Is Misdiagnosis Common?
Borderline personality disorder traits are commonly misdiagnosed with autistic traits. While autism spectrum disorder includes characteristics not found in borderline personality disorder, such as sensory challenges, in many cases, the intensity of emotions and challenging relationships may lead to misdiagnosis.
Not every person with autism or borderline personality disorder displays the same behavioural patterns. This can make assessment even more challenging. However, consulting a mental health professional and observing the symptoms and characteristics over a period of time can lead to a precise diagnosis.
Can BPD be Confused with Autism?
At first glance, autistic spectrum disorder and borderline personality disorder seem to have very little in common. Autism is a neurological difference, while BPD belongs to a group of personality disorders.
However, researchers have found a potential overlap in traits in recent years, which has led to misdiagnoses, particularly for autistic people. BPD and autism have several traits in common, including challenges with executive dysfunction and difficulties with social and interpersonal relationships.
In a 2022 study, a young man with attention deficit hyperactivity disorder (ADHD) who experienced severe self-harm was misdiagnosed and treated for BPD before receiving the correct diagnosis: autism, depression and ADHD. The study found that non-suicidal self-harm, ADHD, and depression symptoms, followed by a lack of autism knowledge in primary healthcare, can be confused with a personality disorder.
Can You Have Both BPD and Autism?
BPD and autism can co-occur, and autistic people are more predisposed to developing BPD, studies confirm. More precisely, the prevalence rates of almost all personality disorders are higher among people with autism and ADHD.
A non-clinical study conducted in college settings found that students with both BPD and autism traits were more prone to self-harm than the BPD group alone, and both groups demonstrated similar levels of depression. While self-harm is a common challenge among both groups, it is more frequent in autistic people, often due to sensory overload. BPD and autism may co-occur with other mental health conditions, underscoring the complexity of diagnosis and treatment.
However, having the correct assessment is crucial in finding person-centred and compassionate support to help people live a balanced and fulfilled life.
Similarities Between Borderline Personality Disorder (BPD) and Autism
Both ASD and BPD face challenges with social interactions and relationships. Individuals with BPD and ASD may struggle with understanding and responding to social cues, leading to difficulties in forming and maintaining meaningful connections.
Additionally, emotional regulation can be a shared concern. Both groups may experience intense emotions and have difficulty effectively managing them. This can lead to mood swings, impulsivity, and sometimes self-destructive behaviours.
Social Challenges
People with BPD and autism often face social and communication difficulties, but the reasons are not always the same. For example, people with autism may struggle with maintaining relationships due to social avoidance and withdrawal. In many cases, they cannot read social cues and find it difficult to express their words and emotions.
In BPD, a person is often prone to complicated relationships due to mistrust, frequent mood swings, and challenging behaviours. People often have an intense fear of abandonment and face challenges with emotional dysregulation.
Emotional Dysregulation
One of the main similarities between BPD and autism spectrum disorders is emotional dysregulation. In many cases, people with borderline personality disorder and autism face challenges in reading and expressing emotions. For example, people with autism spectrum disorder may struggle with expressing their current needs through verbal cues or gestures. Similarly, they might feel uncomfortable talking about other people’s feelings. This can cause intense anxiety and can also lead to behaviours that challenge.
People with BPD are often prone to emotional dysregulation for different reasons. A deep sense of distrust, cognitive distortions, and intimacy issues are often present in people with BPD. This frequently results in complicated friendships and relationships.
Sensitivity with Abandonment
Individuals with borderline personality disorder and autism can experience heightened sensitivity to abandonment, but for different reasons. In BPD, this fear often stems from a history of unstable relationships and a deep-seated fear of rejection. People with BPD may be intensely obsessed with real or imagined abandonment, which can trigger intense emotional reactions.
For those with autism, the sensitivity to abandonment may arise from challenges in understanding and navigating social relationships. They might struggle to interpret social cues and form connections, leading to a fear of being left behind or isolated. This sensitivity can contribute to feelings of anxiety and uncertainty in social situations.
Difficulty with Change
Both borderline personality disorder and autism can lead to difficulties in coping with change. In BPD, this difficulty often arises from a fear of abandonment or perceived rejection when routines or relationships shift. Individuals with BPD may become highly distressed when faced with unexpected changes, which can trigger intense emotional reactions.
In autism, difficulty with change is often related to a preference for predictability and routine. Individuals with autism may find comfort in familiar settings and routines, making any alterations unsettling. This resistance to change can be a source of anxiety and discomfort for people with autistic spectrum conditions.
Difficulty Understanding Social Cues
Both borderline personality disorder and autism can lead to challenges in understanding social cues, which are common personality traits. In BPD, this difficulty may arise from heightened emotional sensitivity and a history of unstable relationships. Individuals with BPD may struggle to accurately interpret non-verbal cues, leading to misunderstandings and potential conflicts in social interactions.
For autistic individuals, difficulty with social cues is a common challenge. People may find it challenging to pick up on subtle gestures, facial expressions, and body language, crucial components of social communication. This can lead to difficulties in forming and maintaining relationships and feeling socially isolated.
Isolation
Isolation is a common experience for individuals with both BPD and ASD, albeit for different reasons. In people with BPD, it can result from unstable relationships and intense emotional reactions, leading individuals to withdraw from social interactions to protect themselves from perceived abandonment or rejection.
For people with autism, isolation may stem from challenges in understanding and navigating social interactions. They can struggle to initiate and maintain relationships, often preferring solitude to avoid the stress of social engagement. This isolation can contribute to feelings of loneliness and disconnection.
Overlapping Behaviour Traits
Borderline personality disorder and autism, though distinct, can exhibit overlapping traits. Here is a list of the most common traits that may appear in both BPD and ASD:
- Sensitivity to abandonment
- Diffuse sense of self
- Difficulty understanding social cues
- Self-harming behaviours
- Social challenges
- Feelings of sadness
- Insecure attachments
Differences Between Borderline Personality Disorder and Autism
Borderline personality disorder and autism spectrum disorders are different and require unique approaches and support. The following lines explain the main differences and characteristics of both BPD and autism.
Main Features and Diagnostic Criteria
Following the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), borderline personality disorder is a type of personality disorder that manifests with instability in interpersonal relationships, cognitive distortions, and intense impulsivity.
BPD describes challenges in interpersonal functioning and troubles with trust and intimacy. The persistently unstable self-image and strong fear of abandonment make it difficult to establish emotional stability.
The main borderline personality disorder traits include:
- Intense fear of abandonment
- Unstable personal relationships (BPD splitting)
- Impulsiveness and frequent mood fluctuations
- Self-harming behaviour
- Periods of affective instability
- Constant feeling of emptiness
- Difficulty controlling anger
Conversely, based on DSM-5, autism spectrum disorder involves frequent and sometimes intense challenges with social communication and interactions affecting all spheres of a person’s life. Here are some examples of autistic traits:
- Difficulties in social-emotional situations
- Trouble with non-verbal communication in social interactions
- Challenges in building, maintaining, and understanding relationships
- Challenges with anxiety
- Difficulties with change
Development
Autism is a neurological difference that becomes apparent in early childhood, often before age 3. It is thought to have a strong genetic component, but the exact causes are not fully understood.
In contrast, borderline personality disorder tends to become more noticeable in late adolescence or early adulthood. BPD is associated with complex factors, including genetic predisposition, early life experiences, and environmental influences. The symptoms of BPD often become more pronounced as individuals face potential triggers and emotional challenges.
Social Interactions
Individuals with autism and BPD experience unique challenges in social interactions. In autism, social difficulties arise from a fundamental difference in processing social cues. People on the autism spectrum may struggle with understanding non-verbal communication, such as facial expressions and body language, leading to challenges in forming and maintaining relationships.
On the other hand, individuals with BPD might be hypersensitive to perceived or imagined rejection. They can exhibit impulsive behaviours in an attempt to maintain closeness. This can lead to a pattern of intense but often turbulent social interactions.
Despite these differences, it’s important to remember that both BPD and ASD benefit from understanding, patience, and tailored approaches to support individuals in their social interactions.
Sensory Sensitivities
People with autism often experience hypersensitivity to sensory stimuli like lights, sounds, textures, and smells. This heightened sensitivity can lead to sensory overload, causing discomfort and distress. For example, a seemingly ordinary sound for others might be overwhelmingly loud and distressing for a child or an adult with autism. Conversely, some individuals with autism may seek out certain sensory experiences, like rocking or hand-flapping, to self-regulate and find comfort.
In contrast, sensory sensitivities are not a prominent feature of BPD. While individuals with BPD may experience intense emotional reactions and challenges with interpersonal relationships, their sensory processing tends to be within typical ranges. This distinction highlights the multifaceted nature of these differences and the importance of recognising the unique characteristics associated with each.
Identity and Self-Image
In autism, individuals may struggle with developing and expressing a flexible and nuanced sense of self. They may exhibit a more concrete self-understanding, often focused on specific interests or routines. This can lead to a strong attachment to particular activities or subjects, providing comfort and stability. However, it may also result in difficulty adapting to new situations or embracing change.
Conversely, in borderline personality disorder, identity disturbances are a central feature. Individuals with BPD often experience a fragile and unstable sense of self. They may have difficulty establishing a consistent self-image and adopt different personas in different situations or relationships. This can lead to feelings of emptiness, confusion, and a constant search for a stable sense of identity.
Overlapping Risks
Following the similarities and differences between borderline personality disorder (BPD) and autistic traits, there are certain overlapping risks that need to be taken into consideration as well. Read more to find the potential risks linked with BPD and autism.
Eating Disorders
Based on statistics, both BPD and autism have high rates of eating disorders that often function as a way of coping with intense emotions and also help them gain control.
According to a study, about 50% of people with BPD meet the criteria for an eating disorder, including anorexia nervosa and half with bulimia nervosa.
In the case of autism, researchers suggest that almost 23% of people on the autism spectrum are diagnosed with anorexia nervosa. However, it should be noted that many people with autism haven’t received precise evaluations.
Self-Harm
As mentioned before, self-harm is commonly present in both groups. In the case of autism, self-harm often occurs due to sensory overload and often appears in autistic teenagers. In BPD, self-harm is frequently a result of an unhealthy attachment to injury and a way to cope with distress.
Substance Abuse
Latest studies show that people with high-functioning autism have an increased risk of developing alcohol or substance misuse. This is often used as a coping mechanism for social anxiety and sensory challenges.
Similarly, almost half of people diagnosed with BPD also have a co-occurring substance misuse disorder, which is also used as a mechanism to cope with intense emotional struggles.
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