Overlapping And Differentiating Clinical Features of Autism and Borderline Personality Disorder in Women and People Assigned Female at Birth: A Cross-Sectional Study

This publication is included in the Autistic Autism Scholarship Project. The publication reports two autistic authors, without identifying them by name.

Barnicot, K., Thompson, E., Turner, S., Mandy, W., McCabe, R., Stark, E., & Parker, J. (2026). Overlapping And Differentiating Clinical Features of Autism and Borderline Personality Disorder in Women and People Assigned Female at Birth: A Cross-Sectional Study. Autism, 30(5), 1292-1304. https://doi.org/10.1177/13623613261431309

Publication date: 2 Apr 2026 Added to AutiHub: 16 Sep 2026 Type: Article Article language: English

This publication is integrated into AutiHub through:

Authors

Publication authors
7
Autistic authors reported by the publication
2

Abstract

Previous research has suggested potential phenotypic similarities between autism and borderline personality disorder (BPD). We aimed to identify overlapping and differentiating characteristics of the two diagnostic groups in women and people assigned female at birth (PAFAB). Women and PAFAB with an autism diagnosis (n = 51) or a BPD diagnosis (n = 51), who had few or subclinical traits of the comparator diagnosis, completed a range of self-report questionnaires. Emotional reactivity, emotional dysregulation, identity disruption, difficulties being alone and rejection sensitivity were significantly more characteristic of BPD-diagnosed participants, with identity disruption representing the biggest difference from autistic participants (d = −1.36, 95% confidence interval [CI] = [−1.79, −0.92]). Autistic participants scored significantly more highly on measures of sensory processing, social cognition and behaviour, preference for sameness and repetitive motor behaviour, with sensory processing representing the biggest difference from BPD-diagnosed participants (d = 1.19, 95% CI = [0.76, 1.60]). Group differences in social cognition, social camouflaging, identity disruption, impulsivity and coping with being alone, together correctly classified 95.1% of participants (area under the curve [AUC] = 0.98). However, comparison with measure scores in previous research suggests more complex phenotypic similarities, whereby autistic individuals may show more BPD-aligned characteristics than the general population and vice versa. Lay Abstract Autism can look similar to borderline personality disorder (BPD), leading to misdiagnosis. For example, both diagnostic groups may experience difficulties in regulating their emotions. To improve diagnosis, we wanted to understand similarities and differences between autism and BPD in adult women and people assigned female at birth (PAFAB). We asked two groups of people to complete online questionnaires: (1) 51 women/PAFAB with an autism diagnosis, who do not meet diagnostic criteria for BPD and (2) 51 women/PAFAB diagnosed with and meeting diagnostic criteria for BPD, who are not autistic. The questionnaires asked participants how they experience their emotions, how they interact and relate with other people, how they experience their identity and self-concept, how they react to sensory input, for example, sounds and smells, and how they use repetitive movements, as well as their preferences for sticking to familiar ways of doing things. We found more differences than we expected between autistic people and people meeting diagnostic criteria for BPD. For example, autistic people described being more sensitive to sensory input, described ‘masking’ more during social interactions and described more challenges in understanding the social behaviour of non-autistic people, compared to people meeting diagnostic criteria for BPD. People meeting diagnostic criteria for BPD described more difficulties with emotion regulation and with their sense of self (‘knowing who I am’), were more likely to behave impulsively and found being on their own more difficult, compared to autistic people. Clinicians, and people with a BPD diagnosis who think they may be autistic, can use these findings to better understand the differences between the two diagnoses. Even though we found lots of differences, it is still likely that autistic people experience more similarities with BPD than non-autistic people do and vice versa.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 19 Sep 2026 01:01.

Cited references
69
With a DOI
62
Without a DOI, from raw bibliography text
7
3 / 69 (4.3%) cited references include at least one author identified as autistic.
References with data to complete
2 / 69 (2.9%)
References with detected author names
68 / 69 (98.6%)
Without detected author names
1
Without a structured title
2
Without a stable identifier
7
References with raw author names still to review
1
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
319
From DOI or external metadata
319
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
1
108 / 319 (33.9%) names are linked to an author already present in AutiHub. 211 / 319 (66.1%) names are not yet linked.
Names linked to a person identified as autistic
9 / 319 (2.8%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 9 / 108 (8.3%). Distinct people identified as autistic: 8 / 291 (2.7%).
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