Borderline or ASD? Help me think this through

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I have a young daughter (11) who has been diagnosed with Autism, Mild, Requiring Support (Asperger's). Meanwhile, my oldest is 20, has always had sensory issues, terrible anxiety, a whole host of issues mostly resulting in her being a bit of a misfit among her peers. She's in college at a state university and doing well academically. Emotionally, not so much. I have suspected she was "different" since she was a preschooler. She seemed to be a little deceitful and manipulative. She also has shown some sensory issues. As a child she might vomit from a strong odor, or gag if forced to try a food she didn't like, hated tags in clothing and ballet tights, etc. I think her most serious sensory issues were when she had to get braces as a young teen. The ortho installed an appliance in the roof of her mouth to stop her from sucking her thumb (in her sleep). This put her in a state of panic that lasted nearly a week and a half. Not from not being able to suck her thumb--it was the feeling of the appliance in her mouth. I still have extreme guilt over this. All orthodontic procedures caused her extreme anxiety/panic.

Anyway, she has traits of both Asperger's and Borderline. She spirals into rage and depression sometimes. She has the black and white thinking of bpd. Also fear of abandonment/rejection. She called a crisis hotline at least twice last spring semester during her meltdowns (spirals out of control). She cuts herself sometimes. She does identify with many of the trats of bpd. BPD probably wouldn't even be on my radar except that my mother and sister are BPD (undiagnosed). I have to consider it as a possibility. I don't know how to help her. I'm trying to figure this out on my own before I choose a psychologist to evaluate her. She/we have managed these issues pretty well until she went away to college. Now it's more than obvious that she needs help--more than I can give.

Any insight is appreciated.

Your daughter should see a psychiatrist as soon as possible and you should stop trying to diagnose your family members online

It sounds like she may be genetically fated to have both borderline and ASD. You can't ignore the possibility she may have both.

Thanks for the replies. I fully admit to trying to diagnose her on my own. I have had many years experience dealing with mental health professionals myself. They can be all over the place. I'd like to have a good idea of what we're dealing with before I choose who to send her to for an evaluation. Ideally someone who has a lot of experience with both bpd and autism--but that's hard to find. I've already been through the eval process with my youngest for autism, but that psychologist has little to no experience with personality disorders.

Choosing a psychologist/psychiatrist is hard for me because of my own experience. I've had some terrible ones. I would say that MOST of them have been unhelpful at best. My experience has been that they look at a set of symptoms and treat the symptoms and don't look for underlying causes. So people like my mom and sister who have been in and out of therapy most of their lives are still undiagnosed. That's sad. So--I'm not apologetic over trying to figure this out myself. Nobody knows my daughter like I do.

I've got a list of psychologists. I'll start calling today.

That's a frightening thought. I've read up a lot of girls and autism, and it's not uncommon for girls to be diagnosed first with Borderline only to find out later that it's actually autism. I think a lot of traits overlap. I really DO wish I could find someone I trust to evaluate her. I'm working on it.

I would start with a specialist on autism.
If she is autistic and more or less able to camouflage, all the other traits and behaviours may be misinterpreted. It happened to me.
If she is not autistic, the possibility will be excluded.

Thank you. That is helpful.

It's difficult to say, however she should be evaluated by someone who is familiar with ASDs in girls and women. Vet them thoroughly because many will say they are qualified in that respect, and actually aren't.

I would ask them.

1. Have you worked with girls and women on the spectrum before?

If so...

2. How many?
3. What ages?
4. Are you familiar with the works of Tony Attwood and Simon Baron-Cohen on females on the spectrum?
5. Are you familiar with Rudy Simone and other influential girls and women on the spectrum?

It would be very important that during the evaluation, the reasons behind her feelings and behaviors are understood. That is what will really differentiate BPD from ASD.

You said she has black and white thinking. Both those with BPD and ASD do, but in different ways.

Those of us on the spectrum tend to be literal in our thinking and not quick on pragmatism, and this tends to make us rigid rule followers. For example, when I was younger, I was told it was wrong to lie. So if someone were to ask me if I thought they were ugly, and I did, I would tell them "Yes".

Someone with BPD, however, might be black and white in their thinking in that they consider people to either be good or bad, and when someone is good, they are all good, and when they are bad, they are all bad. They tend to either idolize or devalue another person. For example, upon meeting someone new, the person with BPD might think this person is the best person in the world, absolutely wonderful, could do no evil. However if that person then makes them feel slighted in some way, they may then regard that person as an absolutely horrible person with no redeeming qualities, who is bad to the core and worthy of destruction. They may alternate between these two polar opposite views of the other person, being unable to merge them into a single entity where people are both good and bad simultaneously. It should be noted that this tendency to alternate between seeing someone all good, or all bad (it's called splitting) is also the way they view themselves. In fact, what people with BPD often tend to do is reflect the world as they see and experience it, and the source of this inner turmoil that they project outward comes down to a weak self identity, inability to prioritize, a mistrust of others, and feelings of invalidation. It's thought this disorder develops in very sensitive individuals who grew up in invalidating environments....for example, having a parent who was a psychologically abusive narcissist, or possibly had BPD themselves. I suspect though that it can also develop in inherently emotionally sensitive individuals who grow up in normal, healthy environments, but owing to their heightened emotional sensitivity, may find those environments invalidating in some way.

Chronos, thank you for your input on this. I will absolutely interview the psychologists I'm considering with the questions you shared. I was worried about this when my youngest daughter was being evaluated. I did ask that psychologist about whether she takes female vs male into consideration. Your questions are much more thorough. Very helpful.

I'm going to talk to my daughter for about the black and white thinking and splitting to see what she thinks. I appreciate how you explained the difference between the b and w thinking of ASD vs BPD. My daughter is actually very self aware, so we are able to talk about these things. That's a positive in this situation.