Intersection of Autism and BPD

[felixthedog]

My 31 dwBPD is also neurodiverse. She demonstrated heightened sensitivity and reactivity from infancy, and underwent neuropsych testing at ages 4 and 16. Though autism and BPD were not the target of testing (age 4 considering ADD, age 16 to get support for testing accommodations), auditory and sensory processing deficits were consistently noted. She is very intelligent and high functioning, and has successfully masked many of her symptoms to adapt to school and work settings. We eventually discovered she had been self-harming and using excessive alcohol as well since her teens (now sober, and reports no longer self-harming). Unfortunately, since stopping drinking, her emotional outbursts, rage, and suicidality have increased.
My question here concerns the overlap between BPD and Autism symptoms (see link below), and the treatment implications of this. She justifies and blames her emotional dysregulation on others' perceived short-comings (often with little to no basis in fact, or highly exaggerated), and thus the "solution" would require others to change their behavior, and apologize for the harm to her she claims they have caused. She rejects any pointing out of her lifelong reactivity to sensory experience and challenges with social cues (and thus relationships). She has lost significant relationships due to her rage attacks. She has been in therapy and on meds without consistent benefit, and started and not completed recommended DBT.
My husband and I believe the underlying issue is autism, and the resulting hypersensitivity, reactivity, etc. has led to huge confusion about relating to the world and people, and this led to coping mechanisms such as alcohol and cutting. To others she may appear neurotypical, and thus there is little tolerance for her emotional dysregulation. This leads to a self-fulfilling prophesy of people abandoning her, and more depression and hopelessness. Very much a Dr. Jekyll and Mr. Hyde pattern. We love and value her Dr. Jekyll which is so talented and caring in many ways, and manage the unpredictable but regular Mr. Hyde episodes as best we can, though there has been lasting damage from this.
Have others here had this experience and do you have thoughts on what has been helpful?
https://neurodivergentinsights.com/boderline-personality-disorder-or-autism/

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Sancho]

Hi felixthedog
I think the autism/bpd discussion is really important for many reasons including the fact that clear diagnosis can be a basis for helpful treatment – as well as the fact that the neurodiversity that is understood in the community tends to lead to greater acceptance of difference in such things as emotional response.

Autism was the first thing that came to mind when I first tried to grapple with her difficulties in her teens. For some time I tried to squeeze what I saw into the descriptions I read about ASD.

The article you shared is really good in identifying both the particulars of each condition as well as the overlap between the two. I think a source of difficulty though is the fact that both these conditions exist on a spectrum. As a teacher I have encountered many students diagnosed with ASD and the range is enormous. Some with the ASD diagnosis would appear on casual encounter to be perfectly neurotypical. Only after prolonged encounter would the aspects of ASD become apparent.

Others with ASD exhibit clear difference immediately.

So how is a diagnosis made as to whether someone is on the ASD spectrum or has BPD? I am assuming they tick off the required number of criteria that are specific to each condition for a diagnosis – if ticked off then the positive diagnosis can be given.

I tend to think that well informed parents may often be the best people to identify a predominant condition. That said, it is also the case that more than one condition can exist at the same time. So someone can be on the ASD spectrum while also having BPD traits.

In the long run the use of identification is to open doors to the best therapies and treatments. However there are no specific treatments for either ASD or BPD – as there are for schizophrenia or bipolar disorders. You have seen this clearly:

She has been in therapy and on meds without consistent benefit, and started and not completed recommended DBT.

What tends to happen with both ASD and BPD is treatment is targeted to address dominant aspects of the disorder – such as mood stabilisation, or depression.

In my case antidepressants were helpful – though DD didn’t continue – for others who are able to engage in a program DBT has also been useful.

I think the overlap of ASD and BPD is very real and where the two co-exist, then the predominant elements could be more evident one day and the other on the next day. If you feel the predominant condition is ASD then I believe you are entitled to express this and look for supports on that basis.

It seems from what you say that neither ASD nor BPD have been the focus of diagnosis in the past. Is it possible to work to establish whether DD meets the criteria of either – or both at this point in time.

Thanks for the post and article – great food for thought.

[Notwendy]

I have seen information about how autism might be missed in girls.

https://www.uclahealth.org/news/article/understanding-undiagnosed-autism-adult-females#:~:text=Females%20tend%20to%20mask%20signs%20of%20autism&text=Experts%20believe%20family%2C%20teachers%20and,fit%20in%20and%20be%20social.

So it is possible that a girl with undiagnosed autism could develop emotional and behavioral issues later on from the social consequences of autism- difficulty making friends, being bullied, and then possibly get diagnosed with BPD later.

But did they coexist or one appeared first?

In your situation, I think you have a good reason to wonder if your D being on the spectrum is her main condition. Being that she is an adult- she needs to be willing to pursue being evaluated for autism spectrum. I think it would be helpful to know if she is, but she's the one who needs to consent to looking into it.

[Sancho]

Notwendy has put things really well I think.

[felixthedog]

Thank you all for your thoughtful replies!
In my dwBPD's case, it is really a both/and. I believe the autistic traits (hypersensitivity to stimuli, mis-reading social cues, exaggerated reactions) set her up for rejection from others, and thus emerging BPD by her late teens. She seems accepting of both diagnoses, but still caught up in blaming others and delivering awful negative tirades which perpetuate the "abandonment" experiences (which are really a firm boundary set by those subjected to her rage). At this stage of life, it is really up to her to manage her symptoms and to develop skills. It is difficult to witness, and I have had so much grief over the impact this has had on our family. As many have stated, we are in a club no one wants to be in but yet here we are. I appreciate the care and support offered in this forum.