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Joined 3 years ago
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Cake day: June 16th, 2023

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  • If a professional is required by law to make these reports, and makes you aware of these duties at the start of your care, then there is no valid ethics complaint and no violation of trust. The therapist must tell you in their informed consent about these limits to confidentiality and should have done so before any personal information was disclosed to them.

    While there is a potential of some harm due to this disclosure, therapists are not in a position to investigate and determine if abuse / credible threats of violence occurred and are explicitly not supposed to do so. They are supposed to make a report and allow other state agencies to investigate. If OPs family ended up hurting someone and the therapist was drawn into legal proceedings, they could equally be sued for having this information and not following their duty to warn.

    OP, these issues do belong in therapy and you should be able to get support for them.



  • Please get a better assessment and differential before you make any conclusions about yourself. The HARE is very old. The PCL-R is more recent and draws from some of the original HARE development. Even so, that instrument alone is not enough to make a diagnosis like that and you’d need convergent validity from other measures and at least a clinical interview. Again, true psychopathy is exceedingly rare and because of it’s nature, less studied than other conditions.

    There are also many things that can look like psychopathy and aren’t including trauma, severe attachment issues and narcissistic personality disorder.



  • Don’t forget to include base rates in your calculations. Autism estimates can be as high as ~1 in 20 or 30 (for AMAB) depending on how you measure it and Psycopathy is far lower even accounting for measurement challenges. Also, the HARE, even the updated one, is more than 40 years old. I would be very suspicious of people using that measure clinically.

    Anecdotally, autistic people can be prone to overly concrete / dichotomous answers on some measures, which leads some to endorse actions or thoughts they have had, but occur extremely rarely, when the measure is asking about a prominent and repeated symptom.

    It is possible to be both, but there are many things that distinguish the conditions. Also, if a person is autistic and has not had that understand or proper accommodations, then “antisocial” habits that develop out of self-protection may be misconstrued as pathological personality traits.

    This is a deep and nuanced conversation and it would be worth deconstructing your answers on the HARE with a therapist or someone who knows you well to see if your perceptions of your symptoms match with other’s perceptions.


  • I’m not in Europe so I don’t have a whole lot of knowledge about the healthcare system or how to direct you unfortunately. In terms of books I like Devon Price’s Unmasking Autism (one of the best for describing the experience of adults on the spectrum) and for younger AFAB folks I like Spectrum Girls Survival guide. I have skimmed and liked Field Guide to Earthlings but haven’t read it completely.

    Also it’s a small organization but Autism Learning Lab is building some nice resources and education. I still believe a full formal social developmental assessment is helpful, but it’s expensive and if you don’t find the right practitioner they can still miss the boat. I tend to advise people to ask a lot of questions about their clinician’s expertise and experience with autism. Learning subtle signs beforehand and asking if they are aware of the “pink flags” etc. described here could help.

    https://pubmed.ncbi.nlm.nih.gov/34121610/


  • I work in the field and am constantly shocked at the number of otherwise skilled practitioners that have a huge blind spots for autism, especially mild or low support need individuals.

    The thing about masking is that it can also hide “impairment” so a good diagnostician should ask about the ways you might mask and the physical and emotional costs of the masking. Sure you can socialize with the best of them, but are you a hollowed out shell at the end of the day? Does the masking leave you with zero resources for your hobbies, less capacity to deal with stress, and burnout? High maskers tend to have higher burnout because they are working hard to function in a world that expects them to appear counter to their nature. All too often someone can appear to function typically but a few times a month or a year they have epic drops in functioning and can’t get out of bed or leave their dark room. They’re diagnosed with depression, which admittedly can be exacerbated by burnout. However, treating burnout with depression coping skills might miss the mark. Anyway, this is a huge frustration for me professionally and I’m sorry you are dealing with it.