I-RAP
Improving Recognition and Understanding of Autism and Personality Disorder
Information about autism and personality disorder
On this page you can find out more about:
1. Language about autism and personality disorder
The DSM-5 and ICD-11 diagnostic systems use the term “autism spectrum disorder (ASD)” to define a spectrum of autism-related experiences, including those formerly labelled as Asperger’s syndrome or pervasive developmental disorder not otherwise specified [1, 2].
Throughout this website, we use the term “autism” or “autistic people” as this is preferred by some autistic people as a way of recognising that being autistic is central to their identity and understanding of themselves [3, 4].
We aim to use neurodiversity-affirming language, viewing autism as a neurological difference that can be disabling, particularly when society does not embrace and accommodate people’s needs [5].
We use the term “personality disorder” to refer to the set of experiences and behaviours described under this label within international diagnostic systems ( ICD-11 and DSM-V) [1,2],
whilst highlighting the strong link between this diagnosis and trauma, and outlining the criticisms of the diagnostic construct here.
References
[1] American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed, text revision). Washington DC: APA. [2] World Health Organization (WHO) (2019). International Classification of Diseases, Eleventh Revision (ICD-11), https://icd.who.int/browse11. [3] Brown, L. (2011). The Significance of Semantics: Person-First Language: Why It Matters. https://www.autistichoya.com/2011/08/significance-of-semantics-person-first.html [4] NHS England (2020). Learning disability and autism – Making information and the words we use accessible. From https://www.england.nhs.uk/learning-disabilities/about/get-involved/involving-people/making-information-and-the-words-we-use-accessible/#autism [5] Bottini, S. B., Morton, H. E., Buchanan, K. A., & Gould, K. (2023). Moving from Disorder to Difference: A Systematic Review of Recent Language Use in Autism Research. Autism in Adulthood.
2. What is personality disorder?
Highlights:
Trigger warning: this section contains references to trauma.
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The concept of personality disorder refers to the idea that some people experience longstanding and extensive difficulties in how they think and feel about themselves and others, and consequently how they behave in relation to other people.
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The most commonly diagnosed type of personality disorder is borderline personality disorder.
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Borderline personality disorder is characterised by experiencing frequent and intense emotional distress, and reacting very strongly to feeling let down or uncared for by other people. This can lead to conflict and difficulties in sustaining relationships. People with this diagnosis may manage feelings of intense distress by self harming or other coping mechanisms like disordered eating or substance misuse. A person with this diagnosis may also feel unsure about who they are as a person, and may experience intense feelings of disconnection from reality (“dissociation”).
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The internal experiences, distress and behaviours of people diagnosed with a personality disorder – particularly borderline personality disorder – can often make sense when we understand how they have been shaped by early experiences of trauma, abuse and neglect.
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3. Criticisms of diagnostic label of personality disorder
Highlights:
Trigger warning: this section contains references to trauma.
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Some people argue that borderline personality disorder is not a personality disorder and that it is not a useful diagnosis.
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Some people argue that no-one should ever be diagnosed with any personality disorder, because:
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It is insulting to suggest someone’s personality is disordered
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It ignores the role of trauma and blames trauma survivors for their distress
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The diagnostic label often leads to stigma and discrimination by clinicians
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4. What is autism?
Highlights:
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Autism is characterised by differences in social interaction and communication, by sensory processing differences, and by a strong need for predictability, alongside repetitive behaviour and highly focussed interests.
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The neurodiversity movement sees autism as a difference in neurology, not a disorder. However, these differences can be very disabling when an autistic person tries to cope with the demands of education, work and social relationships with non-autistic people.
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5. Why is it important to accurately recognise whether someone is autistic?
Highlights:
Trigger warning: This section contains references to suicide.
Accurate recognition of autism:
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Improves self-understanding and self-compassion
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Supports a person feeling understood and listened to by mental health services
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Prevents misunderstanding by mental health services and the world
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Enables autistic people to create environments that better fit their needs
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Facilitates adaptation of interventions and reasonable adjustments
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Prevents offer of inappropriate and distressing interventions
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6. How many people diagnosed with a personality disorder are might be autistic?
Highlights:
We do not know the answer to this as limited research has been carried out. What we do know is:
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Studies show high levels of autistic traits in people diagnosed with borderline personality disorder
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Studies show high levels of personality disorder traits in autistic people, and many people diagnosed with autism have a previous diagnosis of personality disorder.
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7. What do we already know about why autism is sometimes missed or misdiagnosed?
Highlights:
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Most people diagnosed with borderline personality disorder are women or people assigned female at birth (AFAB). Autism can look different in women/ AFAB people, which can lead to it being missed or misdiagnosed as personality disorder.
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Autism and borderline personality disorder can appear similar. For example, both may be characterised by emotion dysregulation and self-harm. This could lead to autism being misdiagnosed as borderline personality disorder.
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