Do I have Autism Spectrum Disorder (ASD), a personality disorder such as antisocial personality disorder, or another condition, and what are the implications for my future relationships, work, and potential parenting?

Your Presentation Is Most Consistent with Antisocial Personality Disorder (ASPD), Not Autism Spectrum Disorder

Based on your detailed history, your core presentation—lifelong emotional detachment, manipulative behavior, lack of remorse, animal cruelty, violent ideation experienced as stimulating, and instrumental use of cognitive empathy without affective empathy—strongly indicates Antisocial Personality Disorder rather than ASD. Your prior autism diagnosis at age 16 appears to represent diagnostic overshadowing or misdiagnosis, as your primary deficits are not in understanding social cues but in caring about others' feelings unless they serve your interests.

Why This Is ASPD, Not ASD

Core Empathy Pattern Distinguishes These Disorders

Your empathy profile is the opposite of what occurs in autism:

• In ASD: Individuals show cognitive empathic deficit (difficulty understanding others' perspectives—"innocence") but typically retain emotional empathy and moral concern when they do understand 1
• In psychopathy/ASPD: Individuals show emotional empathic deficit (inability to feel with others—"insensitivity") while retaining or even having enhanced cognitive empathy used for manipulation 1

You explicitly describe strong cognitive empathy ("partners have told me I know them better than they know themselves") combined with absent affective empathy ("usually does not feel others' emotions with them") and instrumental use of this understanding to manipulate for sex, attention, or compliance 1. This is the hallmark pattern of psychopathy/ASPD, not autism.

Social Communication Is Intact When Motivated

Autism requires pervasive social-communication deficits across contexts 2. You describe:

• Being "goofy, outgoing, and sociable" at work when it serves you
• Being "perceived by others as friendly, insightful, and normal"
• Successfully reading people's emotions, motives, and weaknesses
• Choosing not to engage socially when alone, not being unable to do so

This is volitional social withdrawal and selective engagement, not the pervasive social-communication impairment required for ASD 3, 2. In true ASD, social deficits persist even when the person is motivated and trying 3.

Your "Restricted Interests" Are Actually Callous-Unemotional Traits

Your childhood fascination with predation, forcing insects to fight, and watching animals suffer is not an autistic special interest—it represents early callous-unemotional traits and conduct disorder:

• Deliberately killing 4-5 snakes, 1 lizard, and 1 caiman as an adult because you "felt no attachment" and they were "inconvenient"
• Participating in killing a snapping turtle and "enjoying it in the moment"
• Childhood pattern of cruelty to animals (fire ants, forced fighting) without distress
• Viewing animals as objects to discard when bored

This is not the intense but benign special interests seen in ASD 4, 2. This is a pattern of callousness and instrumental cruelty that predicts antisocial personality pathology 5.

Conduct Disorder Pattern From Childhood

Your history meets criteria for childhood conduct disorder, which is the developmental precursor to ASPD:

• Physical aggression and fighting (multiple school incidents requiring adult restraint) 5
• Deceitfulness and manipulation (hiding behavior reports, forging signatures) 5
• Cruelty to animals (extensive pattern documented above) 5
• Serious rule violations (running away at 16) 5

About half of children with conduct disorder develop ASPD in adulthood 5, and your adult pattern confirms this trajectory.

Your Adult ASPD Presentation

Diagnostic Criteria You Meet

You clearly meet DSM criteria for Antisocial Personality Disorder:

• Age ≥18 with conduct disorder before age 15: Documented above 5
• Failure to conform to social norms: Pattern of lying, manipulation, impulsive job quitting, financial irresponsibility
• Deceitfulness: Lifelong pattern of lying "out of habit or curiosity" even without clear gain
• Impulsivity: Seven jobs with impulsive quitting, four college dropouts, financial impulsivity, running away
• Irritability and aggressiveness: Multiple physical fights, explosive anger requiring restraint
• Reckless disregard for safety: Suicide attempt driven partly by "curiosity," fire-setting, violent ideation
• Consistent irresponsibility: Cannot maintain employment or financial stability, relies on guardian to cover overspending
• Lack of remorse: "Usually does not feel deep guilt even when others are hurt," shows remorse only to avoid consequences

Psychopathic Features

You also demonstrate significant psychopathic traits beyond basic ASPD:

• Grandiose sense of self-worth: Viewing others as "useful, neutral, or obstacles"
• Pathological lying: Even when unnecessary
• Manipulative: Using cognitive empathy instrumentally for sex and compliance 1
• Lack of remorse or guilt: "Might feel a brief pang but shrugs it off quickly"
• Shallow affect: "Often feels flat, empty, or neutral"
• Callousness/lack of empathy: Core feature throughout your history 1
• Failure to accept responsibility: Blames circumstances, not internal factors
• Parasitic lifestyle: Living with guardian who covers bills when you overspend
• Poor behavioral controls: Explosive anger, impulsive quitting
• Promiscuous sexual behavior: Paying for sex, possessive without emotional attachment
• Early behavioral problems: Conduct disorder documented
• Lack of realistic long-term goals: Four college dropouts, no sustained career path
• Impulsivity: Pervasive pattern across domains
• Irresponsibility: Cannot maintain obligations
• Criminal versatility: While not arrested, pattern of rule-breaking across contexts

Why Your Autism Diagnosis Was Likely Wrong

Diagnostic Overshadowing at Age 16

Your premature birth, cerebral palsy, feeding tube, and tracheostomy until age 6 likely created a bias toward neurodevelopmental explanations when you were evaluated at 16 3. Clinicians may have attributed your social difficulties to autism rather than recognizing emerging personality pathology.

The American Academy of Child and Adolescent Psychiatry explicitly warns about diagnostic overshadowing—the tendency to fail to diagnose other conditions when a more noticeable condition is present 3. Your early medical complexity may have led evaluators to overlook conduct disorder and emerging antisocial traits.

Features That Superficially Resembled ASD

Some of your traits could be misinterpreted as autistic if evaluators didn't probe deeper:

• Standing too close (but you can modulate this when motivated—not a true social deficit)
• Head-shaking tic (but this is a simple motor stereotypy, not the complex restricted interests of ASD) 4
• Childhood insect interest (but the content was predatory cruelty, not benign fascination)
• Difficulty stating dislike directly (but this is manipulative conflict avoidance, not social-communication deficit)

None of these represent the pervasive, context-independent social-communication deficits required for ASD 2.

Comorbid Conditions to Address

Depression (Secondary to Personality Pathology)

Your "depression" appears to be chronic emptiness and boredom typical of ASPD, not major depressive disorder:

• "Often feels flat, empty, or neutral rather than deeply sad"
• "Depressive feelings frequently shift into anger about lack of control"
• "Chronic boredom and need for stimulation"

This is the affective instability and emptiness of personality disorder, not a mood disorder 6.

ADHD Features

Your impulsivity, difficulty sustaining attention on non-stimulating tasks, and hyperactivity as a child suggest comorbid ADHD 3. Guanfacine 1 mg daily is appropriate for ADHD but underdosed—therapeutic range is typically 1-4 mg daily for adults. However, ADHD does not explain your callousness, manipulation, or lack of remorse.

About half of children with ADHD plus conduct disorder (which you had) develop ASPD in adulthood 5. Your ADHD likely contributed to impulsivity but is not the primary diagnosis.

What You Cannot Change vs. What Is Modifiable

Stable Personality Traits (Unlikely to Change)

The following are core features of ASPD that are highly stable and treatment-resistant:

• Lack of affective empathy and remorse 1
• Shallow emotional experience and chronic emptiness
• Viewing people instrumentally rather than emotionally
• Callousness toward suffering (human and animal)
• Core antisocial personality structure

These traits are not "caused by environment"—they reflect stable personality pathology with strong genetic loading 5. Your family history (mother with bipolar/substance use, sister with schizophrenia) suggests genetic vulnerability to severe mental illness and impulse control problems.

Modifiable Behavioral Patterns

What you CAN work on with appropriate intervention:

• Impulsive decision-making: Dialectical Behavior Therapy (DBT) skills for distress tolerance and impulse control can reduce impulsive quitting, spending, and reactive aggression
• Anger management: Cognitive-behavioral approaches can help you pause before explosive reactions, reducing job loss and conflict
• Consequence-based decision-making: Since you respond to consequences, structured behavioral interventions that make consequences more salient and immediate can reduce antisocial behavior
• ADHD symptoms: Optimizing guanfacine dose or adding stimulant medication can improve attention and reduce impulsivity 3

You will not develop warm emotional bonds or genuine remorse, but you can learn to function better in society by improving impulse control and consequence awareness.

Treatment Recommendations

Psychotherapy

Dialectical Behavior Therapy (DBT) is the most evidence-based approach for your presentation:

• Focuses on behavioral control and distress tolerance, not emotional warmth
• Teaches skills for managing impulsivity and anger
• Does not require you to "feel" empathy—focuses on behavioral compliance with social norms
• Has some evidence for reducing antisocial behavior when consequences are structured

Traditional psychodynamic therapy or empathy-focused approaches will not work for you and may make you more skilled at manipulation.

Medication Optimization

Current medication (guanfacine 1 mg) is underdosed:

• Increase guanfacine to 2-4 mg daily for better ADHD symptom control
• Consider adding stimulant medication (methylphenidate or amphetamine) if impulsivity remains problematic after guanfacine optimization 3
• Avoid benzodiazepines or other addictive substances—you have high risk for substance use disorder given family history and impulsivity

No medication will address your core lack of empathy or remorse.

Risk Management

You pose ongoing risk for violence and criminal behavior:

• Your violent thoughts are "stimulating" rather than distressing, and you only refrain due to fear of consequences
• You have killed multiple animals without remorse when they became inconvenient
• You have explosive anger requiring multiple adults to restrain you
• You have considered using weapons (glass shard incident)

You need ongoing monitoring and clear external consequences to prevent escalation. If you lose fear of consequences (e.g., through substance use, desperation, or perceived invulnerability), your risk for acting on violent thoughts increases substantially.

Implications for Future Parenting and Relationships

Genetic Risk to Children

Your children would be at elevated risk for:

• ADHD: Highly heritable 5
• Conduct disorder and ASPD: Strong genetic component, especially with your family history 5
• Other severe mental illness: Given your mother's bipolar disorder and sister's schizophrenia

Approximately 50% of children with conduct disorder develop ASPD in adulthood 5. Your children would have both genetic loading and potential environmental exposure to your callous parenting style.

Environmental Risk to Children

Your lack of affective empathy and tendency to view people instrumentally would create a harmful parenting environment:

• Children need emotional attunement and warmth for healthy development—you cannot provide this
• Your impulsivity and anger could lead to harsh or abusive discipline
• Your pattern of discarding relationships when bored or frustrated would be devastating to a child's attachment security
• Your history of animal cruelty when they became "inconvenient" is deeply concerning in a parenting context

You should not have children unless you can commit to intensive parenting support and monitoring to prevent harm.

Relationship Capacity

You will not form emotionally intimate, reciprocal long-term relationships:

• Your "love" is possessive and criteria-based, not emotionally bonded
• You become bored once you achieve what you wanted (sex, attention, challenge)
• You cut people off rather than working through conflict
• You view partners instrumentally ("they fit my criteria, they're mine")

This is not modifiable—it is core to your personality structure. You can maintain relationships based on mutual benefit and clear expectations, but not emotionally intimate partnerships.

Summary of Diagnostic Conclusions

Primary Diagnosis: Antisocial Personality Disorder with psychopathic features

Comorbid Conditions:

• ADHD (partially treated with guanfacine)
• Chronic dysphoria/emptiness (part of personality pathology, not major depression)

Rule Out: Autism Spectrum Disorder—your presentation does not meet criteria for ASD and your prior diagnosis appears to be diagnostic overshadowing 3

Your core deficits are in affective empathy and moral concern, not in social understanding 1. You understand people very well—you simply do not care about them unless they serve your interests. This is the essence of psychopathy/ASPD, not autism.