{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T10:29:26Z","timestamp":1789813766250,"version":"4.0.1"},"reference-count":64,"publisher":"Wiley","license":[{"start":{"date-parts":[[2019,5,26]],"date-time":"2019-05-26T00:00:00Z","timestamp":1558828800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Psychiatry"],"published-print":{"date-parts":[[2019,5,26]]},"abstract":"<jats:p>This case report highlights the relevance of the consequences of trauma in a female patient with an undetected autism spectrum disorder (ASD) affected by bipolar disorder (BD) with multiple comorbidities. A 35-year-old woman with BD type II, binge eating disorder and panic disorder was admitted in the Inpatient Unit of the Psychiatric Clinic of the University of Pisa because of a recrudescence of depressive symptomatology, associated with increase of anxiety, noticeable ruminations, significant alteration in neurovegetative pattern, and serious suicide ideation. During the hospitalization, a diagnosis of ASD emerged besides a history of childhood trauma and affective dysregulation, marked impulsivity, feeling of emptiness, and self-harm behavior. The patient was assessed by the Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale (RAADS-R), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Trauma and Loss Spectrum (TALS-SR), and Ruminative Response Scale (RRS). Total scores 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 the TALS-SR, and 64\/88 in the RRS. We discuss the implications of the trauma she underwent during her childhood, in the sense that caused a complex posttraumatic disorder, a lifelong disease favored and boosted by the rumination tendency of high functioning ASD.<\/jats:p>","DOI":"10.1155\/2019\/4703795","type":"journal-article","created":{"date-parts":[[2019,5,26]],"date-time":"2019-05-26T19:30:39Z","timestamp":1558899039000},"page":"1-6","source":"Crossref","is-referenced-by-count":17,"title":["Is There a Major Role for Undetected Autism Spectrum Disorder with Childhood Trauma in a Patient with a Diagnosis of Bipolar Disorder, Self-Injuring, and Multiple Comorbidities?"],"prefix":"10.1155","volume":"2019","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-8073","authenticated-orcid":true,"given":"Claudia","family":"Carmassi","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1752-0339","authenticated-orcid":true,"given":"Carlo Antonio","family":"Bertelloni","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Salarpi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9489-1195","authenticated-orcid":true,"given":"Elisa","family":"Diadema","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8460-4279","authenticated-orcid":true,"given":"Maria Teresa","family":"Avella","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0520-4785","authenticated-orcid":true,"given":"Valerio","family":"Dell\u2019Oste","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Dell\u2019Osso","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-012-0327-2"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.2174\/1745017901814010177"},{"issue":"2","key":"3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1002\/ajmg.c.31325","volume":"160c","year":"2012","journal-title":"AmericaN Journal of Medical Genetics Part C, Seminars in Medical Genetics"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1017\/s0012162299001656"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-004-1995-5"},{"issue":"6","key":"6","first-page":"1","volume":"67","year":"2018","journal-title":"Morbidity and mortality weekly report. 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