Autism spectrum disorder (ASD) conditions such as autism and Asperger’s, as well as ADHD all fall under the umbrella of “neurodivergence”. Although, this isn’t the case for borderline personality disorder (BPD).
Despite this, when asking, “What is borderline personality disorder?”, you’ll get a lot of the same responses as you’d get to the question, “What is autism?” With overlapping symptoms including difficulty regulating emotions, rejection sensitivity, and a lack of impulse control, both autism and BPD can appear similar on the surface.
That said, there are many key differences between the two conditions, as we’ll explain in this BPD vs autism guide.
1. Neurodivergent or Not?
The sociologist Judy Singer came up with the term neurodivergent in the 1990s. As an individual with autism, Singer felt that identifying autism as a form of neurodivergence helped express the unique strengths and abilities of those with ASD.
Since then, the concept of neurodiversity has grown to include other conditions. Among them are attention deficit hyperactivity disorder (ADHD), dyspraxia, and dyslexia.
There’s speculation that BPD may fall under the definition of neurodivergence. But experts do not formally recognize BPD as a neurodivergent condition.
Despite the many similarities between autism and BPD, this is one of the key differences at the point of diagnosis. Rather than a type of neurodivergence, experts identifying BPD class it as a mental illness.
2. Statistical Prevalence
Statistical misrepresentation led to false claims that “half of children will be autistic by 2025”. In reality, a 2021 report by the Centers for Disease Control and Prevention (CDC) found that 2.3 percent of children in the US have autism. This shows that while there is an increase in diagnosis rates for autism in the US and beyond, it’s still a rare condition.
In comparison, borderline personality disorder is rarer still. Around 1.6 percent of the adult US population has BPD.
3. Gender Expectations and Misdiagnosis
A deeper look into prevalence statistics shows some gender disparity alongside misdiagnosis related to gender expectations for both BPD and autism, although in different directions.
Research suggests that those assigned male at birth (AMAB) may have an equal chance of developing BPD as those assigned female at birth (AFAB). But almost 75 percent of people diagnosed with BPD are AFAB. Experts believe that AMAB individuals with BPD may instead receive an incorrect diagnosis for depression or post-traumatic stress disorder (PTSD).
As for the AFAB people with BPD, there’s a chance they may have misdiagnosed autism. The CDC 2021 report mentioned earlier found a 4:1 male-to-female odds ratio (MFOR) for autism. That said, a 2017 meta-analysis showed that higher-quality studies often had a smaller autism MFOR, with an average of 3:1 across all 54 studies.
Autism research has long seen ASD through a male, cis-gendered lens. This means that gender-diverse populations and women with autism are often misdiagnosed with BPD.
Women are often under more expectations to conform to neurotypical social norms. As a result, they become better at masking from a young age. Gender-diverse populations also have more practice at masking and camouflaging. This can make it easier for them to hide autistic traits from their neurotypical peers.
4. Age at Diagnosis
Most autism research and statistics focus on children because this is when the first symptoms usually start to present themselves. Some of the early signs of autism include little to no eye contact, delayed speech, and limited interests. As awareness about autism increases, it’s becoming easier for parents and teachers to know what to look for and to then recognize autistic traits.
An experienced professional can give a reliable autism diagnosis before a child turns two. Despite this, most children aren’t diagnosed until after the age of four. An early autism diagnosis is vital since it paves the way for earlier and more effective intervention. This is why developmental evaluations can make such a huge difference to the way a child with autism progresses following their diagnosis.
While autism manifests in childhood, this isn’t the case for the vast majority of BPD cases. On occasion, an under-18 may receive a BPD diagnosis if they had shown significant symptoms for at least a year. But almost all diagnoses for BPD are for people over the age of 18 since the teen years are when an individual’s personality develops and matures.
5. Underlying Causes of Behavioral Patterns
Certain BPD and autistic traits can be similar on the surface. But, the most convincing autism vs BPD comparisons recognize that the underlying causes of these behaviors are very different.
For example, both those with autism and BPD can fear abandonment. For people with BPD, this can be a real or imagined scenario that they then respond to with frantic attempts at avoidance. For those with autism, though, difficulty understanding societal norms can make it difficult to maintain friendships. As such, the fear of abandonment is very real and likely a reaction to past experiences.
Another typical symptom of BPD is an unstable self-image. Autistics share this trait to an extent, but rather than a generalized struggle with identity, autism can cause a negative or lacking sense of self. As with the other example, this is often because of real examples of rejection and peer negativity.
Both autistics and people with BPD can seem to have difficulty controlling their anger. For those with BPD, this is often an emotional but disproportionate reaction to a situation. But for autistics, what appears to be anger is more likely to be a meltdown in reaction to sensory overwhelm or a similar trigger.
BPD vs Autism: Explaining the Differences
Autism and borderline personality disorder overlap in various ways, so much so that misdiagnosis is not uncommon. What’s more, an estimated 10 percent of autistic people also have BPD. That said, as this BPD vs autism guide shows, there are several important key differences between the two conditions.
Have a question for us about borderline personality disorder, your child’s autism diagnosis, or anything else we can help you with? If so, get in touch with us here at Developmental Pediatrics of Texas. We’ve been serving Texas since 2000 and remain at the forefront of telemedicine testing and diagnosis.