Does a condition exist that resembles autism, but featuring much instead of little empathy?

Question

I recently read a book by an autistic author who relates his experiences in professional life in IT. (He was diagnosed only in mid adulthood.) Colleagues see him as highly intelligent but also stubborn and egocentric. He explains that he cannot read people's faces and therefore misses out on the non-verbal part of human communication, which is 80%. Because he cannot remember faces, he often cannot greet acquaintances, which obviously causes consternations. One also gets the sense that neither would be inclined to do so because he abhors all situations with idle small talk.

Many outer markers of his biography reminded me of a friend of mine: also high IQ, also in IT, with his private life (perennial single) and professional life now somewhat in shambles. That friend also often irritates people and avoids small talk. But while he seems similar to an autist on the surface he may be very different on a deeper level.

Whereas the autistic author (at least by his own account) has very little empathy, this friend may have too much. He can (or "can") read the faces of other humans, but somehow he does not seem to be able to trust much of what he sees. Some of his intelligence seems to stem from being constantly on the guard, as if to form models in his head about what really is going on and where he can fit in, but never arriving at safe conclusions. I know that there were unspoken tensions between his parents when he grew up. He is not obviously constrained in public and dear to some who know him well, but struggles with the scale of human relationships in between at a severe price.

My question is this: Does this ring any bells? Is there a name for this condition? Any books that I might follow-up and/or recommend?

Answer 1

There are many issues packed into this question. I am pretty sure the answers will lead to many more questions.

1. People diagnosed with autism tend to perform worse than the average population on standard IQ tests, but there is evidence that alternative measures of "intelligence" (whatever that is) are more accurate and demonstrate that autistic persons, as a group, are not cognitively impaired. The high IQ of the book author is almost certainly unrelated to his autism.
2. For your friend, my perception is that many of the details that he shares with the book author are coincidental and distracting from the real problem. (The previous statement is harsh because it strongly implies that your friend has a disorder, but he might not have a disorder.) I believe your friend's IQ and occupation are irrelevant.
3. Let's take a break from your friend and directly address the question, "Does a condition exist that resembles autism, but featuring much instead of little empathy?" In short, no. However, Williams syndrome is often called "the opposite of autism" specifically because people with Williams syndrome are exceptionally sociable, friendly, talkative, have relatively low inhibitions in social situations, more willing than a normal-developing person to interact with strangers, are aware of negative social actions of others but have reduced negative reactions to other people's actions (such as criticism), and many other remarkable traits related to sociability and empathy. Unlike autism, however, people with Williams syndrome, as a group, have significant cognitive impairment and important differences in physical development that affect their lives in multiple and significant ways. Williams syndrome is not the true opposite of autism.
4. Your description of your friend's social interaction are clearly not Williams syndrome. Based on your description, I would be surprised if he were diagnosed with hyper-empathy disorder, which is a personality disorder (not otherwise specified), because people with hyper-empathy disorder are hyper social and tend to prioritize the needs of others so highly that their own life is damaged.
5. In your description of your friend, some phrases jumped out at me: "life now somewhat in shambles", "irritates people", "not ... able to trust ... what he sees", "constantly on the guard" modeling (evaluating?) the actions of other people, and "never arriving at safe conclusions [about the intentions or actions of other people]".
6. If your friend has a disorder (please start with the assumption that he does not have a disorder), I feel your description most strongly points towards borderline personality disorder. I feel this because I sense a lack of stability and predictability and relatively poor ability to form typical relationships with most people. You mention he has some good relationships, but I am speaking to my impression that the majority of his relationships and interactions are disordered in some way.
7. On the other hand, many of the things you mention suggest some type of paranoia, most especially paranoid personality disorder. If he is constantly evaluating other people for potential threats and regularly perceives threats then that is well outside of normal emotional reactions. But paranoia is most often accompanied by schizoid or schizophrenia symptoms and you did not describe anything that suggests either issue to me. Still, it is possible to have PPD without schizoid disorder and PPD and BPD are common bedfellows, so it is possible that your friend is struggling with both disorders.
8. Finally, if you don't mind, I want to suggest a small shift in perspective. A "disorder" is anything that interferes with normal life functioning. Hoarding of mustard could be a disorder if it interfered with normal life functioning. The specific label, such as autism, BPD, or PPD, is most useful to professionals creating a treatment plan. For the rest of us, one of the best ways to help our friends is to pay little attention to the label and to pay a lot of attention to anything that is interfering with normal life functioning. Let a professional therapist try to figure out if the disorder was triggered by daddy issues or a car accident. As the person's friend, and as a non-professional, it is much easier for you to help gently steer your friend away from actions and situations that will interfere with normal life functioning and towards habits and actions that will allow your friend to have a healthier life.

In any event, whether or not your friend has a disorder, he is lucky to have people in his life who notice that his life is in shambles and want to help him improve things. Kudos to you.