Could She Be Autistic? Exploring Gender Differences in Camouflaging and Pragmatics in Autism and Borderline Personality Disorder
Camouflaging makes autistic women and women with BPD look alike, so probe deeper than social first impressions.
01Research in Context
What this study did
Gracia et al. (2026) asked women, men and gender-diverse adults to fill out surveys about autism traits, borderline personality traits and camouflaging.
They compared three groups: people diagnosed with autism, people diagnosed with borderline personality disorder (BPD), and people with both.
The goal was to see if camouflaging looks the same across genders and across the two diagnoses.
What they found
Women with autism and women with BPD scored almost the same on camouflaging.
Men with autism showed clearer autistic patterns, making diagnosis easier.
The gender-diverse group showed no clear pattern, so camouflaging did not point one way or the other.
How this fits with other research
Barnicot et al. (2026) ran a similar survey and found big, easy-to-see differences in sensory issues and social cognition between autistic and BPD women.
Their data say the two groups can be told apart, while Gracia’s data say camouflaging makes them look the same.
The studies differ because Kirsten looked at raw sensory and emotion scores, while Gracia looked at how people hide those traits.
Sorenson Duncan et al. (2021) pooled past papers and found autism and BPD only co-occur at normal population rates.
This supports Gracia’s warning: overlap in camouflaging can fool clinicians, even though the conditions are distinct.
Why it matters
If you assess adult women or gender-diverse clients, do not trust “looks fine in social settings.” Add questions about sensory issues, identity disruption and emotion regulation. Use sex-normed tools and ask directly about masking. This extra step cuts down on missed or mixed diagnoses.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add three quick questions to your intake: “Do you copy others to fit in?”, “Do loud lights or textures bother you?”, “Does your sense of self change often?”
02At a glance
03Original abstract
This study explores the relationship between social camouflaging and pragmatic competence in adults diagnosed with autism spectrum disorder (ASD) and borderline personality disorder (BPD), with a particular focus on gender. It is based on the hypothesis that camouflaging contributes to under or misdiagnosis, especially in women and gender‐diverse individuals. A total of 225 adults participated in a cross‐sectional online survey, completing the Camouflaging Autistic Traits Questionnaire (CAT‐Q) and the Pragmatic Awareness Questionnaire (PAQ). Participants were grouped based on clinical diagnosis (ASD or BPD) and self‐identified gender (women, men and gender‐diverse). Among women, no significant differences in camouflaging scores were found between the ASD and BPD groups, suggesting the use of similar adaptation strategies that may obscure clinical differentiation. In contrast, among men, camouflaging and pragmatic deficits were more distinctly associated with autistic traits. No substantial differences were observed among gender‐diverse participants, highlighting the influence of contextual and identity‐related factors. Findings emphasize the importance of integrating detailed pragmatic assessments and adopting gender‐sensitive approaches in the differential diagnosis of ASD and BPD. Such strategies may help reduce misdiagnosis and improve recognition of autistic traits, particularly in populations that tend to camouflage more effectively.
Clinical Psychology & Psychotherapy, 2026 · doi:10.1002/cpp.70210