Saturday, September 21, 2013

Borderline Personality Disorder and Autism

So I found this nifty article written by a woman with Aspergers who was originally potentially being misdiagnosed with Borderline Personality Disorder so she looked into it and decided to discuss the similarities and differences. I know there has been some interest in this previously but I really don’t feel qualified to talk about Autism, however as this is a first person experience I think this would be helpful and useful to those that have expressed interest before.

By aspertypical on June 12, 2013

Emotionally charged meltdowns, intense relationships, superficial friendships, miscommunications and incorrectly assumed intentions. A lot of people with Asperger’s syndrome could identify with this list. An equal number of those with Borderline Personality Disorder (BPD) could also identify with this list. With individual’s on both sides being misdiagnosed with the other condition, what are the key differences and how can we tell them apart?

Those with a Borderline Personality Disorder (BPD) often present with a pattern of significant impulsivity and instability of affects, interpersonal relationships and self-image. This can manifest itself in an intense fear of abandonment and intense anger and irritability, particularly when others fail to understand them. Typically they flip between idealization and devaluation of others, alternating between high positive regard and great disappointment, and frequently display suicidal and self-harming behaviors**. A world apart from the often black and white mechanical thinking of an individual on the autism spectrum, where objects and animals often gain a greater significance than humans, and where other people’s thoughts are not even understood let alone open to manipulation. Yet the functioning of both individuals can appear the same, and frequently those with autism are misdiagnosed as having a personality disorder, particularly BPD, before their autism is recognized*; this is especially true for females.

Faced with the choice of BPD or ASD my psychiatrist precariously leant on the side of the former. Borderline is most common in females and could be considered an extreme form of the female brain, in much the same way that autism has been considered an extreme form of the male brain. So of course being presented with a depressed and anxious patient, who seems to be oversensitive to all forms of treatment and a general pain in the arse (PITA), shoving them into the bracket of ‘unstable female’ would seem like an appealing option. Fortunately for me I had a team of Asper-believers (namely a therapist, my mum, girlfriend and a few friends), and an imminent date with an adult autism assessment clinic to squash those BPD rumors circling my mental health records. What others should have noted was my lack of displayed emotion, my evident self directed anger, and my desperate struggle to please everyone and not miscommunicate as key signs that my personality was not disordered, my entire neuronal network was disordered and I was desperate to gain control over it. So why did they look the same in me and so many other women?

Autism expert Tony Atwood believes that this misconception of females on the spectrum comes from their ability to hide their autism better than males, resulting in behavior patterns which can mimic those with BPD. This is particularly true if in an effort to mask social confusion and appease others, she models herself on someone else to achieve social success; in the unlikely event that that person happens to have BPD then she has no hope! This can lead to fake and forced social interactions, which can lead others to feel she is manipulative and superficial and completely divert away from the fact she has an ASD. On the other hand the Aspie’s experience of bullying, rejection and betrayal can lead to fears of abandonment and intense and unstable relationships with others, mimicking a BPD.

Fortunately there are some key differences between the two disorders which set them apart. Firstly, whilst those with Asperger’s Syndrome do not get social cues or misunderstand them, those with Borderline Personality Disorder are hyper aware of them, but often distort them. Whilst both can have impairments when it comes to empathy, those with Asperger’s do not understand the social norms that go with a situation, whereas someone with BPD may exploit and manipulate the situation.

Sorry this is the one place I’m going to interject. This whole manipulation thing is overblown and completely misunderstood. People read “manipulation” and think of it in a purposefully trying to take advantage of another person type of way that say, a sociopath might. That’s not what is happening here. With BPD it’s the fundamental lack of communication skills that lashing out from our own internal pain to gain the attention in times of need that is often misconstrued as “manipulation”. It’s not intentional, it just is.

Because of this those with a BPD are often better able to appear charming and sociable, but on the flipside they can be incredibly manipulative of others**, whereas the manipulation of those with Asperger’s derives from an almost obsessive need to control their surroundings and to please themselves. In terms of self-harming behavior both are vulnerable, typically though those with Asperger’s use it to release inner tension, whilst those with BPD may be using it as a cry for help. Generally BPD behavior seems to be a result of defense, usually manifesting itself in late teens and adolescence and commonly developing after a particularly unstable childhood. As we know (or should know, read more of my blog if not!), those with an ASD are born with the condition, it may only become apparent to others over time but it must have always been there.

The danger is in thinking that those with BPD are to blame for their behavior, and I am the first to admit that my prejudice led me to believe it was an attention seeking disorder. It was only after I researched the issue and spoke to those who have worked with them, that it became apparent that those with BPD are no more in control of their behavior than those with an ASD. There tends to be a lack of awareness on both sides as to why their behavior has manifested in the way it has, and actually the treatments for both disorders can benefit the other. Neither respond particularly well to medication, but therapy with an emphasis on interpersonal relationships can hold the key. Particularly work focused on mentalization, which encourages a greater awareness of the intentions of oneself and those around them. Mentalization-based treatment (MBT) was developed with Borderline Personality Disorder in mind, the object of which was to increase the mentalization capacity in patients which should improve affect regulation and interpersonal relationships. For those Aspies who lack a theory of mind (the ability to understand others mental states), this type of therapy can also be incredible beneficial, even in those like me who, on a much more mild level, just struggle sometimes to interpret the intentions of others.

So it seems that BPD is on the borderline of Aspergers in behaviors and functions alone, the gap between the two in terms of origin and mental processing couldn’t be any wider or the two any more diverse. Deemed as ‘incurable’ however, the treatment for both is focused on behaviors, and because of this the two are still tied together in harmony.

Treatment for BPD also focuses on reprogramming how we think. It’s not just about behavioral reprogramming.

If you’ve just scrolled to the end and couldn’t be bothered to read this, someone’s beat me to it and created a much more entertaining video!

So she makes a good point in the video. Her psychologist was point at aspect of things that could have indicated BPD but that she didn’t feel were very extreme or that inhibited her quality of life…. Which makes it NOT a disorder qualification. I think people really forget this this. Just because it looks like an item on a checklist does not mean it’s actually severe enough to meet the qualification for it.


  1. Interesting. Hmm Ive always thought Aspergers and BPD couldn't be any more different, but apparently it is misdiagnosed. I suppose whil symptoms may appear the same, it's about tracing it back to the cause that really seperates certain diagnosis'.

  2. I think it is the same disorder just looked at differently. Autism is usually looked at as an "innocent", oh they don't know any better/cannot communicate, etc. and more understood/acceptable disorder. Borderline Personality Disorder is looked at as a "manipulative", bad, and highly stigmatized disorder. I have Borderline Personality Disorder (MMPI taken) and on my "good" days, I actually have quite a few traits of Autism. On my bad days, I have behavior consistent with BPD. People with Autism have bad temper tantrums and bad behavior that people don't want to acknowledge. I came across something that said Autism is diagnosed early and BPD isn't. The thing is, not many providers screen kids for BPD (it cannot be diagnosed until adulthood), so they may have it and no one looked for it; yet, Autism is screened quite often in kids. That's why Autism is diagnosed in early childhood and BPD isn't.

  3. Interesting, I have a son who was initially diagnosed at the age of 15 as "being on the autistic spectrum", we were told as parents to go and educate ourselves and deal with him as we saw fit, as the "system" could not provide him with any support.
    After some turbulent times, I finally managed to get a formal diagnosis of BPD when he was aged 19, but then after a few further difficult years and private help, began to realise that his behaviour and problems seemed to go beyond the BPD diagnosis. After much fighting with the "system", we managed to get him some further assessment, whereby now the draft diagnosis is that he has Aspergers, aged almost 21. We are waiting for some further info and the draft report, but are at present unsure just exactly where they place him. It's a real significant problem here in Suffolk, because there is little help or support for a person diagnosed with BPD, but much more for one diagnosed with Aspergers. It's difficult as a parent, because whilst we are most definitely not label searching, it makes a big difference to the availability of appropriate help and support to the person who has been diagnosed. The NHS is clearly significantly underfunded and understaffed in this area. All credit to the professionals who are trying to hold it up though.


Leave me a comment! It makes me feel good and less paranoid about talking to myself =)

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