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<ul class="summary-list"><li>Some autistic women are misdiagnosed with borderline personality disorder.</li><li>The two conditions can have overlapping symptoms, such as mood swings and instability in relationships.</li></ul><keyword id="18702225" type="General" weightage="50" keywordseo="bree-conklin" source="Orion">Bree Conklin</keyword> wasn't officially diagnosed with autism until she was 34-years-old. Before that, she had been <a target="_blank" href="https://www.insider.com/she-was-diagnosed-bpd-had-autism-2023-8">misdiagnosed with borderline personality disorder</a> (<keyword id="172783" type="General" weightage="80" keywordseo="bpd" source="Orion">BPD</keyword>) for years. Conklin's story isn't uncommon.Due to overlapping symptoms, some autistic women are misdiagnosed with BPD, which involves a very different treatment plan. <a target="_blank" href="https://neurodivergentinsights.com/a">Dr. Megan Neff</a>, a <a target="_blank" href="https://www.insider.com/psychologist-with-autism-adhd-wasnt-diagnosed-until-late-thirties-2023-9">psychologist who was diagnosed with autism in her late 30s</a>, told Insider that while it's possible to have both autism and BPD, it's quite rare. It's more likely that an autistic person's reactions are being misinterpreted as symptoms of BPD. <keyword id="1742809" type="General" weightage="80" keywordseo="neff" source="Orion">Neff</keyword> also said that cultural stigma around both disorders also plays a role in autistic women and gender-nonconforming people being misdiagnosed with BPD. <a target="_blank" href="https://www.insider.com/guides/health/mental-health/autism-in-women">Autism is under-diagnosed in women</a>, while <a target="_blank" href="https://www.insider.com/guides/health/mental-health/borderline-personality-disorder">BPD is over-diagnosed in women</a>. Insider spoke to Neff about the overlapping symptoms between autism and BPD that lead to misdiagnoses, especially in women. <h2>Both autistic and BPD women can experience big mood swings</h2>Borderline personality disorder is heavily associated with dramatic shifts in mood. Neff said that undiagnosed autistic people can display very similar emotional reactivity, but these reactions are triggered by entirely different things than people with BPD. BPD meltdowns are "almost always triggered by attachment issues, whereas with autism, it might be a change in routine disruption or sensory issues," she said. In other words, a person with BPD might react if they feel abandoned, while an autistic person's triggers can have more to do with physical discomfort and mental burnout. <h2>They can both have unstable relationships</h2>According to Neff, a core feature of BPD is <a target="_blank" href="https://www.insider.com/defining-traits-of-borderline-personality-disorder-2022-4">instability in relationships</a>. Often, a person with BPD might idealize someone, then devalue them the moment they perceive a flaw. "With autism, we tend to have all-or-nothing thinking patterns," Neff said, which can look a lot like BPD when it comes to relationships. Additionally, autistic people may have special interests or areas of hyper-fixation — which can include people, Neff said. In that context, an autistic person's focus on a partner or friend can appear like intense idealization — a common BPD trait. <h2>Both can struggle to know who they really are</h2>Because of their attachment issues, people with BPD can experience huge <a target="_blank" href="https://www.helpguide.org/articles/mental-disorders/borderline-personality-disorder.htm">changes in their self-image</a> in the same way they feel instability in their relationships. They can abruptly switch career paths, friends, and even religions. Neff said autistic people can also struggle with their self-image, but it has more to do with trying to mask their symptoms around others — whether they're conscious of it or not. "What we're essentially doing is ignoring internal cues and adjusting to our environment," she said. "We're reacting to the cues of those around us and figuring out who they need us to be in this interaction." While they might be able to conceal some of their symptoms, autistic people can often feel like they don't know who they really are because they're so focused on fitting in. <h2>Both are at a high risk of depression — and misdiagnosis can worsen it</h2> Many people with BPD experience depression, which can include feelings of <a target="_blank" href="https://my.clevelandclinic.org/health/diseases/9762-borderline-personality-disorder-bpd">anger, emptiness, and self-loathing</a>. Many autistic people experience depression as well — and a misdiagnosis with BPD can make depression worse, Neff said. That's why it's so critical to understand the differences between these two disorders. "It's not just the burden of adding a diagnosis that is highly stigmatized and inaccurate," Neff said. "It's also the psychological burden of not having access to the accurate narrative that would help them understand themselves and create a life that actually works for them."

Autistic women are often misdiagnosed with borderline personality disorder. Here are 4 ways to spot the difference.

<ul class="summary-list"><li>Bree Conklin was diagnosed with borderline personality disorder when she was 27-years-old.</li><li>It wasn't until 5 years later when a different doctor suggested she might have autism instead.</li></ul>When she was 27, Bree Conklin was diagnosed with borderline personality disorder (BPD).The male doctor who diagnosed her while she was working in Germany said it was the cause of her meltdowns, self-harming behavior, and suicidal ideation. According to him, Conklin was also "seductive" and "manipulative" because she dated several men at once.Conklin, however, didn't feel like she was intentionally misleading anyone. "Looking back now, I take things kind of literally, and I thought you can date several people at the same time and then decide which one you would like to be in a relationship with," Conklin, now 39, told Insider. "I would go on three or four dates in a day because I thought that's what adults are supposed to do."<div type="image" title="Bree Conklin" height="810" width="1080" msid="103259241" hostid="261" sizebytes="23190"></div>After she was diagnosed with BPD, Conklin developed an intense interest in the subject, and bought several books on it. But after reading more about the mental illness, the diagnosis confused her even more.BPD is characterized by a severe fear of abandonment, mood swings, and patterns of unstable relationships, <a target="_blank" href="https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237">according to the Mayo Clinic</a>. While Conklin identified with some symptoms like extreme mood swings and instability, she struggled to relate other ones. Many of the books also cited a lack of empathy and frequent lying as characteristics of the disorder, which she did not relate to.Still, she stuck with the diagnosis for years, telling partners and friends that she had BPD and was seeking treatment for the disorder.<h2>She was prescribed medication that made her symptoms much worse</h2>To address her symptoms, Conklin was prescribed Abilify, an antipsychotic medication used to treat disorders like BPD and schizophrenia. But she said it made her experience frightening side effects."I didn't leave my house for three months, and I was convinced that if I ate anywhere, people were trying to poison me," she said. It wasn't until she got off the medication and started <a target="_blank" href="https://www.insider.com/surprising-forms-of-therapy-2019-2">cognitive behavioral therapy</a> that she felt better.Her relationships suffered during this time period, too. She broke up with a partner of three years while she was on Abilify. Additionally, she said some people in her life kept their distance because "they would never put themselves in a position with borderline people ever again."All of this made Conklin feel shame and guilt around her diagnosis. "I felt like I was being punished and that I didn't deserve to be around people, and I almost didn't want to because I didn't want to hurt anybody," she said.It wasn't until five years after her initial diagnosis that she first learned she might be autistic — a moment she said made "everything fall into place."<h2>She realized she might be autistic when she was pregnant</h2>During her second pregnancy, Conklin began seeing a therapist who was puzzled by her BPD diagnosis. Instead, noting Conklin's sensory sensitivities, the therapist wondered if Conklin might be <a target="_blank" href="https://www.insider.com/guides/health/mental-health/signs-of-autism-in-adults">autistic</a>. Conklin also had PTSD and trauma from her past, which the doctor thought might be making her symptoms worse.At first, Conklin didn't know much about autism. But when she did her own research, she realized the symptoms explained everything she'd been going through."A lot of the classic BPD symptoms actually make a lot of sense when you see them through an autistic lens," <a target="_blank" href="https://neurodivergentinsights.com/a">Dr. Megan Neff</a>, a psychologist who also was diagnosed with autism in her 30s, told Insider. For example, both BPD and <a target="_blank" href="https://www.insider.com/3-signs-autism-woman-who-was-undiagnosed-for-years-2022-12">autism symptoms</a> include emotional dysregulation and mood swings.Conklin also finally had an explanation for some of the symptoms that didn't seem to fit into her BPD diagnosis.When alone, she often rubs her fingers together or makes "weird noises," something known as "stimming," as a form of self-soothing. She also noticed her moods dramatically worsened around her menstrual cycle, <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223765/">which is common for autistic people</a>.It took her two years of being on a waitlist to get a formal diagnosis. But Conklin described that time in between as life-changing."For once in my life, I felt like being kind and compassionate to myself," she said. She even encouraged another friend who was diagnosed with BPD to seek out another opinion — and that friend learned that she actually had autism and ADHD.<h2>The experience made her realize how much stigma there is for both conditions</h2><div type="image" title="Bree Conklin" height="1217" width="1170" msid="103259243" hostid="261" sizebytes="46382"></div>Neff said that both autism and BPD have stigmas, albeit very different ones.Misdiagnosed autistic people continue to be judged and unsupported, which can lead to depression and suicidality. "Suicide rates and self-harm rates are much higher among the autistic population," Neff said.Additionally, <a target="_blank" href="https://www.insider.com/guides/health/mental-health/autism-in-women">autistic women</a> and gender-nonconforming people are <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306851/">more likely to be misdiagnosed</a>. Neff said gender bias plays a huge role: Autistic men are more often depicted in media and <a target="_blank" href="https://www.insider.com/the-good-doctor-i-am-a-surgeon-dr-han-autism-2023-5">stereotyped as scientific geniuses</a>.Meanwhile, for people who have BPD, there is also a lot of stigma. "Even within the mental health world, you'll still hear therapists say 'I don't want to work with someone with BPD,'" Neff said.Conklin's experience made her see how differently people treated her with each diagnosis. The German doctor, for example, saw her as flirtatious and disingenuous because he thought she had BPD.Conklin said being formally diagnosed as autistic improved how people treated her, compared to when she was diagnosed with BPD. After trying to get disability benefits for years when she said she had BPD, she was finally granted them with an autism diagnosis.She also said her ex-husband stopped pursuing full custody of their son once he learned she was autistic and started expressing more patience with her as well.On the flip side, people knowing she's autistic leads to her feeling infantilized. She recently had to get a colonoscopy done and the doctors wanted to "strap her down" before the procedure — something she said would only make her freak out more.Conklin said her experience not only made her feel a lot of empathy for misdiagnosed autistic people, but also for people with borderline personality disorder.

A woman was misdiagnosed with borderline personality disorder. 5 years later, she found out she actually has autism. 

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Autistic women are often misdiagnosed with borderline personality disorder. Here are 4 ways to spot the difference.

Julia Pugachevsky

A woman was misdiagnosed with borderline personality disorder. 5 years later, she found out she actually has autism.

Julia Pugachevsky

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