Is There a Major Role for Undetected Autism SpectrumDisorder with Childhood Trauma in a Patient with a Diagnosisof Bipolar Disorder, Self-Injuring, and Multiple Comorbidities ?

This case report highlights the relevance of the consequences of trauma in a female patient with an undetected autism spectrumdisorder (ASD) affected by bipolar disorder (BD) with multiple comorbidities. A 35-year-old woman with BD type II, binge eatingdisorder and panic disorder was admitted in the Inpatient Unit of the Psychiatric Clinic of the University of Pisa because of arecrudescence of depressive symptomatology, associated with increase of anxiety, noticeable ruminations, significant alteration inneurovegetative pattern, and serious suicide ideation. During the hospitalization, a diagnosis of ASD emerged besides a historyof childhood trauma and affective dysregulation, marked impulsivity, feeling of emptiness, and self-harm behavior. The patientwas assessed by the Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale (RAADS-R), the Adult AutismSubthreshold Spectrum (AdAS Spectrum), Trauma and Loss Spectrum (TALS-SR), and Ruminative Response Scale (RRS). Totalscores of 38/50 in the AQ, 146/240 in the RAADS-R, 99/160 in the AdAS Spectrum emerged, compatible with ASD, 47/116 in theTALS-SR, and 64/88 in the RRS. We discuss the implications of the trauma she underwent during her childhood, in the sense thatcaused a complex posttraumatic disorder, a lifelong disease favored and boosted by the rumination tendency of high functioningASD