Autism and Borderline/ Emotionally Unstable Personality Disorder

Evidence indicates that 4% of autistic people also have bpd and 3% of those with borderline personality disorder also meet the autism criteria. (1)

Many late diagnosed autistic people are often first misdiagnosed with EUPD before discovering that they are actually autistic. Many are also diagnosed with EUPD after receiving their autism diagnosis due to a lack of understanding of autism & the overlap between these two conditions.

Autism is a neurological condition that is present from birth & affects how people interact & communicate with the world. It has a lifetime prevalence of 1% (2) & is more often diagnosed in those who have been Assigned Male At Birth close to a ratio of 3:1. (3)

Borderline Personality Disorder (EUPD/BPD) is a mental health condition that affects how people think, feel & interact with others which has been linked to traumatic childhood events such as abuse & neglect. It has a lifetime prevalence of 5.9% (4) & is more often diagnosed in those who have been Assigned Female At Birth (account for 70% of patients with BPD). (5)

Overlapping Experiences & Key Distinctions

1. Emotional Instability :

Autism – Emotional upset is often caused by sensory/cognitive overload or unexpected change & sensitive to the emotional atmosphere.

BPD – Emotional upset is often due to rejection, failure, abandonment or interpersonal conflict & psychotic symptoms may be experienced

2. Sensitivity to Abandonment :

Autism – Rejection Sensitive Dysphoria (RSD) can appear similar & tendency to catastrophise emotions

BPD – Core fear of abandonment & extreme actions taken to avoid this

3. Relationship Difficulties :

Autism – Difficulties making & maintaining friends, often due to masking, social anxiety & masking

BPD – Unstable relationships due to splitting (intense periods of idolisation followed by devaluation)

4. Inappropriate & Intense Anger :

Autism – anger outbursts during meltdowns or when overwhelmed

BPD – appear short tempered & frequent outbursts

5. Increased Risk of Suicidality & Self Harm :

Autism – Self harm typically occurs during sensory overload & autistic people are 3 times more likely to attempt/ die by suicide (6)

BPD – Self harm typically occurs in the aftermath of attachment injury/relationship conflict & 1 in 10 BPD patients die by suicide (7)

6. Substance Abuse/ Addiction :

Autism – twice as likely to abuse substances (8): alcohol/drugs used to cope with & soothe social stress or sensory issues

BPD – found in 50% of patients & due to impulsivity & emotional dysregulation (9)

7. Chronic Feelings of Emptiness :

Autism – due to masking & continuous changing of identity, experienced during burnout or when not engaged in a task

BPD – often feel like something is missing

8. Identity Disturbance/ Unstable Self Image :

Autism – likely to explore different genders, masking to fit in

BPD – frequently change goals, sexual identity, beliefs & vocational aspirations, unable to determine on own

9. Paranoid Ideation & Disassociation:

Autism – paranoia due to social anxiety/ previous mistreatment (bullying), disassociation often present in sensory overload

BPD – 40-50% of patients experience paranoid thoughts and/or auditory hallucinations, depersonalisation, or derealisation (10)

Distinguishing Between the Two

Though there are many similarities between these two conditions that may cause confusion, there is a way to differentiate between the two – focus on Criteria B in the Diagnostic Criteria. Though some of those with BPD may also experience these traits it is far less common.

Criteria B:

Sensory processing differences (under- reactivity, over- reactivity etc,)

Repetitive movements & behaviour (stimming, lining up toys etc,)

Intense, obsessive interests or attachment to objects

Inflexible & ritualistic behaviour (adherence to routine/repetition, literal thinking etc,)

Conclusion

My conclusion is that this topic is all very confusing and complicated. I myself have been recently diagnosed with Borderline Personality Disorder and I’ve found there to be a huge lack of information and research surrounding this area. There are so many people in the world with a misdiagnosis of BPD instead of autism and this is simply due to the lack of understanding from clinicians.

This is something that I hope to research more during my Psychology degree at university.

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