‘I was never broken—I just don’t fit in this world.’ A case report series of misdiagnosed women with higher functioning ASD

Abstract

Background

Differentiating between autism spectrum disorders (ASD) and borderline personality disorder (BPD) is hampered by diagnostic difficulties as there seems to be a significant overlap in symptoms.

Methods

A case series of six women with ASD and a previous diagnosis of BPD is presented.

Results

In retrospect, the women did not present with significant symptoms until they had developed comorbidity, which clinicians in turn misinterpreted. The missed diagnosis or misdiagnosis had significant implications for their prognosis and current level of functioning. This suggests in line with previous research, that women with higher functioning ASD are more at risk of being overlooked.

Conclusion

It is suggested in the literature and supported by this case series that ASD should be ruled out by obtaining a thorough developmental history by an experienced clinician before considering a BPD diagnosis.

Keywords:

• Higher functioning ASD
• misdiagnosis
• comorbidity
• borderline personality disorder
• females at risk

Informed consent statement

All six patients have given oral or written consent to reproduce parts of their story anonymised. If required by the editor, I am allowed to disclose the identity of the patients involved.

Disclosure statement

The author declares no conflict of interest.

Additional information

Notes on contributors

Pernille Darling Rasmussen

Pernille Darling Rasmussen, MD and PhD, specialising in Child and Adolescent Psychiatry. She is affiliated with the Center for Evidence-Based Psychiatry in Region Zealand, Denmark.