From the Guidelines
Autism and borderline personality disorder do not present similarly in children, despite some superficial overlaps. Autism is typically diagnosed in early childhood and involves difficulties with social communication, restricted interests, repetitive behaviors, and sensory sensitivities, as outlined in the DSM-5 diagnostic criteria 1. Children with autism often show these signs from infancy or toddlerhood, including reduced eye contact, delayed language development, and intense focus on specific topics. In contrast, borderline personality disorder (BPD) is rarely diagnosed before adolescence or adulthood because personality is still developing in children. When BPD traits appear in younger individuals, they manifest as emotional dysregulation, fear of abandonment, unstable relationships, and identity confusion.
Key differences in presentation
- Autism involves neurological differences in processing social information and sensory input
- BPD primarily involves emotional regulation and attachment difficulties The fundamental difference is that autism involves neurological differences in processing social information and sensory input, while BPD primarily involves emotional regulation and attachment difficulties. This distinction is important for proper diagnosis and treatment, as interventions differ significantly between the two conditions. Early assessment by specialists who understand developmental disorders is essential for accurate diagnosis and appropriate support, and should include a thorough diagnostic evaluation to determine the presence of autism spectrum disorder, as recommended by the practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder 1.
From the Research
Similarities in Presentation
- Autism spectrum disorder (ASD) and borderline personality disorder (BPD) share features, including social and emotion regulation difficulties 2
- The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder, suggesting similar presentation in some cases 2
Diagnostic Overlap
- The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%] 2
- There were inconsistent findings across clinical areas, making it difficult to determine the extent of diagnostic overlap between ASD and BPD 2
Treatment Approaches
- Dialectical Behaviour Therapy (DBT) is an efficacious treatment programme for chronically suicidal and/or self-harm behaviour in patients with BPD, and may be beneficial for individuals with ASD and similar emotional and sensory challenges 3, 4
- Applied behavior analysis (ABA) is a primary method of treating aberrant behavior in individuals with ASD, and may be compatible with occupational therapy approaches 5, 6
Emotion Regulation and Therapeutic Alliance
- Emotion regulation and therapeutic alliance are hypothesised to mediate the effects of DBT on suicidal ideation and behaviour in individuals with ASD 3
- Modifications to DBT, such as visuals, graphics, and a gaming format, may enhance its effectiveness for autistic individuals struggling with emotion dysregulation 4