as bigoted, self opinionated and intolerant. I tend to think others are stupid and shallow and cannot image how on earth they can possibly think or behave the way that they do. I find it difficult to accept that other people do not think the way I do.

This is of course is impossible. I can only concentrate upon one thing at a time and often times even that is difficult. For instance I can’t do something when someone is talking to me, I either ignore them or stop what I am doing. Using the typewriter key board is difficult because I cannot do this quickly while trying to think what to type which includes such difficulties as trying to think how to express what I intend to say, which of course is a problem in itself ,than to construct it according to grammar and than trying to spell correctly , so what I write is full of mistakes and needs to be corrected considerably therefore it takes a long time to write anything. Even preparing the dinner if it is complicated is impossible now, just lately I cannot co ordinate all the different stages both of these examples are further complicated by my OCD.

My ability to concentrate and focus is greatly impaired. I cannot take in verbal instruction easily and on some occasions not at all. I have always learnt better from books than from a teacher for this reason. I tend to hurry things and can’t cope with reading instructions and cannot comprehended them particularly if they are boring and I have no interest. For instance I learnt to use a computer but don't know which switch on the TV control to use to turn it on! I am intensely interested in the former and have little interest in the latter.

My short term memory is poor. I cannot even recall a series of numbers such as if I were trying to copy a phone number from the computer onto a piece of paper it would take several tempts to do so accurately. The same goes for copying words. I am a poor speller and often need to copy a word letter by letter and like copying numbers this is difficult and I make numerous mistakes and most of my writing is inaccurate, Bizarrely sometimes I do not even notice maybe for weeks than all of sudden I see a mistake which would surely have been hard to miss. I check written work over and over due to my OCD checking compulsions and also because of this tendency as it makes me anxious that I have made mistakes which in fact I do and which may have gone unnoticed for ages despite all the checking.

However my concentration is keen on what would be described as my preservations, my intense interests or occupations as for instance I have sat here for hours involved in the final editing of this account to the degree that I am irritated by any interruption even the necessity of going to the toilet

Information overload
 
After a while my brain fogs over and I cannot think straight. I am overwhelmed and often incapacitated by too much information at one time in rapid succession or if under pressure to react to such information. Too much talking also has this effect, by which I mean whenever I am being subjected to too much talking by another person who does not allow you to get a word in. Conversations exhaust me and intensive occupation requiring complex thinking such as studying and writing something like this does likewise and my thinking becomes muddled and I feel confused despite my ability to concentrate upon matters of interest.

I find it difficult to recognise people unless I have known them for years or see them everyday. This problem is more accentuated whenever the person concerned is seen out of context as it where; if they are somewhere I do not expect to meet them and this occurs even if I have known them for years.

This has occurred for all my life. I go into what was once referred to as a day dream and yes I do day dream. However sometimes I just tune out so to speak or go blank as though I am in a trance. I suddenly stop what I am doing, my eyes glaze over and I stare into space - at least this the way that people who have observed me describe what happens. Some times I can be watching TV, reading, or even listening to someone talking and I have no idea what I have seen, read or heard. it is as though I were not there yet I do not black out as such. It is difficult to explain quite what happens.

I cannot tolerate mistakes. This brings about much torment in my life and often impedes progress to such an extent that I procrastinate the commencement of a task because of the fears of making mistakes. Such as with painting or my writing for my website I will delay starting either of these endeavours because of the torment I know that I will endure because of my perfectionist tendencies which in themselves are impeded by my attention deficits and and tendency to make errors. And concerning my art plain and simply lacking the talent to paint in the detailed manner that I seem not to be able to edit out so to speak the way many artist do. I struggle to include in a painting or drawing all the detail, every blade of grass every leaf, which I do not have the talent to do successfully.

I have difficulty generalising for example this explanation which is in fact only a third of the original length. I am told what I write is over detailed and rambling but to me it appears inefficient, as to my way of thinking all the details matter or at least I have difficulty knowing which do not. This very account of my writing is over detailed and repetitive I have tried several time to describe the situation in a more concise manner but have failed to do so and this must therefore remain as it is otherwise I will never be able to publish it to my website. I cannot be concise. As already mentioned this occurs with my artwork and along with perfectionist anxieties my inability to generalise interferes with painting concerning the inclusion of too much detail, if I try to point from a photo I try to add every detail I do not have the knack of painting the general aspects thus art is frustrating.

An example recently of my inability to generalise arose when for an assessment for CBT I was required to fill in automatic response forms . This is done in order for me to begin to look at my thoughts, take the situations and, with the help of my psychologist, try and find a more rational approach. Now on some level I knew that this would only work with the situations we would discuss during the session. When the time arrived for me to carry this method over to my daily life I knew that I would not be able to apply the thinking I had been taught in the examples to any situation. Every situation would appear to be different and the same methodology would not apply. Lets look at a simple example from my OCD. When I was receiving exposure prevention therapy I would expose myself to a situation which involved contact with a dog, this means I would touch the dog and not wash my hands and than go on to touch my cloths and my possessions and everything in my day to day environment. The idea was to sensitise my fear of dogs and catching rabies. However when nothing happened and no one died because the dog did not have rabies this did nothing to alleviate my OCD concerning contamination by dogs because I could not generalise. The dog I came into contact with may not have had rabies but that would not mean that in general dogs did not have rabies: because one particular dog did have this disease did not mean that other dogs did not. No matter how many dogs I came into contact with this fear could not be generalised therefore the therapy failed.

I have no patience to read manuals unless it is to do with my interests such as a computer manual than I will sit and read this much in the same way as some people would read a novel . But for boring  things such as how to work the video or how to assemble flat packed furniture the instructions are ignored and I tend to try to manage without and get irritated and impatient if this is not possible and I have resort to the tediousness of reading the instructions which are read with some considerable irritation and impatience. I can only learn new tasks which interest me.

These characteristics have been mentioned by others who are on the autism spectrum but are not specifically mentioned in any diagnostic criteria.

I am generally very critical of others, negative and unforgiving, fixating on bad experiences with people or events for an inordinate lengths of time.

I adhere to rules perhaps too rigidly.

I am mainly a serious minded person everything has to have some meaning or purpose. I can do few things for sheer enjoyment. My artwork for instance is sheer torture for the reasons described above and the only reason it is undertaken is so that I can feel I have done something useful, the same applies to my website. Although in the beginning this was not the case and there was some satisfaction if not enjoyment, but enjoyment is relative is it not and depends on your perspective, but since OCD has intruded with its anxieties about everything I write and also checking compulsions it is now not as satisfying as it once was.

I become upset when things do not work out the way I expect them to do, sometimes excessively so even in minor disappointments that others would more easily take in their stride. My temper will erupt over trivial issues. Any inconvenience I become extremely annoyed, with shouting, swearing, hitting something such as thumping on the door or throwing things . My volatile temper would exploded sometimes for the least little thing during disagreements with family members.

I have an extreme dislike of being interrupted particularly if intensely occupied in my preservations. My whole body tenses I become irritated snapping or I ignore the person who has interrupted. if indeed it is a person. Sometimes I find myself extremely irrationally irritated if I have to interrupt what I am doing to for instance use the toilet or get on with tasks such as preparing a meal. Such can induce anger and indeed depression.

I experience an Inability to deal with people assertively - unless I get angry.

I also tend towards being paranoid. I trust no one and this is due to having been taken advantage of, because of my sensitive nature and not willing to hurt another, always wanting to keep the peace and also because of my trusting naivety because I cannot read the intentions of others. However once I have been taken advantage of I never forgive even after decades have passed.

Difficulty it transitions for instance from one task to another.

Not knowing how to finish conversations or written accounts such as this account which, after the section concerning aspects of AS that I do not have, is now provisionally concluded but may be added to or altered as the situation warrants.

Not a problem this is one manifestation I do not have unless of course I am missing the point, often diagnostic criteria such as the DSM can seem somewhat vague, ambiguous and open to misinterpretation by anyone others than professional.

Many people on the autism spectrum have gastrointestinal problems. I for instance have IBS.

It is a known that the intestines have the highest concentration of nerve cells second only too the brain, resulting in a stream of constant communication with the brain and the gut and it is likely therefore  if you have a neurological disorder, a  malfunction of the brain you are more likely to suffer with IBS and other gastrointestinal diseases such neurological dysfunctions include depression, anxiety, panic attacks, OCD and of course autism including AS it is important to note that this communication between the brain and the intestines involves the neurotransmitter serotonin which is also important in mood regulation, dysfunction of serotonin result in all the conditions above. My problems with IBS which although are only relatively recently diagnosed in the last tens years have been a steadily increasing problem right from childhood. However this disorder could also be the result of my depression or OCD rather than AS nonetheless it does add to the possibilty of the presence of AS.