Tuesday, March 19, 2019

Is factitious syndrome a reason for some questionable autism diagnoses

Over the years, I've been skeptical of the autism diagnoses of a variety of people or groups of people.  Those familiar with my work know about my article questioning the diagnosis of Bill Gates and the posthumous diagnoses of Albert Einstein and Thomas Jefferson.  I've also questioned the claims of economist Vernon Smith who claimed to be autistic, but whose conclusions were based on a self-diagnosis obtained by taking a Simon Baron Cohen AQ quiz online.

I created a hornet's nest by wondering on what possible basis IACC members John Elder Robison and Samantha Crane merited a diagnosis, suggesting that they and other prospective members alleging an ASD should provide proof of a professionally obtained Dx.

It is not uncommon for individuals who are married, have children,  never attended a special education school to have alleged to have received a diagnosis well into adulthood, despite the fact that some of them are fairly young (born after 1980) when autism was well known enough and a free diagnosis in their childhood due to provisions in the Individuals with Disabilities Education Act, allowing their school districts to pay for diagnostic testing if they felt they were autistic and needed special ed services.

Many of these are female neurodiversity proponents who claim that they fell through the cracks because the 6:1 or greater male to female ratio reported of higher functioning autistics is not really valid.  They allege that autism is missing in women due to social camouflage based on some supposedly superior ability of women on the spectrum to disguise their autism and pass for normal people throughout their life.  Or that they were diagnosed with something else or discriminated against because autism is seen as a boys' issue.

Other prominent people claiming to be autistic have been Craig Newmark and Braham Cohen.  Ed Asner, father and grandfather of diagnosed individuals also stated he felt he was somewhere on the autism spectrum.  Comedian Jerry Seinfeld also alleged he had an ASD then backtracked.

The latest big story about a new dx is chef Chris Fischer, husband of actress and comic Amy Schumer.  The timing is interesting in that it happened just at the time a special about Ms. Schumer aired on Netflix.  He apparently received a diagnosis of what would have been Asperger's before it was subsumed under a total ASD category well into adulthood and after he married the celebrity.

I pointed out on social media that if Ms. Schumer were single and a 'real' autistic potential suitor approached her, she would not walk, but run or at least not give him the time of day.

One person reprimanded me saying that I should not be claiming that Mr. Fischer's dx is invalid or a lie when I don't know what his life or circumstances were like.  I pointed out, I never said his dx was invalid or a lie, but only that I was skeptical that it was a valid diagnosis.

/While it's true, I don't know all of Fischer's life or how he could merit a diagnosis of ASD, I do know he's a chef he was able to make a living without being repeatedly fired as I was, and was able to make friends with celebrities including Jake Gulluynhall and marry another one when I and most other autistic men are incels. 

Of  course, when I've expressed skepticism of someone else's autism it always came back to me.  How can Jonathan Mitchell possibly have an autism diagnosis for blah blah reasons?  For this reason, I published paperwork discussing my dx from Eric Courchesne's lab when I was a research subject for them. I invite anyone whose diagnosis I've expressed skepticism of to do the same.

Could there be a possible explanation for so many questionable diagnoses?  Lately, there's been some discussion among people I've been following on twitter about an explanation that never occurred to me, but should have.  That is factitious syndrome.

Factitious disorder is an interesting condition It is where people due to mental illness fake a condition or exaggerate certain diseases for attention or other reasons.  At one time it was known as Munchausen's syndrome after the 18th century military man known for his tall tales.

One person who follows me and I them on twitter asked rhetorically why would anyone want to be autistic?

There could be a variety of reasons which could make it very appealing to someone with factitious disorder.  Autism is repeatedly described as a gift, a superpower and another way of being.  Shows like The Big Bang Theory and The Good Doctor also popularize this idea.

In less than a few years, the prevalence (at least according to the likely fictitious CDC ADDM statistics) has doubled or tripled.  I'd be interesting in hearing about any medical condition whose prevalence has been alleged to have risen so fast for so many years according to an agency of the federal government.

All of these reasons could be quite appealing to someone with a profound mental illness that would lead them to have factitious or munchasen's syndrome.

I obviously can't prove who has or who hasn't have factitious syndrome to account for alleging to have autism, but I have little doubts that at least some people claiming to be autistic do so because of factitious disorder.  This could possibly partially account for the explanation for so many high-functioning women claiming to be autistic who are members of the neurodiversity movement when the actual literature suggests their numbers are much lower.

This is something to ponder, I believe. 


Clipping Path said...

Thank you so much for the detailed article.Thanks again.

Irene Tanzman said...

The diagnosis of autism is really just a name given to a set of symptoms. We still don't really know how each individual experiences autism. That is why people are curious about those who can communicate what it feels like. The reason for the diagnosis is to provide a picture of the symptom complex so that we know what interventions might have the best chance of improving a person's life. There are folks who don't seem to have any symptoms, but they say they have autism. I like to give an analogy to another condition, hoarding disorder. Some people can just have a messy house, but it is not hoarding disorder. It only becomes hoarding disorder when the person's rooms can no longer be used for it's intended purpose. Otherwise, the person is merely untidy and not a hoarder. How can the diagnosis of autism be valid when the diagnosis does not interfere with the person's functioning at all? In other words there are no symptoms for a condition that is defined by symptoms. Thanks for the thoughtful blog post.

Autistic1957 said...

Of course some autism diagnosis are a result of people with factitious disorders fooling their assessors. Dare I say that maybe in a few cases vaccine injury autism has happened. Outliers and freakish things happen. The question is factiitious disorder+people without mental illness faking out themselves and clinitions+people just intentionally claiming autism they know they don’t have outliers or epidemic? My opinion is that the perception of widespread “not real” autism is larger then the actual problem but how does one measure this?

I am also tired of historical and celebrity diagnosing. Maybe Bill Gates is autistic, maybe Einstein was Autistic, maybe not. I have no way of knowing. Just bluntly stating that somebody is or was autistic who has never stated so themelves is just plain wrong. But If I am not going to “diagnose” people who never claimed to be autistic it would be be hypocritical of me to “undiagnose” people who claim to be autistic especially those that have a proffessional diagnosis unless there is real reason for doubt. It has to be more then they don’t seem autistic such as Dan Ackroyd claiming he was diagnosed with Aspergers in the early 80s then later claiming he is self-diagnosed.

Anonymous said...

I know the case of an adult diagnosed woman. She confessed she had low self esteem and how she feels good now because "aspies are genius". She never before went to a psychologist or psychiatrist and never returned after her diagnosis. She has a daughter who complain about her apathy and consequent lack of empathy. This woman is intolerant with other autistic who can not get a job. I think she has a personality disorder instead. She never had a true sensorial integration disorder, she don't has a real OCD; her motor clumsiness did not delayed her independence (i'm quoting her reasons for her "asperger's").

Also, she never had special education needs, she could read facial expressions even as a child; she don't has restricted interests and she can not understand those persons who have it, too (etc).

She looked for a diagnosis after reading internet stuff about autistic women and identified herself with the concept of camouflaging and the masquerading of true personality (?); mutism after socializing, "practical" clothes and hairstyle, preference for living with animals, etc. Not enough to say someone is "autistic".

I think this diagnostic vogue bias is an effect of factitious syndrome in some cases, in other is bad information and disease mongering.