Can BPD be misdiagnosed for aspergers?

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The prevalence of personality disorders amongst the ASD population is much higher than in the general population, and BPD is correlated with ASD. A study was done on a sample of females with AS, and something like 15% also met the criterion for BPD. That's much higher than the general prevalence.

One thing to also keep in mind is that the genetic factors and underlying patho-physiology of developmental, mood, and personality disorders are not mutually exclusive (references: Common Genetic Factors Found in 5 Mental Disorders, The Polyvagal Theory).

Finally, I had a therapist who treated adults with Aspergers and had BPD herself. She had an interesting theory, which was that BPD and high-functioning ASD are like two sides of the same coin. It's emotional dys-regulation that's manifested in different ways.

I'm not sure if I satisfy the 5 symptoms needed to fit the criterion for a BPD diagnosis, but I sure have quite a few of the symptoms.

"Finally, I had a therapist who treated adults with Aspergers and had BPD herself. She had an interesting theory, which was that BPD and high-functioning ASD are like two sides of the same coin. It's emotional dys-regulation that's manifested in different ways."

I can definitely see that. I've thought that myself tbh.

I think in woman they are more likely to be misdiagnosed as bpd instead of aspergers as it happened in my case,
before i got back in touch with my parents and went through an autistic diagnostic service, as they need that vital information from parents as asd manifests in childhood as u probably know. I think its a case of lack of awarness of asd in girls/woman untill the last couple of decades. Still not brilliant but at least awareness is propagating.

I suspect that it is more likely that Aspergers would be mistaken for BPD. Especially 20-25 years ago.

A lot of ladies with ASD get misdiagnosed with BPD. It happened to me in 1994, because the psychiatrists had no other label to describe my presentation. The label never fit. I didn't get diagnosed with ASD until I was 34.

I wanted to explain this quote further.

An overwhelming fear of abandonment, a poor sense of self, problems with impulsivity, and unstable and intense relationships are the core traits of BPD. These traits are what explain the disorder, which is very different from ASD and the social struggles that come with it (unless BPD is also present).

Emotion dysregulation is directly related to relationships in BPD. Relationships are how someone with the disorder makes sense of themselves. They need to be with others, because they gain a sense of who they are through others. Stable relationships = stability and a sense of self. The fear of being alone is overwhelming and terrifying to them, so they resort to drastic behaviors to keep others from leaving them.

Someone with BPD doesn't usually have problems with social decoding. They seem to be very aware of any signs of abandonment, real or imagined, because they are preoccupied with this fear. In ASD problems with perspective thinking and social decoding seem to be the main reasons why they struggle with emotion regulation. Anxiety, depression, and alexithymia also influence it.

A highly sensitive temperament seems to be common in both conditions. Some highly sensitive people seem to be more vulnerable to strong emotions and reacting to others, especially towards people who tease/bother them.

Severe bullying and trauma can cause BPD traits/BPD in people with ASD. A struggling youth with ASD can appear to have BPD especially in the school environment where social status is very important.

About all they have in common is meltdowns and self-injury. I have heard of people with AS being misdiagnosed as BPD on that basis, but the reverse is very unlikely since AS is generally diagnosed based on features that don't overlap at all with BPD (obsessive interests, sensory issues, poor reading nonverbal cues - BPD overinterpret nonverbal cues rather than overlooking them).

It's also possible for someone to have both AS and BPD. Autism and bipolar disorder share some common susceptibility genes, and while BPD is mostly environmental (caused by trauma or attachment disruption) it's believed that the genetic susceptibility to bipolar can increase a person's risk of BPD.

Plus, autistic people can be at higher risk for experiencing the environmental triggers, because we're often favorite targets of predators and because unresolved grief over a child's disability can cause attachment problems in the disabled child (it can make parents less emotionally available to their child, and the parent's distress is often frightening and confusing to the child). And autism signs are often first evident in toddlerhood, which is the most critical period for attachment. I've also heard that some parents who might have been OK parents to an NT kid become abusive when raising an autistic kid. For example, when punishment doesn't work to change a child's undesired behavior, parents instinctively tend to escalate the severity of the punishment. If punishment can't work, because the child doesn't understand or can't control their behavior, this escalation can eventually reach the point of abuse if the parent doesn't realize they need to change tactics.

Did your friend say why he or she thinks you're BPD? I've heard of people claiming that BPDs try to fake AS to get attention (I've never heard of this actually happening, by the way). Is that what your friend thinks is going on?



Firstly, most personality disorders don't require that the person be 18 to get a diagnosis. Only antisocial PD has that requirement - and that's because pre-adult ASPDs are supposed to be diagnosed with conduct disorder instead.

Many clinicians do refuse to diagnose any PD prior to adulthood, but that doesn't mean that it only exists in adulthood. Studies have asked BPD adults when they first experienced various BPD symptoms, and generally most had their onset in early teens at the latest. Some symptoms, such as mood swings and feelings of emptiness, are usually seen from early childhood, while the self-injury and suicide attempts usually begin in early adolescence.

Also, some other PDs such as schizoid PD and obsessive-compulsive PD are nearly impossible to distinguish reliably from AS. With schizoid PD, some clinicians have actually suggested that there is no real distinction between it and AS.



They can be a feature of AS, though an uncommon one. Also, BPDs often show self-destructive sexual behavior as a way of coping with negative emotions.



I disagree. Emotional dysregulation is not a core feature of AS. It might be an associated feature, although I think many AS people who have meltdowns are just dealing with unconventional emotional triggers rather than true emotional dysregulation. (Eg sensory overload can trigger meltdowns in a person who is not otherwise prone to strong emotional reactions - it even happens in NTs in rare circumstances.) I have also known many autistic people who have no issues with emotional regulation - just with social skills, sensory processing and other core autistic characteristics.

It depends on why you have the stated traits. For example unstable relationships are a trait of both. If you have Aspergers then then this would at its most basic level be because of a failure comprehend communication (both nonverbal and verbal). So a reason you might be getting diagnosed as aspergers is that you do not communicate with your body and so the doctors take that and then try to get you to respond to their nonverbal ques if you do not respond to those then they assume that you do not comprehend nonverbal communication and are therefore autistic.

Yes, BPD is very commonly misdiagnosed as various other conditions such as Autism, bipolar disorder and even schizophrenia.
There is a drive by some in psychiatry to deliberately misdiagnose BPD as autidmin particular, usually by health professionals who dislike BPD as a diagnosis.
They often claim it is the other way round.... That autism is often misdiagnosed as BPD.. this is nonsense and extremely rare. Also patients with BPD often won't accept the diagnosis and do their best to get another diagnosis, usually bipolar disorder or autism, by reading up on the conditions and then feigning symptoms of these illnesses.
I know this all first hand as I work as a doctor in psychiatry, and see patients feigning autism regularly when they have very clear cut BPD and no evidence of autism at all. Also I regularly see patients with BPD get angry and abusive when I explain they have BPD and say they have autism (this includes people of all ages, even in their 20s,30s,40s etc). They demand a referral for an autism assessment... They do an AQ50 first, and answer all the questions as they have read about online to score a false positive. Then they say all the right things at the assessment, and arewrongly diagnosed with autism.
Yes, a person can have both conditions, but this is very rare.
There is also a push within social care and psychology, as well as psychiatry to massively over diagnose autism and underdiagnose BPD.
If you self harm, have chronic suicidal ideation, tend to be in and out of psych hospital regularly, can be ok one minute and then feel crap (agitated/angry/hearing "voices"), very easily upset by perceived abandonment, get voices telling you derogatory things like you are useless, to kill yourself etc, and you have a history of trauma in childhood/adolescense then you don't have autism, you have BPD. You don't have to have all these symptoms... Eg some people just have chronic suicidal thoughts, some don't get the voices (not a psychotic symptom... just own thoughts misinterpreted as voices from trauma as child), some self harm horrendously, some do it occasionally, some rarely.
People with pure autism do not have the above symptoms unless they have a history of childhood abuse/trauma too.
It is a dogma that autism and BPD overlap a lot. They don't.

So it's impossible to have both?

This is what I think about my 31-year-old brother. He received a diagnosis of Asperger's syndrome at age 30 but I think he has BPD and not Asperger's. As a child he didn't show any symptoms of Asperger's, it's only all come about in the last 2 or 3 years when he gave up his job because it was too stressful, even though he is capable of working.

He was popular at school and was never bullied (he says he wasn't). OK he was a shy student in the classroom but the popular kids still accepted him and he got along with them fine. I knew most of them because they were always coming to our house for sleepovers and stuff, and they were genuine friends (not fair-weathered or anything).

But despite all that he still began to suffer with depression and low self-esteem when he reached his 20s, and he also developed these symptoms:-

He is extremely private, he doesn't want a girlfriend because he's afraid he will have to be exposed, touched and share his room or bed.

He hates himself, constantly runs himself down, believes he's useless, ugly, stupid, etc, and doesn't really know who he is or why he's here.

He has unhealthy lifestyles and attitudes, like intentionally plans to smoke himself to death.

He often wishes he wasn't born and sometimes contemplates suicide.

He is stubborn about things, won't change his ways or style, lives in a pigsty (not literally), and basically won't "move forward".

He's very sensitive, to the point where if you say the wrong thing he will disappear off and sulk for hours or even days.

He has mood swings; switches from being sociable and happy to being miserable and depressed for no reason.


This group of symptoms doesn't point to Asperger's to me, as he doesn't have the typical Asperger's symptoms with these, and he didn't have these symptoms as a child. But he seemed so adamant to be on the spectrum, but even after a diagnosis I still don't think he is. It just seems that he wants to be on the spectrum so badly that he milked his way through the assessments. After all, Asperger's is being overdiagnosed these days.

I'm diagnosed BPD currently as one of my disorders. Not sure if it's correct but I have some characteristics so maybe it is... Now my husband was diagnosed with it too and I for sure see symptoms in him...

Bi-polar is a common co-morbid of Autism but would never be confused as autism in an of itself.I don't see how BPD on it's own could ever be confused with any ASD.

It's not impossible, but uncommon.
Autism and BPD together, that is.


Bipolar disorder, contrary to the above person's message, is not a common comorbid condition with autism.

Nobody is talking about bipolar. This thread is referencing Borderline Personality Disorder. At least 1/3 of the commenters here don't seem to get that, even though someone commented about it earlier.

I have never heard of borderline personality as being a co-morbid of autism,nor could I see it being misdiagnosed for autism.

I agree. Autism isn't a comorbid for BPD.


People with autism are never misdiagnosed as having BPD

However lots of people with BPD (and who usually know they have BPD) want diagnosed with autism instead as they don't like BPD as a diagnosis and there are a lot of stupid (or odd) professionals out there happy to give them the wrong diagnosis of autism instead. I see it all the time, as I work in this field.

This year alone I've seen 8 BPD patients, very unhappy with this diagnosis, insist they have autism instead, get a second opinion from an "expert" in Autism, and get a diagnosis of autism. And they all had no autistic traits at all, and all definitely had BPD 100%. I've seen several others who were unsure of their illness (but had BPD) and daft psychologists and psychiatrists diagnosed Autism wrongly. It's an epidemic these days... This misdiagnosis..... Like BPD being misdiagnosed as Bipolar was several years ago (and still is too).

Last edited by Merlinto on 12 Dec 2019, 4:37 pm, edited 2 times in total.