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Autistic women are often misdiagnosed with borderline personality disorder. Here are 4 ways to spot the difference.

window reflection on a woman's face
nullWestend61/Getty Images
  • Some autistic women are misdiagnosed with borderline personality disorder.

  • The two conditions can have overlapping symptoms, such as mood swings and instability in relationships.

  • Autistic women experience high rates of depression, and misdiagnosis can make it worse.

Bree Conklin wasn't officially diagnosed with autism until she was 34-years-old. Before that, she had been misdiagnosed with borderline personality disorder (BPD) for years.

Conklin's story isn't uncommon. Due to overlapping symptoms, some autistic women are misdiagnosed with BPD, which involves a very different treatment plan.

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Dr. Megan Neff, a psychologist who was diagnosed with autism in her late 30s, told Insider that while it's possible to have both autism and BPD, it's quite rare. It's more likely that an autistic person's reactions are being misinterpreted as symptoms of BPD.

Neff also said that cultural stigma around both disorders also plays a role in autistic women and gender-nonconforming people being misdiagnosed with BPD. Autism is under-diagnosed in women, while BPD is over-diagnosed in women.

Insider spoke to Neff about the overlapping symptoms between autism and BPD that lead to misdiagnoses, especially in women.

Both autistic and BPD women can experience big mood swings

Borderline personality disorder is heavily associated with dramatic shifts in mood.

Neff said that undiagnosed autistic people can display very similar emotional reactivity, but these reactions are triggered by entirely different things than people with BPD.

BPD meltdowns are "almost always triggered by attachment issues, whereas with autism, it might be a change in routine disruption or sensory issues," she said.

In other words, a person with BPD might react if they feel abandoned, while an autistic person's triggers can have more to do with physical discomfort and mental burnout.

They can both have unstable relationships

According to Neff, a core feature of BPD is instability in relationships. Often, a person with BPD might idealize someone, then devalue them the moment they perceive a flaw.

"With autism, we tend to have all-or-nothing thinking patterns," Neff said, which can look a lot like BPD when it comes to relationships. Additionally, autistic people may have special interests or areas of hyper-fixation — which can include people, Neff said.

In that context, an autistic person's focus on a partner or friend can appear like intense idealization — a common BPD trait.

Both can struggle to know who they really are

Because of their attachment issues, people with BPD can experience huge changes in their self-image in the same way they feel instability in their relationships. They can abruptly switch career paths, friends, and even religions.

Neff said autistic people can also struggle with their self-image, but it has more to do with trying to mask their symptoms around others — whether they're conscious of it or not.

"What we're essentially doing is ignoring internal cues and adjusting to our environment," she said. "We're reacting to the cues of those around us and figuring out who they need us to be in this interaction."

While they might be able to conceal some of their symptoms, autistic people can often feel like they don't know who they really are because they're so focused on fitting in.

Both are at a high risk of depression — and misdiagnosis can worsen it

Many people with BPD experience depression, which can include feelings of anger, emptiness, and self-loathing.

Many autistic people experience depression as well — and a misdiagnosis with BPD can make depression worse, Neff said. That's why it's so critical to understand the differences between these two disorders.

"It's not just the burden of adding a diagnosis that is highly stigmatized and inaccurate," Neff said. "It's also the psychological burden of not having access to the accurate narrative that would help them understand themselves and create a life that actually works for them."

Read the original article on Insider