Getting accurate diagnoses for mental health conditions can be a challenge, particularly when mental health conditions have overlapping symptoms. This is the case with BPD vs. Autism. There are several complexities in diagnosing and differentiating mental health disorders, particularly Borderline Personality Disorder (BPD) and Autism Spectrum Disorder (ASD), but with the correct diagnosis, individualized treatment strategies can be managed.

Overview of BPD and Autism

A borderline personality disorder is one of 10 personality disorders, whereas Autism falls under the category of neurodivergent disorders. Borderline personality disorders are characterized as unstable emotions, self-image, relationships, and impulsivity, while Autism can also be characterized as having unstable emotions, relationships, and impulsivity, but as a result of slightly different causes.

Symptomatology Comparison

When looking at BPD symptoms vs. Autism, it’s easy to see the overlap.

Emotional and Behavioral Symptoms

For starters, when looking at BPD symptoms vs. Autism, there are shared traits with regard to emotional regulation and behavioral symptoms, but they stem from different things.

Borderline personality disorder will manifest as having poor emotional regulation, an individual who has trust issues, and problems forming intimate relationships. They might be emotionally intense where it’s not necessary, jumping back and forth between an idealized version of themselves and their relationships and a devalued version.

This, along with a fear of abandonment and poor self-image, can lead to impulsive behaviors that are harmful, such as:

• Spending sprees
• Binge eating
• Reckless driving
• Substance abuse

There are overlaps between the emotional and behavioral symptoms, but individuals with Autism engage in repetitive behaviors that are often outside of social norms and don’t have the emotional development that other people do. Emotional expression and even comprehension of other people’s emotions are very challenging and can disrupt social interactions and relationships.

Social Interaction and Relationships

One of the biggest differences between BPD vs. Autism has to do with the core characteristics. Those with borderline personality disorder have unstable emotions and problems with interpersonal skills, which affect their social interactions and relationships. However, Autism presents as having challenges with repetitive behavior and social communication.

For example:

Someone who struggles with borderline personality disorder might have trust issues and find it difficult to maintain relationships with people they like because they are constantly worried that they will be abandoned by that person, and this anxiety can lead to intense anger or mood swings as well as impulsivity that causes the other person to leave.

Someone who struggles with Autism will have difficulty with social interactions and relationships because they don’t understand them, so they won’t pick up on nonverbal cues. They don’t necessarily have eye contact in their relationships or understand the exchange of social reciprocity, and this can make it difficult to start relationships, let alone maintain them.

Cognitive Functions

Autism presents as having problems with cognitive function, particularly with regard to repetitive behaviors. Individuals who struggle with Autism will engage in repetitive behaviors like fixating on unique interests that are considered abnormal or unique rituals. These impulsive or repetitive behaviors are typically there to help control sensory input or self-soothe.

By comparison, while people with BPD vs. Autism share repetitive behaviors, those with borderline personality disorder have impulsivity that stems from the lack of emotional regulation. An unstable self-identity means that they are more likely to utilize self-harm actions in response to that dysregulation, not as a way to manage sensory sensitivities.

Diagnosis and Assessment Challenges

It can be difficult to differentiate between Autism vs. BPD.

Overlapping Symptoms

There are several overlapping symptoms at face value:

• Low empathy for others
• Poor emotional regulation
• Difficulty with social relationships
• Problems with social cues
• Self-harm tendencies

Diagnostic Criteria

However, overcoming the diagnosis and assessment challenges is made easier when you work with a professional psychiatrist or therapist who can help you understand the causes of these shared traits. There are notable differences between them, and understanding the reasoning behind things like low empathy or repetitive behaviors can help shed light on which diagnosis is more accurate.

Importance of Accurate Diagnosis

Getting an accurate diagnosis is essential to finding the right type of treatment. Not all treatment strategies work for everyone, and getting medication or therapy for the wrong condition can deter successful outcomes.

Treatment Strategies and Management

Treatment strategies and management do have some overlap.

Treatment Approaches for BPD

For borderline personality disorder, the main treatment is therapy. With borderline personality disorder, things like dialectical behavioral therapy can help individuals change the way they see their world and their relationships and learn to adjust so that they can successfully live with their condition long-term.

Dialectical behavioral therapy provides an opportunity for individuals with BPD to break the negative cycle of having intense emotions and then letting those emotions think that they are a bad person.

Sometimes holistic treatment like art therapy or music therapy can provide a way to better express thoughts and emotions rather than expressing them verbally.

In certain cases, medication can be prescribed to help with specific symptoms, though not to reverse the condition. These might include anxiety medications or depression medications.

Treatment Approaches for Autism

For Autism, treatment can include a diverse combination of:

• Behavioral treatment like social skills training
• Education
• Developmental therapy
• Medication

Things like behavioral training can help someone with Autism develop living skills or social skills, understanding emotional cues or humor, and teaching them how to carry on conversations with others.

Speech and language therapy serves as a developmental therapy to help people with Autism learn to use language.

For those who need it, occupational therapy might be used to help them build independence, developing basic skills like dressing, bathing, and eating.

In some cases, medications like antidepressants or antipsychotics can be prescribed, although there is no single treatment meant for Autism.

Integrative Care Needs

Integrative care needs are essential. There is no single combination of treatments that helps reverse Autism or borderline personality disorder but instead helps individuals learn to live with their condition and manage symptoms appropriately.

Special Considerations for Females

When you look at female Autism vs. BPD, there are some special considerations.

Gender Differences in Presentation

With BPD vs. Autism and females, there are some gender differences. BPD is more commonly diagnosed in women than it is in men, and yet Autism is underdiagnosed in women because women can typically build better social engagement or hide any vulnerabilities.

For example:

A woman who is autistic and obsesses with a unique hobby that she constantly tells other people about might be considered social or chatty instead of being recognized as autistic.

There are other gender differences in presentation for things like BPD, where women are more likely to experience mood issues, eating issues, and anxiety in relation to BPD.

Challenges in Diagnosing Women

It can be difficult to recognize BPD vs. Autism and females because women are better at masking their symptoms, and they can learn to mimic things like facial expressions or socially acceptable behaviors.

Some of the current tools used to diagnose Autism recognize characteristics that are less common in women and more common than in men, which can lead to a bias in the healthcare industry.

With borderline personality disorder, the symptoms share similarities to many other conditions like depression, bipolar disorder, and anxiety. Moreover, stereotypes about women being overly emotional continue to exist, and this can lead to the symptoms of BPD being dismissed or misdiagnosed.

Conclusion

There are key distinctions in the core causes of characteristics between BPD vs. Autism, and yet there are several overlapping aspects that have to do with poor social relationships, emotional regulation, impulsivity, and behaviors. It is important to understand the nuanced differences in order to get an accurate diagnosis, particularly for females, and from there, to receive personalized treatment.