Engendering misunderstanding: autism and borderline personality disorder

Abstract

Objective and Method: Female autism can be misdiagnosed as borderline personality disorder, leading to mistreatment and unnecessary harm. By educating clinicians on how female autism can mimic borderline personality disorder, we can increase the accuracy and effectiveness of diagnosis, ultimately improving patient outcomes.

Result: There is a common myth that clinicians can easily recognise borderline personality disorder, leading to a shortcut in the diagnostic process and the potential for missing signs of autism in early childhood.

Conclusion: Clinicians must be encouraged to pursue thorough differential diagnoses, especially for women and transgender individuals who experience emotional lability with self-harm.

KEY POINTS

• Autism is underdiagnosed in girls, women, and transgender individuals due both to diagnostic bias, and the quieter, less visible signs and symptoms of female autism.

• As females are so adept at camouflaging difference, distress generally only becomes manifest during mid childhood and adolescence, when mental illness gets misidentified as primary cause.

• Early mood difficulties often transform into more serious distress with emotional lability and self-harm. This can get misrecognised as borderline personality disorder, causing preventable harm.

• Borderline personality disorder is something that clinicians often feel they can recognise immediately, increasing the need to consciously think about differential diagnoses especially when presented with females who self-injure.

Keywords:

• Borderline personality disorder
• autism
• female autism
• diagnosis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.