BPD and ASD

Emotionally charged meltdowns, intense relationships, superficial friendships, miscommunications and incorrectly assumed intentions. A lot of people with Asperger’s syndrome could identify with this list. An equal number of those with Borderline Personality Disorder (BPD) could also identify with this list. With individual’s on both sides being misdiagnosed with the other condition, what are the key differences and how can we tell them apart?

Those with a Borderline Personality Disorder (BPD) often present with a pattern of significant impulsivity and instability of affects, interpersonal relationships and self image. This can manifest itself in an intense fear of abandonment and intense anger and irritability, particularly when others fail to understand them. Typically they flip between idealization and devaluation of others, alternating between high positive regard and great disappointment, and frequently display suicidal and self-harming behaviours**. A world apart from the often black and white mechanical thinking of an individual on the autism spectrum, where objects and animals often gain a greater significance than humans, and where other people’s thoughts are not even understood let alone open to manipulation. Yet the functioning of both individuals can appear the same, and frequently those with autism are misdiagnosed as having a personality disorder, particularly BPD, before their autism is recognised*; this is especially true for females.
Faced with the choice of BPD or ASD my psychiatrist precariously leant on the side of the former. Borderline is most common in females and could be considered an extreme form of the female brain, in much the same way that autism has been considered an extreme form of the male brain. So of course being presented with a depressed and anxious patient, who seems to be oversensitive to all forms of treatment and a general pain in the arse (PITA), shoving them into the bracket of ‘unstable female’ would seem like an appealing option. Fortunately for me I had a team of Asper-believers (namely a therapist, my mum, girlfriend and a few friends), and an imminent date with an adult autism assessment clinic to squash those BPD rumours circling my mental health records. What others should have noted was my lack of displayed emotion, my evident self directed anger, and my desperate struggle to please everyone and not miscommunicate as key signs that my personality was not disordered, my entire neuronal network was disordered and I was desperate to gain control over it. So why did they look the same in me and so many other women?
Autism expert Tony Atwood believes that this misconception of females on the spectrum comes from their ability to hide their autism better than males, resulting in behaviour patterns which can mimic those with BPD. This is particularly true if in an effort to mask social confusion and appease others, she models herself on someone else to achieve social success; in the unlikely event that that person happens to have BPD then she has no hope! This can lead to fake and forced social interactions, which can lead others to feel she is manipulative and superficial and completely divert away from the fact she has an ASD. On the other hand the Aspie’s experience of bullying, rejection and betrayal can lead to fears of abandonment and intense and unstable relationships with others, mimicking a BPD.
Fortunately there are some key differences between the two disorders which set them apart. Firstly, whilst those with Asperger’s Syndrome do not get social cues or misunderstand them, those with Borderline Personality Disorder are hyper aware of them, but often distort them. Whilst both can have impairments when it comes to empathy, those with Asperger’s do not understand the social norms that go with a situation, whereas someone with BPD may exploit and manipulate the situation. Because of this those with a BPD are often better able to appear charming and sociable, but on the flipside they can be incredibly manipulative of others**, whereas the manipulation of those with Asperger’s derives from an almost obsessive need to control their surroundings and to please themselves. In terms of self-harming behaviour both are vulnerable, typically though those with Asperger’s use it to release inner tension, whilst those with BPD may be using it as a cry for help. Generally BPD behaviour seems to be a result of defence, usually manifesting itself in late teens and adolescence and commonly developing after a particularly unstable childhood. As we know (or should know, read more of my blog if not!), those with an ASD are born with the condition, it may only become apparent to others over time but it must have always been there.
The danger is in thinking that those with BPD are to blame for their behaviour, and I am the first to admit that my prejudice led me to believe it was an attention seeking disorder. It was only after I researched the issue and spoke to those who have worked with them, that it became apparent that those with BPD are no more in control of their behaviour than those with an ASD. There tends to be a lack of awareness on both sides as to why their behaviour has manifested in the way it has, and actually the treatments for both disorders can benefit the other. Neither respond particularly well to medication, but therapy with an emphasis on interpersonal relationships can hold the key. Particularly work focussed on metallization, which encourages a greater awareness of the intentions of oneself and those around them. Mentalization-based treatment (MBT) was developed with Borderline Personality Disorder in mind, the object of which was to increase the mentalization capacity in patients which should improve affect regulation and interpersonal relationships**. For those Aspies who lack a theory of mind (the ability to understand others mental states), this type of therapy can also be incredible beneficial, even in those like me who, on a much more mild level, just struggle sometimes to interpret the intentions of others.