BPD & neurodivergence
What is BPD?
Borderline personality disorder (BPD) - also called emotionally unstable personality disorder (EUPD) - is characterised by a pattern of emotional instability, unstable self-image, intense and turbulent relationships, and impulsive behaviour. It affects fewer than 1% of the UK population, and approximately 75% of those diagnosed are women.
People with BPD often experience intense fears of abandonment, a shifting sense of who they are, chronic feelings of emptiness, difficulty managing anger and other emotions, and impulsive or self-harming behaviours. Many people with BPD have experienced significant trauma, particularly in early relationships.
BPD is a real and serious condition that causes genuine suffering. The people who have it deserve compassionate, effective support.
The names are changing
The term “borderline personality disorder” has been widely criticised. In the ICD-11, BPD has been replaced by a dimensional personality disorder diagnosis with a “borderline pattern qualifier.” Many clinicians and researchers now prefer to use “borderline pattern” or simply describe the specific difficulties rather than using the label. Some services still use the term EUPD.
The misdiagnosis problem
How common is it?
Research shows that 17.9% of autistic women had been previously misdiagnosed with a personality disorder - most commonly BPD/EUPD - before their autism was recognised. A 2024 study in The Lancet Psychiatry found that personality disorders were among the most commonly perceived misdiagnoses in autistic adults.21
This is not a minor statistical curiosity. For the women affected, years of being treated for the wrong condition means years of therapy that does not address their actual needs, years of carrying a stigmatised label, and years of not understanding why they feel different.
Why it happens
The surface features of autism and BPD can look strikingly similar. But the underlying reasons are fundamentally different.
| Feature | In autism | In BPD |
|---|---|---|
| Emotional intensity | Driven by sensory overload, overwhelm, or the cumulative cost of masking | Driven by fear of abandonment and interpersonal triggers |
| Unstable sense of self | Reflects masking - performing different roles in different contexts, losing track of who you really are | Reflects identity disturbance - self-image shifts rapidly in response to relationships and perceived rejection |
| Relationship difficulties | Related to communication differences, social exhaustion, and difficulty reading unwritten social rules | Related to intense fear of abandonment, idealisation and devaluation patterns, and desperate attempts to avoid being left |
| Self-harm | Often a response to overwhelming sensory or emotional distress; may be more deliberate or ritualistic | Often impulsive, directly triggered by perceived or actual rejection |
| Impulsivity | May reflect autistic directness, stimming, or difficulty with transitions | Related to emotional dysregulation and attempts to manage unbearable feelings |
| Onset | Present from early development (though may not be recognised until adulthood) | Typically emerges in late adolescence or early adulthood |
Diagnostic overshadowing
Once BPD is in a person’s clinical record, it shapes how everything else is interpreted. This is called diagnostic overshadowing.
An autistic woman who has a meltdown in a clinical setting may have it recorded as “emotional instability” or “borderline behaviour.” Her need for predictability may be interpreted as “control issues.” Her difficulty explaining her emotions (alexithymia) may be read as “manipulation” or “evasiveness.” Her sensory needs may not be asked about at all.
Over time, the BPD label becomes self-reinforcing: every presentation is filtered through it, making it harder and harder for autism to be seen.
What the research shows
A 2025 phenomenological study found that autistic adults who had previously been diagnosed with BPD/EUPD experienced the personality disorder diagnosis as a misdiagnosis that introduced significant stigma. Receiving their autism diagnosis was described as “life-changing” - shifting the conceptual frame from “something is wrong with your personality” to “your brain works differently.”1
How ADHD gets mistaken for BPD
The overlap between ADHD and BPD is equally significant, though less widely discussed.
Emotional dysregulation is a core feature of ADHD. People with ADHD experience emotions intensely and rapidly - but this is how ADHD brains work, not a sign of personality pathology. The emotional intensity of ADHD is often triggered by sensory or cognitive overload, not by interpersonal abandonment fears.
Rejection sensitivity - the acute, sometimes overwhelming sensitivity to perceived rejection or criticism - is common in ADHD. It can look very similar to BPD’s fear of abandonment, but the mechanism is different: it is a neurological response to perceived rejection, not an attachment-driven pattern.
Impulsivity in ADHD reflects executive dysfunction - difficulty with impulse control, working memory, and considering consequences. In BPD, impulsivity is typically driven by attempts to manage unbearable emotional pain.
Relationship difficulties in ADHD often relate to executive function challenges: forgetting to reply to messages, time blindness, difficulty sustaining emotional labour. In BPD, relationship difficulties typically involve idealisation-devaluation cycles and intense fear of abandonment.
Can you have both?
Yes. Autism, ADHD, and BPD can co-occur. Neurodivergent people have higher rates of trauma, and trauma is a major contributor to the development of BPD. Growing up undiagnosed and misunderstood, experiencing bullying, social exclusion, and the cumulative impact of masking can all contribute to genuine personality difficulties alongside neurodevelopmental difference.
The question is not simply “is it autism or BPD?” but “what explains what?” A thorough assessment considers developmental history, the context of current difficulties, sensory needs, masking, trauma, and the specific patterns of emotional and relational difficulty.
What to do if you think you have been misdiagnosed
If you have a BPD/EUPD diagnosis and suspect you may be autistic or have ADHD, you have options.
Request reassessment. Ask your GP or current mental health team for a neurodevelopmental assessment. Be explicit about why you think this is relevant. You may need to advocate firmly for yourself - or bring someone who can support you.
Gather your history. Neurodevelopmental conditions are present from childhood, even if they were not recognised. Information about your early development, school experience, sensory sensitivities, and social difficulties from childhood can support the assessment process.
Seek specialist assessment. If your local services are not experienced in differential diagnosis between personality disorders and neurodevelopmental conditions, a specialist assessment (privately or through specialist NHS services) may be worth pursuing.
Know that both can be true. Getting an autism or ADHD diagnosis does not automatically mean your BPD diagnosis was wrong. But it does mean that your treatment should account for your neurodevelopmental needs, not just your emotional difficulties.
Your experiences are valid
Whether your difficulties are best explained by autism, ADHD, BPD, trauma, or a combination - your experiences are real, and you deserve support that actually fits. If you have spent years feeling that your diagnosis does not quite explain your experience, trust that feeling. It may be telling you something important.
Treatment considerations
If you are neurodivergent and have genuine BPD/borderline pattern difficulties, treatment needs to account for both.
DBT (Dialectical Behaviour Therapy) is the most established treatment for BPD, but standard DBT was designed for neurotypical people. Adapted DBT that accounts for sensory needs, communication differences, and executive function difficulties can be effective. See our DBT page for more on adaptations.
Neurodiversity-affirming therapy does not aim to make you less autistic or less ADHD. It acknowledges your neurodevelopmental differences and works with them, while addressing the genuine emotional and relational difficulties that may also be present.
Trauma processing - through EMDR, psychodynamic therapy, or other trauma-focused approaches - may be important if your personality difficulties are rooted in traumatic experiences.
Further reading on neurobetter
neurobetter services
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If you are in crisis
If you are struggling right now, please visit our Get Help Now page for immediate support options, including Samaritans (116 123), Crisis Text Line (text SHOUT to 85258), and NHS 111.
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Tamilson, B., Eccles, J.A. and Shaw, S.C.K. (2025). The experiences of autistic adults who were previously diagnosed with borderline or emotionally unstable personality disorder: A phenomenological study. Autism, 29(2), pp. 504-517. https://doi.org/10.1177/13623613241276073 ↩
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Kentrou, V., Livingston, L.A., Grove, R. et al. (2024). Perceived misdiagnosis of psychiatric conditions in autistic adults. The Lancet Psychiatry, 11(6). https://doi.org/10.1016/S2215-0366(24)00126-7 ↩
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