BPD vs. autism: Differences & overlap in symptoms

Key Takeaways

Autism and BPD are two different conditions, but they can create similar challenges with social and emotional functioning.
In addition to having some overlapping symptoms, it’s not uncommon for autism and BPD to co-occur. When this happens, it’s important to access care that addresses both concerns at the same time.
While there’s no cure for autism or BPD, both conditions can be managed with the right support. Treatment may include therapy and/or medication. However, it will largely depend on the severity of a person’s symptoms and their individual needs.

Autism spectrum disorder (ASD), or autism, is a neurodevelopmental condition. It can cause ongoing challenges with communication and learning, repetitive behavior, and restricted interests. Borderline personality disorder (BPD) is a different mental health condition. BPD can lead to emotional instability and impulsivity. It can also affect how people see themselves and their ability to form healthy, stable relationships.

Both autism and BPD can cause similar difficulties with interpersonal and emotional functioning. It’s also possible for a person to live with both conditions at the same time. This overlap can make it difficult to know whether a person is living with autism, BPD, or both.

So if you’re having trouble managing your emotions, relationships, or any other important aspects of your life, don’t hesitate to ask for your help. A therapist can talk to you about your symptoms, provide an evaluation, and help you get the support you need to manage your mental health.

Can autism look similar to borderline personality disorder?

Yes, autism can look similar to BPD. Let’s review a few examples of symptoms that can be characteristic of either condition.

Social interaction: Both autism and BPD can negatively impact social skills and your ability to show empathy. This can make it hard to maintain relationships.
Emotional regulation: Autism and BPD can affect your ability to manage, identify, and express emotions. These conditions can also make it difficult to understand other people’s emotions and respond appropriately.
Repetitive behaviors: People with autism may engage in repetitive behaviors to relieve stress or just for fun. Repetitive behaviors can be mistaken for impulsivity in people with BPD.
Self-harm: Both autism and BPD can elevate a person’s risk for self-harm and suicidality.*
Restricted interests: People with autism and/or BPD may be more likely to have rigid ways of thinking or intense interests.

*A note on safety: If you’re having thoughts of harming yourself, don’t hesitate to ask for help. You can contact the National Suicide and Crisis Lifeline by dialing 988 from any phone. Their counselors will provide confidential support and resources to help keep you safe.

How can you tell the difference between BPD and autism?

While they share some symptoms, there are some important differences between BPD and autism. First, autism is typically diagnosed when a child is very young — often well before they enter school. BPD symptoms, on the other hand, typically begin to emerge in late adolescence or early adulthood.

Another important distinction is that, while BPD and autism can show up in similar ways, the underlying function of the symptoms isn’t the same. For example, both conditions can cause relationships challenges. For people with autism, this might be due to things like discomfort with eye contact and/or difficulty identifying social cues. On the other hand, people with BPD often have a history of unstable relationships. For them, this might be due to an intense fear of abandonment and/or emotional instability.

To the untrained eye, these distinctions might be difficult to detect. But fortunately, there are mental health professionals who are skilled in working with people with autism and/or BPD. They can help you identify the source of your symptoms and create a personalized plan to manage them.

Can you have autism and BPD together?

It’s possible to have autism and BPD together, and research suggests it’s not uncommon. While there’s limited data on the prevalence of this experience, one study found that as many as around 15% of people with BPD likely also have autism.

Experts are still working to understand the connection between these conditions. While having one won’t automatically lead you to develop the other, they may result from similar risk factors. There’s evidence to suggest that both BPD and autism may be tied to similar biological, environmental, and genetic differences.

Can one condition be misdiagnosed as the other?

Because autism and BPD share some symptoms, it’s possible to receive a misdiagnosis. This can prevent a person from receiving the care they need. If you think you received a misdiagnosis in the past, don’t hesitate to speak to your provider or seek another opinion.

Remember, you deserve to have an accurate understanding of your mental health. You also deserve to work with a provider who will listen to your concerns, provide helpful feedback, and help you access the support you need.

Personalized care for BPD and ASD

Treatments for BPD and autism vary considerably and are largely dependent on the severity of a person’s symptoms and their individual needs. But fortunately, if you’re living with both conditions, there are treatments that can address both concerns at the same time.

For example, mentalization-based therapy has been shown to have a positive effect on both autism and BPD. This approach focuses on helping people foster emotional regulation and empathy. It can also help people understand thoughts, feelings, and behaviors in themselves and others.

While there’s no cure for autism or BPD, they can be managed with the right support, and some people may require lifelong care. There’s also evidence to suggest that having co-occurring BPD and autism may increase your risk of severe depression and suicidality. In those instances, it’s important to prioritize safety planning in treatment.

Currently, there are no approved medications for autism or BPD. But for some people, medication can be helpful in alleviating symptoms of co-occurring conditions, like depression. You can always talk to your provider about whether this is the right option for you.

Find care with Rula

BPD and autism are two distinct conditions that can create similar challenges with social and emotional functioning. And since these conditions can also co-occur, it can be difficult to tell whether a person is living with BPD, autism, or both.

So if you’re having trouble managing your emotions, navigating social situations, or forming healthy relationships, rest assured that you’re not alone and you don’t need to have an official diagnosis to ask for help. With Rula, you can connect with a therapist who offers the specialized care you deserve in just a few clicks.

To start the process today, check out our therapist-matching program. There, you can sift through your options, select an in-network provider, and schedule your first live video session for as soon as tomorrow.

Rula's editorial process

Rula's editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness. Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.