Moving Towards a Profile 0f Borderline Personality Disorder and Autism

This is a psychological profile, much like my other profiles. It’s not meant as a post to explain why it happens or the trauma behind it, it is just focused solely on the profile, much like my moving towards a female profile of autism profile. Discussions of underlying trauma and the heterogeneity would be another completely different post.

This topic is a part of my MasterClass Train the trainer on the Assessment and Diagnosis of Autism in females.

Part one

For years, I have been asked to comment on my work with individuals that have both Autism and Borderline Personality Disorder (BPD). This is one of my most frequently asked questions. These requests have come from parents, doctors, psychologists, psychiatrists, university professors, parents, family members and partners. Yes, there is an overlap between autistic spectrum conditions and BPD. It is important to note that I am not talking about children. BPD and autism can be mistaken for one or the other they can also be misdiagnosed as they have met any similar traits or someone can be diagnosed with autism and miss the borderline personality disorder which cannot be diagnosed until over 18.

It is not difficult to observe a person who is both Autistic and has Borderline to someone who has worked in the area for some time. that’s not to say that it’s a complex area to work in. There are distinguished elevated traits that define both disorders versus one or the other. They are very obvious traits in those with the profile of a person who has both Autism and BPD. Some people have been misdiagnosed, yes, however there is a profile emerging of individuals who have both Autistic traits and BPD traits. This profile is a complex one, but is noted by many professionals, colleagues and parents who work in this area.

The profile consists of traits from both Autism and BPD, and as such, can be challenging to manage, as reported by parents, professionals, doctors, social workers, the prison system, partners, family members and friends. This profile will be updated on a regular basis.

Differences noted are an elevation of the core areas that cause difficulty for individuals on the Autism Spectrum, including social communication, emotional immaturity and dysregulation, self-harm and suicidal ideation, impulsivity, and a dramatic personality type. A person with Autism is not as histrionic as someone with both Autism and BPD. A person who has both is often observed with the following typical traits:

Complete avoidance of communication as a means of problem solving. Utilizing immature social skills such as telling on others, reporting them to someone else is common.

The sudden Burning of bridges in a much more dramatic and impulsive way than an Autistic person. This has been interpreted by former partners and family members as ‘ghosting’, blocking or reporting the person on social media. It is the suddenness and lack of appropriate explanation that is reported to be very frustrating.

Misunderstanding someone’s good intentions for them in a malevolent way when that is not the intention.

Often impulsively report (or tell on) others for something that the person did not actually do.

Putting words in others people mouths causes the family member, partner or professional to repeatedly say, “I did not say that” or “stop putting words in my mouth” and is reported to be one of the most problematic frustrations by a family member.

Are extremely rigid about how others should behave, however they themselves do not behave in a similar fashion. If they believe someone is not behaving how they think the person should be, they will tell on them, report them or otherwise be self-righteous in policing other people behaviors.

Are often led by their intense emotions, to the extent that they cannot think properly, and act purely from their own emotions and point of view. This presents itself as disallowing a conversation to take place, jumping to conclusions, catastrophizing, putting words in other peoples mouth and ignoring boundaries or misinterpreting someone setting appropriate boundaries.

When someone initiates a boundary (for e.g., “Please dont have anything to do with that person, they are bad news”), the boundary, which was actually meant to help the person, is received and taken as a threat or harassment. The parent or professional has noticed that the person does not understand boundaries and lacks them, hence they try to teach them about boundaries and report finding it next to impossible to get the chance to speak about the importance of boundaries because the person immediately accuses the boundary initiator as harassing them, when that is actually the farthest from the truth. This can often get the Autistic Borderline into considerable trouble with law enforcement, once law enforcement find out the details of what really happened. Multiple parents have reported that when they impose a boundary, it is taken as harassment. In the mind of the Borderline Autistic, they do not understand boundaries and interpret them as harassment. Sometimes it has been reported that they are genuinely surprised when the Police show up at their door to arrest them. Parents have reported being in utter frustration that they “cannot even have a normal conversation about a topic”.

Are often emotionally and socially the emotional age of a child, despite being an adult chronologically. They will react as if they were a child.

They are often are serial complainers and at times may also stalk others or obsess over people, usually a celebrity and at times, act on that. This leads to them getting in trouble with the law for stalking or being an accomplice to stalking. Often their lack of insight and dramatic and dysfunctional social communication deficits, lead them into trouble, due to their use of childish complaints, threats, and inability to have a conversation or resolve a conflict. In other words, parents report that it is almost impossible to have a conversation with them. They report their adult child as behaving more like a child that their age, often not allowing the other person to speak, putting words in their parents mouths (often one of the most frustrating traits for a parent) and obsessing and stalking people. Some examples of this may be following a person, driving by their house, following them on the Internet or social media, loitering near their homes and/or assisting someone else to stalk that person on or off-line. Some have gotten into trouble for not adhering to boundaries between a teacher and a student, usually for sex with a minor.

A simple boundary request is met with a barrage of hostility, accusations and putting words in the person being stalked’ s mouth. This is highly disturbing to the person being stalked and loved ones who only want the best for the Borderline Autistic.

The use of defense mechanism are observed in a very dramatic and erratic fashion. Projection is often used. For e.g,., a person who is asking someone to stop stalking them is not met with any empathy, but rather excuses as to why their behaviors should continue. Zero degrees of empathy may be heard via remarks such as, “well you put yourself on social media and thats is what social media is for, so I am not doing anything wrong’. Or, “there are all kinds of pages on social media. How could I possible know it was your page”.

A Borderline Autistic see the world very differently than someone who is Autistic only. Rational conversations can take place, including the teaching of new skills. The reactions are far less dramatic and often there is little putting words in another’s mouth. There is a noticeable difference in terms of reactions or over-reactions to other people. Most commonly seen is ‘splitting’, either placing them on a pedestal or abuse and discard the person. They think in very black and white, all or nothing thinking, which caused tremendous difficulties in terms of maintaining friendships or relationships.

Sample comversations will be supplied to assist in understanding how a conversation gets derailed and just how difficult it can be to just talk to a Borderline Autistic individual.

Interpersonal reactivity was reported by most people to be the most challenging in terms of trying to maintain a relationship with the person. Reduced empathy was also noted as a difficult challenge for family members followed by reduced interpersonal trust.

Self-harm occurs in the context of BPD via interpersonal conflict and emotional dysregulation and reduced mentalizing, whereas in ASC, self-harm typically results from sensory dysregulation.

This means that different intervention approaches need to occur according to the profile or phenotype of the person.

It is not uncommon for Autistic individuals to have developed narcissistic traits as a mean of coping with their undiagnosed Autism. The earlier the intervention, the better the prognosis. Both people with ASC and BPD are significantly challenged in terms of understanding and responding to emotions and in interpersonal functioning.

BPD patients have elevated autistic traits and a strong drive to systemize, suggesting an overlap between BPD and ASC. However the BPD impairment in interpersonal functioning, poor empathy, problems with trust and intimacy and difficult personality traits, including disinhibition, antagonism, difficulty with altered social cognition and impulsivity is challenging to treat. Parents, family members, friends, partners and professionals agreed that it was these very traits that they found challenging to address (with the purpose of assisting them to have better relationships) with the person in question.

Higher suicidality is observed in patients with co-existing BPD. To many professionals the most obvious difference in BPD and autism is one person wants and craves attention. This attention is dysfunction as it is sought through negativity, being the victim a lack of boundaries and a lack of impulse control.
Any females with ASC don’t want or like attention and in trying to fit in may get into trouble via social naivety.

TO BE CONTINUED in Part 2….

More traits

Intervention and treatment

The trauma behind borderline personality disorder

More research and References

Baron-Cohen, Simon, Dudas, Robert E. & Locejoy, Chris (Jan., 2001, 13(1) PLoS One. The overlap between autistic spectrum conditions and borderline personality disorder

Chabrol H, Raynal P., Compr Psychiatry. 2018 Apr, 82:141-143. The co-occurrence of autistic traits and borderline personality disorder.

Dell’Osso L, et al. Compr Psychiatry. 2018. May; 83:7-11. Correlates of autistic traits among patients with borderline personality disorder.

3 thoughts on “Moving Towards a Profile 0f Borderline Personality Disorder and Autism

  1. Hello, I’ve just read your article about BPD and autism. I found it very interesting as our son has just been diagnosed with both, however, I can’t find ‘part 2’, please can you send a link on where it is?
    Kindest regards
    Julie K

  2. I have an 18 yr old transgendered son who was diagnosed with ASD at the age of 15. At the time he was presenting as a female. His therapists have suggested he was headed for BPD for years but said “he can’t officially be diagnosed with that until he’s 18”. Well, now he’s here. His current therapist has diagnosed him as BPD with ASD traits rather than the reverse. (I agree with this diagnosis.)
    He has had incredibly difficult issues with suicidality, and depression and anxiety. He has been in and out of hospitals and residential treatment centers since he was 11. He has a very high IQ and talks about getting his PhD, despite not being able to get through the day without breaking down. Are there any studies going on that might be helpful to him, eg where he would be a test patient or where experimental treatments might be studied? He has so much to offer it would really be a loss to society if he wasn’t able to fulfill his possibilities.

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