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BPD vs Autism: Similarities and Differences

December 18, 2023

Changes in mood, seemingly emotional instability, and intense emotional outbursts… These are signs of both borderline personality disorder and autism, so what are their differences? Is it possible that your child has both?

Studies have discovered that some individuals with autism spectrum disorder (ASD) also present with a form of personality disorder. Of the various forms of personality disorders, borderline personality disorder (BPD) and autism as a combination seem to be the most prevalent.

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Understanding Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD), as defined by the DSM-5, is a condition marked by instability in relationships, self-image, and emotions, along with impulsive behaviors. 

Individuals with BPD often struggle with:

  • poor empathy,
  • trust issues, 
  • difficulties in forming intimate connections,
  • impulsivity,
  • antagonism,
  • disinhibition,
  • emotional intensity.

The DSM-5 outlines specific symptoms of BPD, including:

  • Fear of abandonment, leading to frantic efforts to avoid it.
  • Unstable relationships, described as “splitting,” involving extremes of idealization and devaluation.
  • Disturbance in self-image, affecting mood, values, opinions, goals, and relationships.
  • Impulsivity in potentially self-damaging areas such as spending, sex, substance abuse, reckless driving, or binge eating.
  • Self-harming behaviors, including recurrent suicidal thoughts, gestures, threats, or self-mutilation.
  • Intense mood swings, with marked reactivity lasting a few hours to rarely more than a few days.
  • Chronic feelings of emptiness.
  • Inappropriate, intense anger or difficulty controlling anger.
  • Stress-related paranoid thoughts or severe dissociative symptoms.

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Similarities Between BPD and Autism

A 2017 study comparing the empathy between BPD and ASD found that empathy in both conditions was low. The symptoms of BPD and autism spectrum disorder have been found to overlap, with common traits including difficulties in social understanding.

A study conducted in 2021 specifically delved into understanding both affective and cognitive empathy, bringing attention to shared aspects of these two forms of empathy.

The list below summarizes key similarities between BPD and ASD:

  • Low empathy: Both BPD and ASD show low empathy.
  • Symptom overlaps: Significant overlap occurs, especially in struggles with understanding social cues.
  • Self-harm tendencies: Both involve self-harm, although ASD links to sensory overload, while BPD connects to emotional issues.
  • Emotional regulation: Issues with emotional control affect empathy in BPD and ASD.
  • Social interaction challenges: Shared difficulties in social interactions contribute to empathy-related problems in both BPD and ASD.

BPD vs Autism: What are the Differences?

Although they share some similarities, Borderline personality disorder (BPD) and autism are distinct mental health conditions with notable differences. Let’s explore the key distinctions between them.

Nature of the conditions:

  • BPD: A personality disorder marked by emotional instability, self-image issues, and challenging interpersonal relationships. Features include intense mood swings, impulsivity, and difficulty regulating emotions.
  • Autism: A neurodevelopmental disorder primarily characterized by challenges in social communication and interaction, repetitive behaviors, and restricted interests.

Development:

  • BPD: Symptoms typically emerge in late adolescence or early adulthood, potentially improving with age and therapy.
  • Autism: Symptoms are evident early in childhood, representing a lifelong neurodevelopmental condition. Early intervention and therapy can assist in managing challenges.

Social interaction:

  • BPD: Individuals may struggle with unstable relationships and an intense fear of abandonment, facing difficulties in maintaining stable interpersonal connections.
  • Autism: Persistent challenges in understanding and engaging in social interactions, including difficulty with nonverbal cues, eye contact, and social reciprocity.

Emotional regulation:

  • BPD: Emotional dysregulation is a common sign, leading to rapid mood swings, intense anger, and impulsive actions.
  • Autism: While emotional expression and understanding others’ emotions may be challenging, these difficulties differ from the emotional instability seen in BPD.

Repetitive behaviors:

  • BPD: Impulsivity is common, involving self-harming actions or unstable self-identity.
  • Autism: Repetitive behaviors manifest as rituals, obsessions, or fixations on specific interests, often serving as a way to self-soothe or manage sensory sensitivities.
Borderline Personality Disorder (BPD) and Autism
https://www.autismparentingmagazine.com/borderline-personality-disorder/

Are Autistic People Often Misdiagnosed with BPD?

It is possible to diagnose an individual with both autism and BPD. Often, for such a diagnosis, the risk of suicide increases due to the symptoms and distress caused by this comorbidity, highlighting the importance of appropriate and accurate diagnosis.

Many wonder if BPD and autism are more common in females. A 2021 research article mentioned an older study’s findings that 15% of 41 female patients with BPD fulfilled the criteria for ASD.

Individuals with both undiagnosed and diagnosed comorbidity experienced more frequent suicide attempts, negative self-image, and lower global functioning.

It is not clear whether autistic people are being misdiagnosed with BPD. However, there’s sufficient evidence to consider a diagnosis of both these conditions to rule out any possibility of comorbidity or co-occurrence.

Accurate diagnosis is essential as, if symptoms of both ASD and BPD are left untreated, it could pose a risk should it be found to be comorbid.

Navigating the Autism and BPD Comorbidity

It is unknown whether some autistic children are misdiagnosed with BPD, but these two conditions can co-occur. Parents need to consider consulting with a qualified practitioner should there be a concern that their autistic child or children show symptoms of borderline personality disorder.

As always, prevention is better than cure. Therefore, if it is suspected that there’s any possibility of an autistic child also presenting with BPD, prompt diagnosis is required to receive adequate treatment and prevent the risk associated with carrying both diagnoses due to the mental health challenges that arise.

FAQs

Q: Can you be autistic and have BPD?

A: Yes, an individual can have Borderline personality disorder and autism. However, a thorough assessment by a mental health professional is crucial for an accurate diagnosis.

Q: How are BPD and autism similar?

A: While BPD and autism share challenges in social interaction and emotional regulation, they differ in their core characteristics, with BPD involving emotional instability and interpersonal difficulties, while autism primarily features difficulties in social communication and repetitive behaviors.

Q: What treatment is effective for both BPD and autism?

A: The treatment effectiveness for individuals with both BPD and autism may vary, but a tailored approach that combines elements of psychotherapy and behavioral interventions has shown promise in addressing overlapping symptoms and improving overall functioning.

Q: How can you help someone with autism and BPD?

A: Supporting individuals with BPD and autism requires patience, understanding, and seeking guidance from mental health professionals. Family involvement in therapy and treatment planning can be highly beneficial.

References:

DSM-IV and DSM-5 Criteria for the Personality Disorders
https://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf

Empathy, Mentalization, and Theory of Mind in Borderline Personality Disorder: Possible Overlap With Autism Spectrum Disorders
https://www.frontiersin.org/articles/10.3389/fpsyg.2021.626353/full

The overlap between autistic spectrum conditions and borderline personality disorder
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184447

Correlates of autistic traits among patients with borderline personality disorder
https://www.sciencedirect.com/science/article/abs/pii/S0010440X18300026

Investigating the Relationship between Autistic Traits, Ruminative Thinking, and Suicidality in a Clinical Sample of Subjects with Bipolar Disorder and Borderline Personality Disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151773/

Case Report: Mechanisms in Misdiagnosis of Autism as Borderline Personality Disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8855062/

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