Although there is more in common than expected between borderline personality disorder (BPD) and autism spectrum disorder (ASD), the differences are very important to be underestimated. These differences make the two disorders differ from each other. For suitable intervention and treatment, the differences and similarities between BPD and autism should be known correctly. The mental complexity of individuals with these disorders should be emphasized and their exclusion by society should be prevented.
It is very important to learn about both disorders, their differences, and their similarities. Individuals may struggle with one or both. Therefore, interventions and treatments are very important. These methods to be followed will increase their quality of life. It will also prevent their stigmatization and exclusion by society.
Women on the autism spectrum and genderqueer individuals are more misdiagnosed with borderline personality disorder than other groups on the spectrum. Having BPD makes their life more complicated. And individuals on the autism spectrum are more likely to develop BPD than other people. It is important to know which is the main disorder, because of the fact that ignoring that the individual is also on the autism spectrum causes an increase in the severity of BPD symptoms.
One of the most important reasons for this misdiagnosis is that specialists do not think much of the autism option during BPD evaluation. During the BPD evaluation, the autism option should be ruled out at first. Because it should not be forgotten that the individual on the autism spectrum is more prone to developing BPD.
Similarities Between Borderline Personality Disorder (BPD) and Autism
We mentioned that BPD and autism are actually very similar disorders. The most basic of these similarities is that they have problems understanding and expressing their emotions. They have difficulty understanding and using verbal cues, gestures, and facial expressions. They do not like to discuss their own feelings. They are uncomfortable knowing the feelings of the people around them, often they do not understand.
Emotional difficulties are also problems experienced by individuals with both disorders. They experience different types of emotional difficulties. While individuals with BPD experience more insecurity and intimacy problems, individuals with autism have more difficulties in reading emotions and empathy. As a result, the two groups find it difficult to establish and maintain relationships.
Differences Between Borderline Personality Disorder (BPD) and Autism
Interpersonal relationships are a very complex issue for both individuals with autism and individuals with BPD. Although the reasons are different, they usually have problems with this issue. The reason why individuals with autism have problems is that they do not understand social cues correctly. They cannot express themselves correctly because they cannot understand correctly. Even if they understand the emotion, they may not have the vocabulary to express the situation.
Individuals with BPD, on the other hand, have problems in interpersonal relationships due to their insecurity. This insecurity causes their feelings to change frequently, and it causes confusion in the other person. The emotional fluctuations they have to cause the people around them to distance themselves from them.
Difficulties in social relations are valid for both groups. While individuals with autism are left alone according to their own preferences, individuals with BPD distance themselves from the people around them due to their emotional fluctuations and stay alone even if they do not want to be alone.
Overlapping Traits of Borderline Personality Disorder (BPD) and Autism
Fear of Abandonment
Both individuals with autism and individuals with BPD are highly sensitive to feelings of abandonment. They try to avoid situations of abandonment and rejection. When they feel themselves in such positions, they give very strong and unexpected reactions.
A Distorted Sense of Self
Lack of self-identity is commonly observed in individuals with these disorders. In fact, this is a defining feature for individuals with BPD. In both groups, they try to adapt to society and socialize by imitating the people around them or copying their behavior.
This condition is common in individuals with high-functioning autism but is also observed in people with BPD. They need social masking because they chronically feel a sense of emptiness.
Challenges in Social Life
Initiating and maintaining social interactions, communications, and relationships is a challenge for people in both groups. Although the reasons behind these challenges are different, it can be said that they have the same origin in a way.
This situation, which is the main feature of BPD, is one of the situations that individuals on the autism spectrum struggle with. In extreme cases, sensory issues and overloads can cause emotional dysregulation as well.
Diversity and Fluidity
This issue is mainly about sex and gender. The common situation in both groups is gender-queering. In addition, individuals with BDP show variability and fluidity in all senses of self. Individuals on the autism spectrum have more gender diversity than neurotypical individuals. Individuals with autism and BPD who tend to question themselves more in every aspect have a lower rate of being heterosexual compared to the rest of society.
Depersonalization and Derealization
Although depersonalization and derealization are terms that are often compared to each other, they are actually quite different from each other. Depersonalization is alienation from one’s body, while derealization is one’s alienation from the environment in which one lives. This alienation is at a very extreme level and the person thinks that both his/her own body and the outside world are not real and fictional. Although these experiences are common in both groups, they may have different causes. It can be a response to trauma, but it can also be the result of a trauma.
Even though there are many attachment styles that can be observed in those groups, the insecure attachment style is the more common one they develop. However, it is not easy to say something certain about this issue since everyone with these disorders is unique and develops their own attachment styles.
Overlapping Risks of Borderline Personality Disorder (BPD) and Autism
Eating disorders are observed at very high rates in individuals in both groups. It usually manifests as bulimia nervosa and anorexia nervosa. It arises as a result of a sense of control. According to studies, 1/4 of individuals diagnosed with anorexia nervosa are on the autism spectrum.
Substance Abuse and Substance Addiction
In the past, it was assumed that individuals with autism had low rates of substance use and addiction due to their strict adherence to rules. However, according to current research, the use of alcohol and substances has increased approximately twice the rate of individuals in these two groups in order to cope with social stress and sensory problems more easily. Alcohol and substance use has become a preferred method for individuals in these groups who experience very strong emotions.
Individuals with both autism and BPD encounter more victimization than neurotypical individuals. Especially women with autism are more likely to be victims of violence. There are some risk factors at this point of victimization. We can categorize these factors as taking everything literally and difficulties in understanding social and contextual cues. Sexual assault experiences are also common in these groups.
Prone To Commit Suicide
Individuals with high-functioning autism are more likely to commit suicide than the general population. Because of the fact that they are aware of everything around them, it is difficult to deal with them at some point. They see suicide as an exit from everything.
Self-harming behavior is commonly observed in individuals in these two groups, who have difficulties in understanding both themselves and the outside world. While it occurs as a result of more sensory issues in individuals with autism, it occurs in individuals with BPD when they do not get the result they want from attachment. These behaviors can be hair pulling, hitting oneself, banging their head against a wall, skin picking, and cutting certain parts of their body.
It is inevitable that both groups will have co-occurring mood disorders. Depression and anxiety are the most common ones. In addition to these, major depression is also frequently observed. In these cases, medication or therapy should be sought accordingly.
Borderline Personality Disorder
A borderline personality disorder is a disorder that causes problems in the way a person perceives the environment, the way he/she thinks, and his/her feelings about people and relations. It usually begins to develop during adolescence and young adulthood. The meaning of the word in the name of the disorder, which causes the question “What is borderline?” can be expressed as “borderline and uncertain”.
People with the borderline disorder may experience sudden mood changes and ambivalent thoughts about who they are and what their role is in life. As a result, their interests and values can change quickly. People with borderline personality disorder tend to see things as very good or very bad. They may see someone they see as a friend one day as their enemy the next. For this reason, they establish intense and unstable relationships in social life.
It is not possible for people with the borderline disorder to have all the symptoms. Some may have a few symptoms, while others may have almost all of the listed symptoms. Even a regular event can trigger the appearance of symptoms. For example, symptoms may begin to appear in a person who leaves his or her immediate environment due to a business trip. It doesn’t mean that everyone with BPD has to show every symptom with the same level of severity and duration. It shows differences in each person. Common borderline symptoms can be listed as follows.
- Getting close to someone too quickly or cutting off contact with someone too quickly, fear of abandonment
- Having rapidly changing extreme feelings about family, friends, and immediate surroundings
- Unstable and impaired sense of self
- Reckless driving
- Excessive and unreasonable spending of money
- Substance and alcohol use
- Eating too much or not eating at all
- Engaging in excessive sexual behavior
- Making dangerous and impulsive movements
- Self-harming behaviors
- Recurrent suicidal thoughts or attempts
- Sudden and intense mood swings
- Constantly feeling emptiness
- Having anger control problems
- Having trouble with trust, excessive and irrational skepticism about other people’s intentions
The expression of feelings of a person with borderline personality disorder in his own words is summarized as follows:
“Having a borderline personality disorder is like hell for a lifetime. Not any lighter. Pain, anger, confusion, resentment, and never knowing what to feel the next minute. It hurts because I hurt my loved ones. I think I’ve been misunderstood. Nothing gives me joy. I am rarely “very happy” and therefore worried. Then I physically harm myself. Then I experience guilt because of it. An endless cycle of stress!”
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