Autism Spectrum Disorders and Borderline Personality Disorders: Comorbidity and Difficulty of Diagnosis in Women

Abstract

Background : This paper addresses the challenges of diagnosing both Borderline Personality Disorder (BPD) and Autism Spectrum Disorder (ASD) simultaneously. We argue that this is particularly complex in women due to their tendency to engage in “social camouflage” behaviors, which mask underlying social difficulties. Purpose : Clinicians frequently encounter cases involving the co-occurrence of a personality disorder and another psychiatric condition. The comorbidity of ASD and BPD presents a unique challenge, as both disorders involve emotional dysregulation, sensitivity to rejection, and difficulties in social relationships. Women, in particular, often demonstrate better social adaptation or “camouflaging” of symptoms, which can obscure accurate diagnosis and hinder treatment. This paper aims to raise awareness among therapists about the need to consider this dual diagnosis and suggests some therapeutic avenues for treatment. Methods : We review and analyze the existing literature on this topic, followed by the presentation of two anonymized clinical cases from our practice. Through the exploration of these cases, we illustrate the difficulties faced by patients, their families, and therapists when managing ASD and BPD comorbidity. Results : Practitioners may initially focus on diagnosing and treating BPD, but the concurrent presence of ASD can complicate the patient’s well-being and create additional challenges for the family and the entourage. The cognitive fatigue that individuals with ASD experience during social interactions can exacerbate BPD symptoms and impede therapeutic progress. Therefore, therapists must carefully consider the possibility of this dual diagnosis, especially when treating women with borderline traits.