Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta‐analysis

Abstract

Autism spectrum disorder (ASD) and borderline personality Disorder (BPD) share features, including social and emotion regulation difficulties. The evidence for the overlap in prevalence and clinical characteristics was systematically reviewed. Ovid Medline, PsycInfo, and PubMed were searched until November 30, 2020 using keywords relating to BPD and ASD. Studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort, or casecontrolled design were included. Of 1633 screened studies, 19 were included, of which 12 reported data suitable for meta-analysis. Most samples were of small, clinically ascertained groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across clinical areas. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder. Based on this data we were not able to assess whether there is misdiagnosis of one in favor of the other. Neurocognitive differences may underlie similar behavioral symptoms, but further research using larger, well-validated samples is needed. Lay SummaryAutism spectrum disorder (ASD) and borderline personality disorder (BPD) have overlaps in their symptoms. The overlap in how frequently they co-occur and their presentation was systematically reviewed. We searched the key databases and including all studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort or case-controlled design. Of 1633 studies, 19 were included, of which 12 reported data suitable for pooling. Most samples were of small, clinical groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across studies comparing ASD and BPD related symptoms and problems. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was similar to the population prevalence of each disorder. Further research using larger, well-validated samples is needed.

Media coverage of Belgium’s first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines

“…Although autism spectrum disorders (ASDs) and BPDs are accepted by the American Psychiatric Association as two distinct disorders, a symptomatic overlap between both disorders may exist ( 31 , 32 ), often making differential diagnosis difficult and challenging. Asperger’s Syndrome, one of the diagnoses for which the patient was granted euthanasia and which is nowadays known as high functioning ASD (without intellectual disability), appears to share various features of BPD ( 32 ) (for more information on this issue we refer the reader to De Hert et al ( 5 ). This partly explains why some females with BPD have undiagnosed ASD.…”

Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions

“…People with ASD experience fewer close relationships, higher levels of social isolation, and significantly more mental health problems, 34 with estimates of up to 72% of individuals meeting criteria for at least one comorbid mental health diagnosis, 35 often in the realm of mood and anxiety disorders consistent with Brittany’s history 36 . A recent pooled estimate of ASD in persons with BPD shows a prevalence rate of 4%, suggesting that BPD comorbid with ASD is not uncommon 37 …”

“…36 A recent pooled estimate of ASD in persons with BPD shows a prevalence rate of 4%, suggesting that BPD comorbid with ASD is not uncommon. 37 SENSITIVITY AND SELF-HARM IN BPD AND ASD Both BPD and ASD share an altered sensitivity profile. In BPD, this presents as heightened emotional sensitivity, 38 whereas in ASD, sensory sensitivity is more often observed (e.g., hypo-and hypersensitivities to auditory, tactile, or gustatory stimuli).…”

Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia

“…The patient may have had some traits or symptoms that are part of the spectrum of ASD (as introduced by DSM-5). However, although there can be an overlap between symptoms of BPD and ASD, the co-occurrence of both disorders is exceptional ( 69 , 70 ).…”