'The true me': Unravelling the dual narrative of borderline personality disorder and autistic spectrum disorder.

Abstract

Objectives: There is growing recognition that some individuals who receive a diagnosis of borderline personality disorder (BPD) are later diagnosed with autism. However, existing literature on this topic remains limited. This study aimed to explore the experiences of individuals diagnosed with BPD prior to autism, how they made sense of these diagnoses, navigated clinical systems and learnt to manage the complex challenges associated with this diagnostic sequence.

Methods: Thirteen (6 male, 6 female, 1 non-binary) adult participants took part in semi-structured interviews exploring their diagnostic journeys. Reflexive thematic analysis was used to develop a nuanced understanding of their experiences.

Results: Three themes were constructed: (1) The Limitations and Challenges of Diagnostic Overshadowing, capturing how participants felt their BPD diagnosis failed to fully explain their difficulties, prompting them to seek further assessment; (2) Stereotyping and Misconceptions, exploring the impact of stigma and stereotyping, both internalized and encountered within clinical settings; and (3) Learning to Cope in a New World, describing how receiving an autism diagnosis enabled participants to reframe past experiences and develop new, often sensory-informed coping strategies.

Conclusion: These findings underscore the need for diagnostic processes that are open, curious and sensitive to overlapping presentations, and attentive to how historic stereotyping may shape clinical decision-making. They also highlight the importance of post-diagnostic support that empowers individuals to understand and adapt to their neurodivergence, fostering growth rather than perpetuating shame.