Overlapping Autistic and BPD Traits

Sensitivity to Abandonment

Rejection Sensitive Dysphoria is common among Autists and ADHDers. Rejection sensitivity is an intense sensitivity to rejection or perceived rejection. People with RSD often go to great lengths to avoid situations that cause them to feel rejected. They also have strong reactions when they perceive themselves as being rejected.

A Diffuse Sense of Self

A diffuse sense of self. A core feature of BPD is a “diffuse sense of self” or lack of “self-identity,” often resulting from early childhood development/trauma. High masking autists, who learn to socialize through copying/becoming chameleons, often lack a true social identity (Attwood, Vid.1).

Chronic Feelings of Emptiness

These feelings are commonly reported among high-masking autistics. This likely is related to diffuse identity due to social masking. Many autists also experience a sense of emptiness during burnout and when not actively engaged in a task (Attwood vid.2).

Social Difficulties

Social interactions & maintaining long-term relationships can be challenging for both groups. However, the core reasons behind difficulty often have different origins and must be considered.

Emotional Dysregulation

Emotional dysregulation is a core feature of BPD. Autists also struggle with emotional dysregulation due to the autistic brain wiring/chemistry. Sensory overload and sensory meltdowns can also lead to emotional dysregulation.

Relationship Difficulty

Relationships can be challenging for both groups. This is due to differences in social cognition, social interactions, and maintaining long-term.

Sexual and Gender Diversity and Fluidity

Gender-queering is more common among Autistic people and people with BPD. People with BPD more commonly shift in their core sense of self, including sexual and gender identity (Biskin and Paris).

Autistic people are more likely than NTs to be gender diverse, and gender diverse people are more likely to have autism than cisgender people.

  • People who don’t identify with the sex they were assigned at birth are 3-6 times more likely to be Autistic than cisgender people (Warrier et al.)

  • Autistics are more likely to be non-heterosexual than the general population (Sarris).

  • Emerging research demonstrates a higher percentage of gay and gender-diverse individuals represented within BPD populations (Reuter et al. and Singh).

Depersonalization and Derealization

  • Depersonalization involves the sensation that a person’s body/self is unreal or altered in a strange way.

  • Derealization involves the experience of the external world being bizarre, unreal, or dream-like.

Both can be a response to trauma; however, they can also be a response to sensory overload as the body shuts down to keep from taking in more sensory information. These experiences are common among both groups (Botbol).

Insecure Attachment Style

BPD is characterized by an insecure attachment style (typically anxious/preoccupied) (Agrawal et al.).

Autists often experience insecure attachment. Autists are more likely to have an avoidant attachment style: One study found a higher rate of avoidant attachment styles among Autistic individuals. No association were found between anxious attachment and autistic traits) (McKenzie and Dallos).

Another study found Autistic children had higher rates of disorganized attachment (22%). Certain Autistic behaviors may look like disorganized attachment. Thus, it can be challenging to identify an autistic trait vs. disorganized attachment style (Coughlan et al.).


Overlapping Risks

Eating Disorders

Both have a high % of eating disorders (may function as a method of self-soothing/gaining a sense of control)

  • One study found that 53.8% of people with BPD met the criteria for an Eating Disorder (21.7% anorexia nervosa and 24.1% bulimia nervosa) (Salters-Pedneault).

  • While the rates vary, most researchers agree that about 23% of people diagnosed with anorexia nervosa are Autistic. However, it is likely an underrepresentation due to the fact Autism often goes undiagnosed within this population (Westwood and Tchanturia).

Substance Abuse/Addiction

Substance abuse/addiction: For a long time, it was assumed that substance abuse was low among autists (due to adherence to rules).

Emerging research shows the hidden side of autistic addiction. A recent study in Sweden found that Autistic people with average to high intelligent quotients (IQ) were twice as likely to struggle with addiction to alcohol or other drugs. Among Autists, drugs are sometimes used to cope with social stress and sensory problems (Szalavitz).

Alcohol and drugs are a powerful way of attempting to regulate one’s nervous system when it is flooded with stress hormones. This can be a common way a person self-soothes following trauma. Approximately half of the people with BPD also have a co-occurring substance abuse disorder, often alcohol (Trull et al.).  

Victimization

Victimization: Both groups have elevated risks of victimization (Botbol). Recent research has demonstrated that Autistic women and genderqueer people are more likely to be survivors of violent victimization. Some risk factors include:

  • challenges in social reasoning

  • missing contextual cues

  • a tendency to take things literally

One study found that Autistic adults were 7.3 times more likely to endorse past experiences of sexual assault (Weiss and Fardella).

Suicidality

Autists with average to high IQ are three times more likely to attempt or die by suicide than the general population (South et al.)

Self-Harm

Self-harm is common among both groups. Self-harm more commonly happens in the context of sensory overload for Autists. In the context of BPD, it more often occurs following an attachment injury (Botbol).

  • One study found that parents reported self-harm behavior among their autistic youth in 15% of cases (Huang).

  • Autistic teenagers are also more likely to engage in self-harm behavior. Self-harm can be in the form of cutting, skin-picking, hair-pulling, and hitting.

Eating Disorders

Both Groups have a high percentage of eating disorders. One study found that 53.8% of people with BPD met the criteria for an Eating Disorder (21.7% anorexia nervosa and 24.1% bulimia nervosa) (Salters-Pedneault).

While the rates vary, most researchers agree that about 23% of people diagnosed with anorexia nervosa are Autistic. However, many agree, this is likely an underrepresentation due to the fact Autism often goes undiagnosed within this population (Westwood and Tchanturia)

Co-occurring Mood Disorders

Both groups have an elevated risk of having co-occurring mood disorders such as depression and anxiety.

  • According to one study, 79% of Autists met the criteria for a co-occurring psychiatric tradition at least once in their life (Lever and Geurts).

  • Major depressive disorder and PTSD commonly co-occur with BPD. One study reported 83% of those with BPD would meet the criteria for Major Depression at least once in their life (Beatson).