Misdiagnosis between autism and borderline personality disorder (BPD) is increasingly recognized in clinical practice, especially in adults and autistic women. Because both share overlapping characteristics related to social struggles and emotional intensity, they’re often mistaken for one another. Understanding the nuances “why” behind those experiences is important and can be the first step towards finding the right support.
Autism and Borderline Personality Disorder: Similar Characteristics but Different Origins
Interpersonal Struggles
Autistic people and people with BPD may struggle with interpersonal relationships, but for different reasons.
Autistic individuals tend to struggle because of lack of social intuitiveness and processing issues. For example, an autistic person may struggle do better in one-on-one social interactions versus groups. They may struggle socially if communication is not clear or direct enough. A lot of energy and effort is needed to navigate social situations, even if others perceive the autistic person to be socially “successful”.
Individuals with BPD are often initially perceived as socially pleasant. However, over long periods of time, they often experience unstable relationships as a result of emotional dysregulation and impulsive behaviors stemming from emotional dysregulation. Relationships can be sources of great happiness and stress and a fear of abandonment is intense.
Emotional Regulation
At a glance, emotion dysregulation in autism and BPD can look similar. However, the root cause of dysregulation is often often different.
For autistic individuals, emotion dysregulation often stems from “overload”. For example, sensory overload as a result of too many sensory inputs or too much of a negative sensory input. Communication struggles, such as feeling misunderstood despite making great efforts to communicate neutrally and effectively, can result in significant emotional dysregulation. Additionally, unexpected changes to plans or routines can bring about a “meltdown”.
For those with BPD, emotional dysregulation typically stems from interpersonal stress, rooted in attachment insecurity. For example, the fear of abandonment can cause extreme emotion distress. Sometimes invalidating comments or perceived criticism can bring about emotional dysregulation.
Why Autistic Women Are Often Misdiagnosed with BPD
A growing body of research shows that autistic girls and women are more likely to receive other psychiatric diagnoses, such as BPD, before receiving an autism diagnosis. This may be related to masking or camouflaging of autistic traits, social expectations and gender biases in mental health assessment, or internalized expressions of autistic traits where external behaviors resemble emotional dysregulation.
Can Autism and BPD Coexist?
The research indicates co‑occurrence is possible; though, prevalence estimates vary and more large-scale studies are needed to clarify how often this happens and what influences it. One study interestingly found that many individuals diagnosed with BPD exhibit subthreshold autistic traits and that autism and BPD may co-occur at higher rates than originally thought.
The Impact of Misdiagnosis
Mislabeling an autistic adult as having BPD can be harmful. Clinical experiences and qualitative research show that people with autism who have received a BPD diagnosis often feel misunderstood, stigmatized, and directed toward interventions that do not address their actual needs.
In contrast, a correct autism diagnosis can open avenues for neurodiversity-affirming support, sensory regulation strategies, and social communication interventions that promote wellbeing and self-acceptance.
Common FAQs: Autism vs BPD
Can someone have both autism and BPD?
Yes, autism and BPD can co-occur. Research indicates that some individuals diagnosed with BPD may have elevated autistic traits, highlighting the need for a comprehensive assessment to accurately rule in or rule out diagnoses.
What are common signs that autism has been misdiagnosed as BPD?
As noted above, it’s possible to be autistic and have BPD. However, many autistic individuals are misdiagnosed with BPD. That may be the case if social interactions confuse you, you struggle with sensory overload, you have strict routines or ways of doing things, and/or have very deep passions that feel all encompassing.
What are the treatment differences for autism vs BPD?
Neurodivergent-affirming support for autism typically focuses on better accommodating yourself, addressing internalized ableism, setting healthy boundaries, and navigating social dynamics. “Gold standard” treatment for BPD is Dialectical Behavioral Therapy, which focuses on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
Take the Next Step: Work with a Clinician Who “Gets It”
Diagnoses are only useful if they are accurate and can provide a useful roadmap to a better life. If you feel like your current diagnosis leaves out a huge piece of your identity, it is time for a second look.
Seeking an assessment with a clinician who specializes in the non-stereotypical presentations of autism (sometimes called high-masking autism) and the nuances of neurodivergence can be life-changing. You deserve to understand your brain for what it actually is, not what it’s been mistaken for.
Ready to gain clarity? Email Dr. Lee to schedule a therapeutically-focused, neurodivergent-affirming adult autism assessment.
Already know that you’re autistic and want neurodivergent-affirming support? Contact us or book a free 20 minute consultation call with Dr. Barajas, Dr. Goldman, or Dr. Han to see how we can help.
