"I Don't Think Anyone's Ever Asked Me About the Two Before": Making Sense of Co-occurring Autism and BPD in Inpatient Mental Health Settings.
Autistic girls in inpatient care say no one explores how autism and BPD overlap, so they feel misunderstood and mislabeled.
01Research in Context
What this study did
Katherine and her team talked to autistic teens in a mental-health hospital. They asked how it feels to have both autism and borderline personality traits.
The teens filled out short surveys and joined small group chats. Staff also shared notes about each teen’s care plan.
What they found
No teen had ever been asked about autism and BPD together. They said the two labels clash and leave them confused.
Girls felt the clash more. They said staff expect BPD mood swings, so autistic stress gets blamed on personality.
How this fits with other research
Kiep et al. (2017) watched younger girls camouflage autism at recess. The hospital girls in Katherine’s study used the same hiding tricks, but staff read it as BPD manipulation.
Dincel et al. (2025) found one in eight autistic teens dissociate after trauma. Katherine’s teens link this trauma to being told their autism is just BPD drama.
Waizbard-Bartov et al. (2022) showed girls’ autism severity can rise through childhood. Katherine shows what that rise feels like when labels pile up in high school.
Why it matters
If you write charts for adolescent girls, ask about both autism and BPD in the same breath. Use plain questions like, “Which parts feel like autism and which feel like mood swings to you?” This small step cuts label clash and builds trust within the first session.
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Add one dual question to intake: “Tell me how autism and any mood or personality labels feel different or alike for you.”
02At a glance
03Original abstract
There is lack of consensus in the literature regarding sex differences in social outcomes for individuals on the autism spectrum. Furthermore, little research has focused on the social experiences of high school students with autism spectrum disorder (ASD) during the school day. Using a large racially/ethnically diverse sample of high school students with ASD receiving special education services (n = 547; 76 females, 471 males), we examined sex differences in social interactions of youth both during and after school. We also tested for sex differences in background and phenotypic characteristics including autism severity, IQ, adaptive behavior, and mental health. Results indicated few statistically significant differences between males and females in social interactions and phenotypic characteristics (including raw scores of autism symptom severity). However, analysis of standardized scores of autism symptoms suggested that symptom scores for females with ASD diverged more from same-sex peers in the normed sample than scores of males with ASD. Lack of sex difference in social participation for youth with ASD in this study stands in contrast to patterns of sex differences in the general population. Findings suggest that few differences between males and females with ASD, both in social participation and autism symptom severity, might result in females with ASD being more dissimilar to their same-sex peers than males with ASD. Implications of findings for understanding sex differences in ASD across the life course are discussed. LAY SUMMARY: The present study examined sex differences in social participation in a large, diverse sample of high school students with autism spectrum disorder (ASD). Males and females were very similar in their social interactions both at school and outside of school, based on reports by teachers and parents. Level of autism symptoms was also similar for males and females. However, standardized scores of autism symptoms, which take into account age and sex specific norms, suggested that females with ASD may have behaviors that are more divergent from their same-sex peers than males with ASD.
Journal of autism and developmental disorders, 2025 · doi:10.1089/aut.2018.0004