Females with severe self-injury may have undiagnosed ASD

Females admitted to psychiatric hospitals as a result of serious self-harm may have undiagnosed autism spectrum disorders (ASD), according to a study from Norway.

Arvid Nikolai Kildahl and colleagues note, “Cognitively able autistic individuals appear to be at risk of being misdiagnosed with other disorders prior to receiving an autism diagnosis. In particular, personality disorder appears to be a common misdiagnosis in adult autistic females, a diagnosis which is often seen as the primary hypothesis in cases involving severe self-harm.”

The researchers analyzed data on 42 patients (40 females and two males) who had undergone frequent or extensive stays at psychiatric hospitals due to self-harming behaviors. They note that “[t]he majority of the participants met the criteria for personality disorders,” and all were diagnosed with an anxiety disorder.

Of the patients, only four females had been diagnosed with ASD. However, using the Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R) to screen the patients, the researchers found that a much larger number qualified for an autism diagnosis. Because studies use different cut-off points for an ASD diagnosis on the RAADS-R, the researchers calculated their results by applying four separate cut-off points. They report, “The mean RAADS-R score in the sample was 86.67, with more than half the sample (24 participants, 57.1%, all female) scoring over the original cut-off of >65. Applying the different cut-offs, 21 participants (50.0%, all female) scored >72, 17 (40.5%, all female) scored >98, and 11 (26.2%, all female) scored >120.” They add, “Participants with higher scores on the RAADS-R reported more anxiety, depressive, and trauma-related symptoms, as well as poorer functioning across measures of personality, close relationships, emotion regulation and alexithymia [difficulties in recognizing and expressing emotions].”

The researchers conclude, “These findings highlight the importance of actively screening for and assessing autism in patients with severe self-harm. Undiagnosed autism may involve a risk that unhelpful interactions with the mental health care system exacerbate these patients’ difficulties over time.”

Citations

“Screening for autism in psychiatric inpatients with severe self-harm—results from the Extreme Challenges research project,” Arvid Nikolai Kildahl, Tuva Langjord, Geir Pedersen, Oddbjørn Hove, Øyvind Urnes, Terje Torgersen, Ingeborg Helene Ulltveit-Moe Eikenæs, and Elfrida Hartveit Kvarstein, Nordic Journal of Psychiatry, April 2025 (free online). Address: Arvid Nikolai Kildahl, Division of Mental Health and Addiction, Oslo University Hospital, Norway, [email protected].