Monthly Archives: December 2017

Attachment Disorder vs. Autism: An Overview and My Personal Experience

I am currently reading the book A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum by Judy Eaton. I’m only halfway through the second chapter and it’s so incredibly validating. The book talks about misdiagnosis and co-occurring diagnosis of many psychiatric conditions in autistic girls and young women. I can relate to so much of it.

One concept that I found resonated particularly with me was “secondary misdiagnosis”. This refers to a situation where, while a woman was diagnosed as autistic initially, somewhere along the way, her diagnostic records “disappear” and she is rediagnosed as something else. Yes, that’s me! The book has a UK-based focus and I have been told quite often that, in the NHS, your records automatically move where you go. This is not the case here in the Netherlands: you have to transfer them yourself. Apparently though, in the UK, records can disappear too.

In the second chapter, the author discusses misdiagnosis of autistic girls as having an attachment disorder, disruptive behavior disorder or (emerging) personality disorder. Today, I will talk about attachment disorders.

In August of 2016, I demanded an independent second opinion on my autism diagnosis, which my psychologst had removed, for the first time. My psychologist told me she’d set things in motion, but would have to consult with the brain injury unit’s psychiatrist first. After all, my having sustained a brain injury shortly after birth was her primary reason for removing my autism diagnosis. As she returned, the weirdest diagnostic process I’ve ever seen, emerged: she started negotiating diagnoses with me. She said she was willing to diagnose brain injury-related personality change instead of the personality disorder she’d initially diagnosed me with, generalized anxiety disorder and an attachment disorder. I took time to think and eventualy ignored the attahment disorder thing, while reluctantly agreeing to the rest. We still used DSM-IV, after all, where you have to have endured “pathogenic care” to be diagnosed with attachment disorder.

In DSM-5 and the newest edition of the ICD, which was published in 2016, your early childhood still has to have been less than ideal, but the criteria leave room for milder forms of less than optimal care, such as your parents not having been very nurturing. I guess in my case, even with perfect parents (which I don’t have), my premature birth and three months in the hospital would suffice for the current “inadequate or inconsistent care” criterion for reactive attachment disorder.

However, the criteria for RAD say that the child cannot be diagnosed with it if they have an autism spectrum disorder. I understand this doesn’t mean autistic children and adults do not have attachment issues, since I for one do. However, when someone is diagnosable with autism, they cannot be diagnosed with RAD too. In other words, my psychologist ought to have ruled out autism – which she did a pretty poor job of doing – before trying to label me with RAD.

There are several features of attachment disorder that overlap with autism and particularly with pathological demand avoidance. For example, children with attacchment disorder as well as those with PDA can be superficially charming (in order to get what they want), indiscriminately affectionate with unfamiliar adults and inaffectionate with primary caregivers. Both are often defiant or manipulative. They also both can be controlling or bossy. Children with RAD are however more likely to be cruel to animals or other people or destructive towards property. They often show a preoccupation with such things as fire, blood, death or gore. Autistic children as well as those with RAD may avoid eye contact, but RAD children do make eye contact particularly when lying.

Judy Eaton outlines several distinguishing features between autism and attachment disorder. In the ICD-10, the following are mentioned:


  • Children who have a reactive attachment disorder will have the underlying ability to react and respond socially.

  • When abnormal social reciprocity is noted in children with reactive attachment disorder, it will tend to improve significantly when the child is placed in a more nurturing environment.

  • Children with reactive attachment disorder do not display the types of unusual communication seen in children with autism.

  • Children with reactive attachment disorder do not have the unusual cognitive profile often observed in children with autism.

  • Children with reactive attachment disorder do not display the types of restricted interests or repetitive behaviours seen in children with autism.

I definitely see how I have attachment issues. I am usually more open to strangers than to my own parents. Particularly as a teen, I’d also direct most of my aggression towards my mother. I could also be quite defiant. I however also definitely have communication oddities, repetitive behaviors and restricted interests and an unusual cognitive profile. I never “recovered”, though that could be blamed on the fact that I lived with my apparently inadequate parents till I was nineteen. Or it could be that I’m autistic.

Food Plan: A Week of Healthy Eating

It’s been six months since I embarked on my weight loss and healthier living journey. It’s been going with ups and downs. I lost five kilograms in my first month of attempting to lose weight. Then, I slowly lost more then gained it back. At the end of October, I was at the same weight I’d been at in early July. IN other words, while I had maintained the loss of those first five kilograms, I hadn’t lost any more. Now over the month of November, I lost three kilograms again. I now only need to lose two kilograms to no longer be obese. This means that the goal I set last June, which was to be just plain overweight rather than obese within a year, is still within reach.

One exercise I came across when reading journaling guides for overeaters, is to imagine one day of normal eating. The idea is to imagine what it’d be like to eat normally for a day, then put that plan into actual action. The thing is, even when I was still deep in disordered eating, I usually had a few days of mostly normal eating before I’d down a whole bag of sweets and/or a bag of crisps and/or other unhealthy foods wthin half an hour. For this reason, I’m going to change the exercise a little and create a food plan for a week. Most things I have already implemented, in fact.

Breakfast

I will eat a healthy breakfast each day. This means I’ll eat lower-fat yoghurt with muesli. I used to eat crunchy muesli most days, but I changed that to regular fruit muesli about a month ago. This contains significantly less calories than crunchy muesli, but it does seem to contan somewhat more sugar. Last week, I bought muesli with nuts, which I think I’ll like better than fruit muesli anyway and which is less sugary.

Lunch

I used to eat two slices of bread with peanut butter. Last month, I decided to get sandwich spread instead, which is much lower in calories, although some people tell me it’s not necessarily healthier.

In addition to bread, I started eating a few carrots, tomatoes and cucumber slices for lunch each day. I love to snack on vegetables and particularly the carrots make me feel full too.

Dinner

My husband cooks and serves my food, so I generally trust him to make me relatively healthy meals and limit my portions. Each Friday though, he gets us fries with a snack. When I restarted my weight loss journey a month ago, I thought I’d have to let go of this, but I don’t. Weight loss doesn’t mean never eating any unhealthy food, after all. That’s why I’m pretty wary of Overeaters Anonymous’ idea of abstinence as a goal. I much prefer Eating Disorders Anonymous’ idea of balance.

Snacks

I can have fruit or rice crackers as snacks when I’m home from day activities in the afternoon. During morning coffee at day activities, I should try to turn down the gingerbread, as it’s pretty high in calories and I don’t even like it very much.

On Wednesday, we have a cooking activity at day activities. I love it and am so glad I have been able to fully participate in it, including eating, while still losing weihgt. The staff usually serve it, so they decide on portion sizes.

Every other Friday, my mother-in-law accompanies me to the pharmacy to pick up my medications. I have decided that I can still buy myself something to snack on at the grocery store that’s near the pharmacy, but it needs to be something relatively healthy. For example, the last time, I had chicken bites. Then, I ate them all in one sitting, which I’m not planing on doing tomorrow. I’m still undecided as to whether I can get myself the chicken bites again and hope I’ll restrain myself and leave some for my husband, or whether I should get something else. Here, the goals of abstinence versus balance are competing again.

Drinks

I usually have coffee, tea and water throughout the day. I can have a fizzy drink or juice every once in a while. I should aim for at least two liters of fluids each day. Not even so much for weight loss purposes, but more to prevent getting constipated.

Doctor #WotW #PoCoLo

So I had two doctor’s appointments this week. First, like I said last Monday, I was seeing my GP on Wednesday regarding my mild motor skills impairments. A little explanation is in order. I have always had fine and gross motor skills impairments. Since they are so mild, they have always seemed practically non-existent in the face of the major disability of my blindness. As a child, I held my parents’ hand till I was at least twelve. This was however seen as a lack of self-confidence. I did use my white cane when prompted, but since I had trouble accepting my deterioratng vision, I apparently chose dependence on others over the white cane. When I did use it though, I often used it as a walking stick.

Now I’m no longer ashamed of the white cane. I in fact prefer to have it with me even if I walk sighted guide, because then at least people will see I’m blind. Still, despite having had countless orientation and mobility training sessions, I still cannot seem to use the white cane in its proper way. Even so, I feel very unsteady when walking independently. I would love to learn to improve, because, even though there is no route in our village I’d like to learn to walk without anyone accompanying me, I’d love to be able to walk without holding onto someone’s arm. That would enable me to go to events on my own by accessible transportation, which I now avoid due to not wanting to ask strangers to be my guide.

As for my fine motor skills impairments, I cannot eat neatly no matter how hard I try. I find this terribly embarrassing. I also struggle with preparing my own breakfast, pouring myself drinks and other skills that require the use of both hands. I can perform tasks that require just my right hand just fine and I can use my left hand for support, but activities that require coordinating both hands, just don’t work without adaptations. I’m curious to know whether such adaptations exist.

My GP looked up what seemed to have been a letter written by my previous GP in the institution. It said that I was born prematurely (correct), had a stroke as a baby (not correct, it was a brain bleed) and developed hydrocephalus as a result (correct). The resulting impairments are diagnosable as acquired brain injury. I seem to have read that when a person sustains a brain injury before age one year (or three in some countries), it’s not diagnosed as an ABI. The correct diagnosis, well, I don’t know. Motor impairments are, or so Dr. Google tells me, often diagnosed as cerebral palsy, but then they have to be severe enough, which I doubt mine are. I didn’t question the doctor though, although the confusing diagnosis did frustrate me more than I’d hoped it would. After all, my intention was to ask about treatment options.

The doctor told me that, if I’ve been stable for over two years, there’s no hope for neurological improvement. This timeframe is longer in children, but since I’m now 31, I’ll pretty much have to learn to live with my impairments. Still, I might benefit from occupational therapy and possibly a little physical therapy to help me learn to use adaptations and learn compensatory strategies. The doctor is going to contact the nearest rehabilitation center to ask whether an occupational therapist can take me on. My blindness may be an issue though, in which case I’ll need to see an occupational therapist at the blindness agency. They don’t often know acquired brain injury though. Seeing both is not an option insurance-wise.

I also saw the mental health agency’s general doctor on Thursday. The physical health screening with the nurse and all the things I didn’t know about my childhood conditions, were what had prompted me to see my GP. I discussed the GP visit for a bit. Then we went over the lab work the doctor had ordered. Everything was within the normal range except for one thing, creatinine, which was a little high. The most likely reason for this is that I don’t drink enough water.

With these two appointments and my having been having them on my mind all week, my word of the week is going to be “doctor”.

The Reading Residence
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