Can women with borderline personality disorder also have autism?

Yes, women can have both borderline personality disorder (BPD) and autism spectrum disorder (ASD). In fact, the two conditions can co-occur, and research suggests that about 10% of women diagnosed with BPD also have autism, and vice versa ¹¹. However, autism in women is often missed or misdiagnosed as BPD, because the symptoms can look similar ¹⁰. This overlap can lead to confusion and delays in getting the right diagnosis and treatment.

What the research says

Studies show that BPD and autism can coexist. One review found that in approximately 10% of women diagnosed with BPD, there is also autism, and the reverse is also true ¹¹. This means that having one condition does not rule out the other. The same review noted that women with autism may have persistent suicidality and BPD-like traits, which can mask the underlying autism ¹¹. Another article highlights that female autism can be misdiagnosed as BPD, leading to mistreatment and harm ¹⁰. This misdiagnosis often happens because women with autism are skilled at camouflaging their differences, and their distress may only become obvious in adolescence or adulthood, when it is mistaken for a primary mental health issue ¹⁰. The diagnostic challenges are compounded by the fact that standard screening tools may be less sensitive for women, as they often present with subtler social-communication differences and context-specific restricted interests ⁹. Therefore, when a woman has BPD traits and atypical symptoms, clinicians should consider autism as a possible underlying condition ¹¹.

What to ask your doctor

• Could my symptoms be explained by both borderline personality disorder and autism?
• What are the signs of autism in women that might be missed?
• How can I get a thorough evaluation that considers both conditions?
• Are there specific screening tools that work better for women?
• What treatments are available if I have both conditions?