Is Misdiagnosis Common?
Borderline personality disorder (BPD) is sometimes misdiagnosed as ASD due to shared traits, like emotional dysregulation. However, there are specific traits of Autism Spectrum Disorder that are not commonly found in borderline personality disorder, such as sensory challenges.
Not every person with BPD or ASD will showcase the same behavioural patterns and symptoms. The key to correct diagnosis and getting the right support plan is consulting with a mental health professional who will closely monitor and observe the symptoms over a more extended period.
Key Takeaways
- Differences in Social Interaction and Communication Styles: BPD and autism spectrum disorder (ASD) are distinct conditions with differing patterns of social interaction and communication. Recognising these differences can help avoid misinterpretation and promote understanding and support for individuals with either condition.
- Varied Emotional Regulation and Sensory Processing: Emotional dysregulation is a main feature of BPD, characterised by intense mood swings and difficulty managing emotions. In contrast, individuals with autism may experience challenges in understanding and expressing emotions, coupled with sensory sensitivities or aversions as well as cognitive empathy.
- Importance of Individualized Assessment and Treatment: Given the overlapping symptoms and complexities of BPD and autism, accurate diagnosis and appropriate treatment planning are essential. A comprehensive assessment by qualified mental health professionals, including psychiatrists, psychologists, and behavioural therapists, can help differentiate between the two conditions and guide personalized treatment approaches.
Can BPD be Confused with Autism?
Yes, BPD can be confused with autism, even though Autistic Spectrum Disorder and borderline personality disorder may look like they have very little in common. Autism is a neurological difference, while BPD is a personality disorder and mental health condition.
Researchers found an overlap in traits in recent years, which led to multiple cases of misdiagnosis, especially for autistic adults. BPD and autism share traits like challenges with executive dysfunction and social interaction difficulties. In 2022, a study showed that people with attention deficit hyperactivity disorder (ADHD) experienced self-harm tendencies and were treated for BPD. However, they were misdiagnosed before getting the correct diagnosis of ADHD, autism as well as depression. The study showed that autism, as well as depression and ADHD, have overlapping symptoms with borderline personality disorder traits.
Can You Have Both BPD and Autism?
BPD and autism can co-occur, and the prevalence rates of all personality disorders are much more common for people with ADHD and autism.
BPD and autism may co-occur with other mental health challenges and conditions, which underscores the complexity of determining the proper diagnosis and treatment plan. However, having a correct assessment is essential in finding compassionate support and creating a person-centred care plan to help people live a fulfilling and balanced life.
Similarities Between Borderline Personality Disorder (BPD) and Autism
Both people with BPD and ASD face multiple social and communication difficulties with interactions and developing relationships. People with BPD and ASD may sometimes struggle with responding to social cues and understanding different social interactions, which leads to difficulties in forming as well as maintaining meaningful connections.
Emotional dysregulation is also a shared trait, as people with autism and borderline personality disorder may experience intense emotions and face challenges when regulating and managing them. This can lead to intense mood swings, self-destructive behaviours as well as impulsivity.
Social Challenges
People with BPD and ASD often face communication difficulties as well as social challenges; however, the reasons are not always the same. People with autism may find it difficult to maintain relationships due to withdrawal or social avoidance and face challenges reading social cues while having difficulties expressing their emotions and words. People with borderline personality disorder might find it hard to maintain relationships due to frequent mood swings, fears of abandonment and emotional dysregulation.
Emotional Dysregulation
One of the most significant similarities between ASD and BPD is emotional dysregulation. In both cases, people may face challenges expressing emotions and understanding other people’s feelings. People on the autism spectrum may struggle to express their needs and may use gestures and verbal cues. At the same time, people with BPD are also prone to emotional dysregulation due to a deep sense of mistrust, intimacy challenges as well as cognitive distortions. This is known to result in complicated relationships and friendships.
Sensitivity with Abandonment
Individuals with borderline personality disorder, as well as autism, can experience some increased sensitivity to abandonment; however, the reasons are different. In BPD, the fear usually stems from having a history of unstable relationships or fear of rejection, so people with BPD may be stressed about real or imagined abandonment, which causes intense emotional reactions.
For people with autism, the sensitivity to abandonment could stem from challenges in understanding and navigating social relationships, which could cause challenges when interpreting social cues and forming connections with other people.
Difficulty with Change
Both autism and BPD can lead to challenges when coping with change. In BPD, these difficulties usually arise from a fear of abandonment or perceived rejection due to changes in routines or relationships. People with BPD may become stressed and anxious when faced with changes, which is known to cause intense emotional reactions.
For autistic people, the difficulties that stem from change are often related to the preference for routine and predictability. Individuals may find some comfort in familiar routines and settings, and the resistance to change can lead to developing anxiety and discomfort.
Difficulty Understanding Social Cues
Both autism and borderline personality disorder can lead to challenges in understanding social cues, which is one of the shared personality traits. In BPD, the difficulty may stem from increased emotional sensitivity, and some people with BPD may find it difficult to interpret non-verbal cues, which can lead to misunderstandings and potential challenges with social interactions.
For autistic people, difficulty with social cues is common. Some people find it challenging to pick up facial expressions and understand people’s gestures and body language, leading to difficulties in forming relationships and feeling isolated.
Isolation
Isolation is a common experience for people who are diagnosed with both ASD and BPD; however, the causes are different. People with BPD may feel isolated due to unstable relationships or intense emotional reactions, which can lead to withdrawal as a coping mechanism for protecting oneself from rejection or abandonment.
For autistic people, isolation could stem from challenges with understanding social interactions and how to respond to them. They may have difficulty maintaining or initiating relationships, so they often prefer being alone and avoiding the stress of social engagement.
Overlapping Behaviour Traits
Borderline personality disorder and autism have overlapping traits. Here are some of the most common characteristics:
- Difficulty understanding social cues
- Sensitivity to abandonment
- Emotional dysregulation
- Self-harming behaviours
- Social challenges
- Mood swings
Differences Between Borderline Personality Disorder and Autism
Borderline personality disorder and autism are ultimately significantly different and require unique approaches and support, and we will explain more about the differences in the following paragraphs.
Main Features and Diagnostic Criteria
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), borderline personality disorder is a personality disorder that manifests with cognitive distortions, intense impulsivity and challenges with interpersonal relationships.
BPD commonly involves challenges in interpersonal functioning as well as difficulties with intimacy and trust. The lingering negative self-image and fear of abandonment make it hard to establish emotional stability.
The main traits of BPD include:
- Unstable personal relationships
- Fear of abandonment
- Impulsiveness and mood fluctuations
- Self-harming behaviour
- Feelings of emptiness
- Difficulty controlling anger
Autism spectrum disorder is a neurological difference and part of neurodiversity. It is not a mental health condition. Autistic people commonly experience challenges with social communication, emotional dysregulation and sensory challenges that can affect all spheres of a person’s life.
Common autistic traits include:
- Difficulties accepting change
- Challenges in building and understanding relationships
- Challenges with non-verbal communication in different social interactions
- Difficulty regulating emotions
- Strong pattern recognition
- Sensory challenges
Development
Autism is a neurological difference and a part of neurodiversity. It often becomes apparent in early childhood, although some people are not diagnosed until adulthood. It is considered to have some genetic component; however, the exact causes are not fully understood.
Borderline personality disorder often becomes noticeable in early adulthood or late adolescence, and it is associated with complex factors like genetic predispositions and environmental influences. The symptoms of BPD become more pronounced as people face triggers or emotional challenges.
Social Interactions
People with BPD or Autism Spectrum Disorders may experience challenges in various social interactions. For autistic children, social difficulties may arise from a fundamental difference in processing social cues, as individuals may have difficulty understanding non-verbal communication, like body language and facial expressions, which can lead to challenges in forming and maintaining relationships.
Individuals with BPD may face intense sensitivity to perceived or imagined rejection and may exhibit impulsive behaviours in an attempt to maintain closeness to others. This can also lead to a pattern of intense and turbulent social interactions. Despite these differences, it is essential to remember to be understanding and patient while tailoring the approaches to improve well-being and social interactions.
Sensory Sensitivities
People with autism often experience sensory challenges due to hypersensitivity or hyposensitivity to lights, sounds, smells and textures. This can lead to sensory overload, distress and discomfort. For example, an ordinary sound may overwhelm autistic people, and some individuals may seek out other sensory experiences like rocking or hand flapping.
Sensory sensitivities are not a prominent feature of BPD, but many individuals experience intense emotional reactions. The distinction outlines the importance of understanding and recognising the unique characteristics related to each challenge.
Identity and Self-Image
Autistic individuals may face challenges developing or expressing a flexible and nuanced sense of self. They may exhibit a different self-understanding focused on routines and interests. This can lead to a stronger attachment to particular subjects and activities and stability and comfort. It may also result in difficulty adapting to new situations.
In borderline personality disorder, identity disturbances are a primary trait, and people with BPD often experience an unstable self-image, which can lead to feelings of confusion, emptiness, and constant search for one’s true identity.
Overlapping Risks
There are many overlapping risks for individuals with BPD and autism. It’s important to understand the risks to protect people’s well-being and for an accurate diagnosis.
Eating Disorders
Based on the statistics, both autism and BPD have high rates of eating disorders, which may function as a coping mechanism for intense emotions and other challenges. According to studies, about 50% of people with BPD meet the criteria for eating disorders. For autistic people, researchers suggest that about 20% of people on the spectrum are diagnosed with anorexia nervosa.
Self-Harm
Self-harm is often present in both ASD and BPD, but in autistic spectrum conditions, it occurs due to sensory overload, while in BPD, it is a way to cope with distress.
Substance Abuse
People with high-functioning autism face an increased risk of developing substance or alcohol abuse. This is often used as a coping mechanism for sensory challenges and social anxiety. Additionally, 50% of people diagnosed with a personality disorder have a co-occurring substance misuse disorder, which may be the result of a coping mechanism for emotional distress.
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FAQs
Can BPD and autism be confused with each other?
Many individuals wonder about the similarities between BPD and autism, particularly regarding social difficulties and emotional regulation. Understanding the distinctions between the two conditions can help clarify any confusion and guide appropriate assessment and treatment.
How do you differentiate between BPD and autism?
This question often arises as people seek to understand the specific criteria and diagnostic indicators used to distinguish between borderline personality disorder and autism spectrum disorder. Exploring the unique features of each condition, such as patterns of social interaction, emotional expression, and sensory processing, can provide clarity on differentiation.
Can someone have both BPD and autism?
Individuals may inquire about the possibility of co-occurring BPD and autism, as both conditions can present challenges in social functioning and emotional regulation. Understanding the complexities of dual diagnosis and the potential overlap of symptoms can inform assessment and treatment strategies tailored to address the individual’s unique needs.
