BPD vs Autism: Understanding the Differences and Similarities

Autism spectrum disorder (ASD) and borderline personality disorder (BPD) differ primarily in their classification—autism is a neurodevelopmental condition, and BPD is a personality disorder. They also diverge in several traits, though they share a number of surface similarities such as different ways of relating to other people. Both diagnoses are commonly misunderstood, making it important to distinguish between them to ensure autistic individuals and people with BPD receive meaningfully tailored support. Autism and BPD seem to co-occur at somewhat higher rates than other groups—although more research is required to determine how commonly they overlap—and individuals with either diagnosis can also benefit greatly from understanding the traits of each diagnosis.

Autism spectrum disorder is a neurodevelopmental disorder, meaning it affects the development of the brain and nervous system. Autistic individuals experience differences from neurotypical peers in a range of traits and behaviors.

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Autism is dimensional, and autistic people exhibit various behaviors and characteristics to different extents. Autism can mean something different for each individual, both in terms of how autistic traits present and in the type and level of support an individual needs.

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While the autism spectrum entails a great diversity of experiences and characteristics, the following characteristics make up the main diagnostic criteria for autism:

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Communication and social approaches

To an autistic person, neurotypical social norms typically don’t feel intuitive. Autistic people may interpret social cues differently than others do, and typically favor more direct, literal communication. Autistic people might also need more time to process and respond to spoken communication, especially when they are under stress.

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Sensory and cognitive processing

Autistic individuals process information differently than neurotypical people. Autistics are more likely to exhibit bottom-up, detail-driven cognitive processing. They often have logical, principled thinking styles and strong pattern recognition skills. Autistic individuals also tend to be more sensitive to sensory stimuli, like certain textures and loud noises, than neurotypical peers.

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Special interests and repeated behaviors

Autistic individuals feel most comfortable with familiar environments and activities, and they generally have a strong preference for sameness. For autistic people, unforeseen changes to plans and disruptions to their routines can be very distressing.

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It is also common for autistic individuals to have more intense, but fewer, interests,  including special interests, which they can often sustain an extended focus on.

A personality disorder is a mental health condition characterized by sustained differences in how people relate to others, think about themselves and process emotions. These differences are considered adaptations of core personality components.

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Because people with personality disorders experience emotions and relate to others differently than those without personality disorders, they may experience more interpersonal conflict and social disconnect than others. They may feel misunderstood and stigmatized, and because personality disorders can be underdiagnosed or misdiagnosed, it can be more difficult for them to access tailored support.

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Personality disorders are a lifelong diagnosis, but interventions like psychotherapy can support individuals with personality disorders to manage distress, maintain healthy relationships and thrive in life.

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What is borderline personality disorder?

Borderline personality disorder (BPD) is a type of personality disorder that significantly affects an individual’s ability to regulate their emotions and have healthy relationships. People with BPD often experience the following:

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• Heightened emotions, including intense anger
• Mood swings
• Impulsive behavior
• Fear of abandonment
• Differences in relating to other people
• All-or-nothing thinking
• Unstable sense of identity
• Frequent dissociation from the self

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Individuals with BPD often experience difficulty regulating emotions. They tend to experience very overwhelming emotions, including anger that’s difficult to control. People with BPD can also experience rapid, intense mood swings. They may behave impulsively, sometimes in ways that can cause them harm.

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BPD is associated with a strong fear of abandonment, and many people with BPD take drastic measures to avoid abandonment. Individuals with BPD also often experience binary, all-or-nothing thinking, and can bounce between seeing themselves and others as very positive and very negative. These attributes can make it difficult for individuals with BPD to maintain stable relationships and a stable sense of identity.

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Though borderline personality disorder and autism are very different diagnoses, they share several traits. Autistic individuals and people with BPD both experience differences in how they relate to others, experience emotions and process information, though each group experiences these differences in unique ways.

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Social experiences

Individuals with BPD and autistic people often experience social relationships and relate to people differently than others without autism or BPD. They might approach new relationships at different paces than other groups. For example, autistic people sometimes take more time to build trust and form a connection with a new person, while individuals with BPD are more likely to grow close to new people rapidly. Some autistic individuals, however, can be quick to share about themselves and their interests with new people, which can appear to others as though they’re diving into new connections quickly.

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Preference for familiar styles of thinking

Both autistic people and individuals with BPD can find themselves rooted in certain ways of thinking. For people with BPD, this often means binary thinking. For example, they might think someone or something is either completely perfect or completely malicious. While some autistic individuals exhibit binary thinking, it is more common for autistics to experience difficulty adapting to change, including new ideas. Both groups can find it difficult to engage with alternative or unfamiliar perspectives.

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Rejection sensitivity

Rejection sensitivity, also called rejection sensitive dysphoria, is a fairly common experience  across both autistic people and those with BPD. This means that both groups are more sensitive to social rejection. They are more likely to expect and tune into signs of potential social rejection, and may feel even more upset than others when they feel rejected.

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Mental health outcomes

Both autistic individuals and people with BPD are more likely to report poorer mental health outcomes and life satisfaction. Both groups are also more likely to self-harm, experience suicidal thoughts, attempt suicide or die by suicide. It’s estimated that up to 70% of individuals with BPD have attempted suicide, and as many as 24.3% of autistic people have attempted suicide.

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Interventions like psychotherapy can be very effective at helping individuals with BPD and autistic people achieve better mental health outcomes. Neurodiversity-affirming therapy and psychotherapeutic approaches like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) can be particularly impactful in improving overall well-being. 

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If you or someone you know is thinking about hurting themself, call, text or chat 988 for immediate support.

Despite their overlap in presentation, autism and BPD are very different diagnoses. The biggest difference between the two is how they are classified, though they diverge in a few key characteristics as well.

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Classification

The key difference between autism and BPD lies in how they are classified. Autism is a neurodevelopmental disorder, while BPD is a personality disorder.

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Neurodevelopmental conditions are present during early childhood and can affect many behaviors and skills, including motor and language skills, learning and other behaviors.

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Mental health conditions influence a person’s mood, emotions and cognitive processing. Not all mental health diagnoses persist for the duration of a person’s life, but personality disorders often do. Unlike neurodevelopmental conditions, however, personality disorders typically emerge during adolescence or early adulthood.

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Impulsivity vs sameness

Impulsive behaviors are common among people with BPD. While autistic individuals may sometimes act impulsively, perhaps speaking without considering their words first, autistic people generally prefer familiarity and repetition. They typically avoid impulsive actions that may affect set plans or lead to unforeseen events.

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Emotional regulation

Emotional dysregulation is a major diagnostic criterion for BPD, but is not necessary to diagnose autism. Although many autistic people do report difficulty regulating emotions, this trait looks different for autistics than it does for people with BPD.

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Autistic individuals may have difficulty with emotional regulation for a variety of reasons, but for many, emotional dysregulation can result from sensory sensitivity or sensory overload, frustration with social difficulties and support needs that aren’t accommodated. In other words, for autistic people, emotional dysregulation is a secondary characteristic that can be caused by common autistic traits. For those with BPD, however, dysregulation is an inherent part of their diagnosis, although it can be heightened when an individual has not yet built strong coping and emotional regulation skills.

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Nature of social differences

While autistic individuals and people with BPD both experience social differences, they manifest in very different ways. Autistic individuals typically don’t find neurotypical social behaviors intuitive and may interpret social cues differently. They may communicate in more literal and direct ways than others. For non-autistics with BPD, this is not necessarily the case. Social differences in people with BPD typically center on instability in relationships and emotions.

Autism and BPD are diagnosed through slightly different processes. Diagnostic evaluations for both hinge on a clinical interview with a psychologist or psychiatrist. BPD and autism have very different diagnostic criteria, so diagnostic interviews for each are structured differently.

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How is autism diagnosed?

An autism assessment typically incorporates a few diagnostic tools, the most important of which is a comprehensive clinical interview with the individual being assessed. To receive a diagnosis, an individual must meet the following criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

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• Persistent differences in social communication and interaction across multiple contexts
• At least two of the following characteristics:some text
  • Repetitive movements and behaviors
  • A strong preference for sameness and routine
  • Intense, restricted interests
  • Sensory hyper- and/or hyposensitivity
• The above behaviors and traits are present during early childhood, interfere with daily life and are not better explained by other developmental disorders

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A clinician may also incorporate additional diagnostic tools like questionnaires and interviews with people close to the individual—especially those who spent a lot of time with them during their early development. These additional tools paint a picture of the individual’s autistic traits throughout their lifetime.

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How is BPD diagnosed?

An assessment for BPD also includes a thorough clinical interview with a psychologist or psychiatrist. Clinicians assess for the following criteria from the DSM-5, which an individual must meet to receive a BPD diagnosis:

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• Persistent instability in relationships, emotions and self-image, as well as pronounced impulsivity, demonstrated in at least five of the following:some text
  • Urgent attempts to avoid abandonment, whether real or imagined
  • Intense, unstable relationships with alternation between idealizing and devaluing the other person
  • A consistently unstable sense of self
  • Impulsivity that could potentially result in harm to oneself
  • Ongoing suicidal or self-harming behaviors
  • Intense mood swings
  • Routine feelings of emptiness
  • Disproportionately intense anger, or challenges controlling anger
  • Temporary paranoia or severe dissociation

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Clinicians also often ask about an individual’s family mental and physical health history and may sometimes request a physical exam. This information can help them rule out other conditions that might be causing these behaviors.

Many support options are available for autistic individuals and people with BPD. Because both autism and BPD are diagnoses a person is likely to have for the rest of their life, interventions focus on improving coping skills and sense of wellbeing. Interventions for BPD and autism differ in that support for autism does not generally seek to change autistic traits, while interventions for BPD do strive to reduce and even eliminate BPD traits in order to improve quality of life.  Interventions for BPD may focus on reducing BPD characteristics, such as unstable relationships and difficulty controlling anger. Interventions for autism focus more on developing coping and self-advocacy skills, as well as reducing any symptoms of anxiety and depression.

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Therapy

Psychotherapy, also called talk therapy, is the primary intervention for both BPD and autism. For both diagnoses, the goal of therapy is to support the individual in building skills to cope with and manage difficulties, break patterns of thought and behavior that might be hurting them and improve self-advocacy skills.

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Long-term therapy relationships tend to be the most impactful; it’s important to find a provider you trust and whose approach feels effective and resonant.

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Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are most commonly used to support individuals with BPD and autistic people. 

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Cognitive behavioral therapy

CBT, one of the most evidence-based types of psychotherapy, helps individuals identify and disrupt unhelpful or harmful patterns of thought and behavior. CBT can be effective at helping both autistic individuals and people with BPD improve their mental health outcomes. For example, it can help both groups address core beliefs they might have about themselves and others that, for autistic people, contribute to anxiety and lower self-esteem, and, for individuals with BPD, drive unstable relationships and unsteady self-image. 

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Dialectical behavior therapy

DBT was developed specifically for BPD treatment, but it is beneficial for anyone who’s struggling with suicidal ideation and behaviors. It’s considered the first line of support for people with BPD and can also be impactful for individuals who struggle with substance use as well as those with eating disorders and post-traumatic stress disorder (PTSD).

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DBT focuses on accepting and regulating emotions, more than traditional CBT, as well as intervening with unhelpful or harmful behaviors. It incorporates approaches like mindfulness, and supports people in achieving healthier, more rewarding interpersonal relationships.

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Medication

Medication is not the primary support tool for BPD or autism. However, clinicians may prescribe psychiatric medication to autistic individuals or people with BPD for specific reasons, and many people across both diagnoses take medication to help improve mental health symptoms.

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Individuals with BPD can be prescribed medication to treat specific symptoms connected to BPD, or to address co-occurring mental health conditions like depression and anxiety. These can include antidepressants, anti-anxiety medication, mood stabilizers or antipsychotics.

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Autistic people may be prescribed medications like antidepressants and anti-anxiety medications to treat symptoms of anxiety and depression, which commonly co-occur with autism.

If you’re autistic or think you might be, Prosper Health can help you get answers and support. Prosper Health provides telehealth autism assessments specifically for adults and covered by insurance.

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A diagnosis can go a long way to help individuals better understand their lived experience and identify their support needs. Because BPD can be misdiagnosed, it’s important to seek support from a clinician who’s experienced in working with patients with BPD if you believe you may have it.

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For autistic individuals or those with both autism and BPD, Prosper Health can provide ongoing support through neurodiversity-affirming therapy. Prosper Health therapists specialize in working with autistic adults and can work with you to support your unique circumstances and meet your goals for your mental and emotional health.