Asperger Syndrome vs. Borderline Personality Disorder

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Some clinical mumbo:
NIMH on BPD
NINDS on Asperger's

Thank you for opening up a dialogue about BPD and Asperger's. This is something I'm dealing with right now in my personal life.

I made a vehn diagram about the symptoms once, and there is a lot of overlap, but also stunningly things that are the inverse of each symptom.

I have BPD and I have greatly suspected having it since I was about 14, but have only recently been diagnosed. (You, in fact, cannot be diagnosed with BPD until you are at least 18 ). I'll give you the hard facts first before interjecting my opinion.

There are 9 diagnostic critera in the DSM IV for BPD currently.
(I took this from wikipedia, but it is correct)
1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
5.Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing of scars, or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7.Chronic feelings of emptiness, worthlessness.
8.Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9.Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms

The diagnostic critera for AS is less straightforward than this, but there are 6 in the DSM IV.

1.qualitative impairment in social interaction
2.restricted, repetitive and stereotyped behaviors and interests
3.significant impairment in important areas of functioning
4.no significant delay in language development
5.no significant delay in cognitive development, self-help skills or adaptive behaviors (other than social interaction)
6.criteria are not met for another specific pervasive developmental disorder or schizophrenia.[1]

Because the diagnostic critera for AS can seem vague it is easy to think of AS critera as being the less specific version of some BPD symptoms. As you can see the diagnostic critera are similar in that persons with BPD can experience impairment in social interaction (instable relationships), have impaired functioning (due to instable emotions/ suicidal thoughts/impulsive actions), sterotyped behaviors (impulsive behaviors are often repetitive). Although not a critera for diagnosis, Borderlines have obsessions (often with people) and black and white thinking (things are all good or all bad).


Currently, the research concludes that AS/ Austism is a result of inborn and physiological neurological differences and BPD is a result of trauma similar to PTSD. Although, this is the current belief, it has been found that their are physiological differences in the BPD brain as well. This is an interesting article regarding this issue:

http://www.nimh.nih.gov/science-news/20 ... hips.shtml

Autism/ AS is considered a delay in the development which manifests itself in impaired social function, while I believe BPD is a delay in delvelopment which manifests itself in impaired emotional function.

My home is a great experiment in this issue as I am a Bordie (as I like to call it) and I live with and am dating an Aspie. We are very similar and I feel he is the only person who understands me and how I think and feel. I have meltdowns, inappropriate reactions to things he does, i'm resistant to changing my routines but he is always patient with me. And I understand, and sometimes share his obsessive interests, social anxiety, and literal thinking.

From my personal experience, its like BPD and AS are Yin/ Yang disorders two sides of of the same coin.

Boy, do I wish I didn't have issues with social interaction, I'd have more than 3 friends. I have lots of routines (I'd list my morning routine, but I don't want to bore anyone), and don't get me started on obsessive interests.

::pokes my post::

Bordie parrot right here! (although I copied and pasted cuz' I'm lazy, I made sure it was correct though).

The diagnostic criteria don't mean much [as they don't explain anything], nor are they meant to be used by themselves. It's best to read the expanded description of both disorders in the DSM-IV-TR (it explains it in-depth).

They're entirely two different things as they're explained.

That's an interesting point. Being diagnosed with a personality disorder doesn't happen until the age of eighteen, yet being diagnosed with Asperger's can happen at any time.
Could the reason the two are mistaken for one another in the young adult be BPD is one possible outcome of having AS? (even though it can result without AS too). Having AS can mean experiencing certain social traumas repeatedly throughout childhood impacting the personality, plus there are preexisting genetic vulnerabilities.
The personality develops all throughout childhood. With something like AS, a series of experiences are encountered (intervening to prevent the development of these personality disorders is very important, IMO because they can wreck havoc in adulthood) and this can create a personality that is or resembles the Borderline type.

Very true...but there is another disorder that looks like BPD...bi-polar disorder. The same things are true in bi-polar disorder, but there are additional criteria completely unrelated to the spectrum. Bi-polar disorder seems to have a proven underlying chemical imbalance, which suggests environment would be unrelated to behaviors, and i'm sure everyone here would agree environment plays the same role in defined disorders as it plays in the NT world. But with experience with my family, who seem to all fall into the DSM-IV among these diagnosis', I do wonder if BPD as brought up in this forum, could be linked to environment alone, making that the difference.

Always pondering.
Tygereyes

That's interesting about PDs. I probably developed Schizoid behaviour/PD due to my solitary interests and aloof behaviour as a child. I've thought this, but I've never brought it up with anyone.

I can see how the emotional upheaval that people with an ASD can have can be thought of as a mood disorder, and this is why many are misdiagnosed with bipolar; emotions can fluctuate to the extremes in AS due to things people wouldn't suspect would set off said extremes, but are very real triggers for someone with AS. These emotional disturbances are secondary to the primary symptoms of AS, so they aren't the thing people look for first.

I know I changed throughout my childhood and my experiences influenced these changes. I think I became far less stable as my childhood progressed. I blame this on two things, lack of adequate intervention and my genetic predisposition.

Yes, they can look similar if one doesn't know anything about either disorder.

A professional has, when seen me, considered:

Female,
teenager,
unexplainable temper tantrums (meltdowns),
unexplainable dissociation (overloads, non-reaction, speech oddities),
highly unstable relationships (no friends, problems with getting to know new people due to lack of social skills),
rigid and black and white thinking (routines, lack of social understanding that leads to fear or resent of people who lie, have hidden motives, act in unexplainable ways),
worry about relationships (worry about being bullied, lied to, people reacting in unexplainable ways due to little social understanding),
self mutilation(meltdowns),
unstable mood (going into overloads, meltdowns due to sensory issues or breaks of routines; probably for many another factor is (not me) also anxiety),
inappropriate anger (again meltdowns, stress, anxiety caused by typical non-ASD compatible situations that then lead to distress or even anger),
delusions (people are not real, thinking they don't think or feel),
impulsiveness (have it due to ADHD, but the psych didn't think I had it haha. One can display behaviour that's interpreted as impulsive when for example one has little/no understanding of dangers and if one doesn't understand what should not be said or done in social interaction).

And that's how you can easily make a BPD diagnosis out of an ASD by personal interpretation of just the criteria, but no knowledge of either disorder.

That 'professional' doesn't work in my city anymore haha

Last edited by Sora on 04 Oct 2008, 12:51 pm, edited 1 time in total.

BPD and AS are both very complicated and it is difficult to understand based just on diagnostic critera alone. I posted it for reference sake.

Bi-Polar disorder is a mood disorder and the main difference between Bi-Polar and BPD is that people with Bi-Polar have clear cut mood phases either manic or depressive that last more than three months.

People with BPD experience a full range of difficult emotions (sadness, anger, fear) that change very quickly, we have depressive tendencies due to the uncontrollable emotions but can go from totally fine to completely an emotional mess in no time at all. My therapist explained it as being someone who goes from 0 to 100.

"emotions can fluctuate to the extremes in AS due to things people wouldn't suspect would set off said extremes, but are very real triggers for someone with AS."

Speaking from experience someone with BPD does indeed have triggers for extremes and can often be confusing for the person on the sidelines (ask Butch). The fear of abandonment, or being left is often a trigger that we are sensitive to. If someone leaves me suddenly I may rage or have a crying fit.

A note on personality disorders:

If you look at other personality disorders, there is usually one or a few personality traits that are excerbated. BPD is a range of traits and behaviors that are not always extreme, and including dissociation.

I always wondered if I had an aspie brain that derailed to BPD because of trauma. Then again, not all Bordies are abused or experience trauma.

My best friend since age 5 has borderline personality disorder, and she is *definitely* not Aspie at all. I realize that is just an anecdote, but I also don't get how people can look at the criteria for BPD and see similarities to AS.

Sure you can look at someone with BPD and someone with AS and say, "Look, both of these people have difficulty with interpersonal relationships." Yeah, so do a *lot* of different populations, for varying reasons. People with BPD don't have the difficulty interpreting nonverbal cues the way those with AS do, for example. They don't have sensory issues. They don't stim They don't have obsessive interests *the same way* people with AS do- the expression of their intense interests are qualitatively different from the way people with AS have intense interests. My friend's interests for example, might involve taking up a cause passionately, but briefly. It's not like she is obsessed with say, politics, and spends all her time thinking about politics and talking about politics. Rather it's like she chooses something to base her personality around for a period of time, before latching onto something else.

They also aren't literal thinkers. They may think in black-and-white, but so do *many* people with a mental disorder- that's a major thing Cognitive Behavioral Therapy is designed to treat. I've also never noticed a need for routine in my friend. In fact, she is extremely adventurous (to the point of being reckless). Also, the kind of identity problems my friend dealt with for years are not common in people with AS to my knowledge. People with AS don't seem to reinvent themselves all the time (including changing sexual orientation) as quickly and seemingly casually as other people change their wardrobe.

They have problems with long-term relationships, but this is not related to the difficulties with nonverbal communication and social interaction that people with AS have. Note also that there isn't a problem with *short-term* relationships (at least not in my experience). Again, unlike Aspies who often find it difficult to make friends.

My friend certainly has had difficulty with relationships, but not because she can't carry on a conversation. Her relationships were tumultuous, because her personality was unstable. She would seem to identify herself as "so-and-so's girlfriend" for a while, and she would be completely and passionately wrapped up in the relationship, and then she would get wrapped up in something else and the relationship would end.

The obsessiveness worked the same way. For a while, her identity would become bound up in a certain activity or cause, but only until she became interested in something else.

I've never noticed a need for structure or routines.

After going through a rough patch for a number of years, she has actually improved markedly thanks to some excellent out-patient therapy (she herself acknowledges that this one professional helped her a lot), and is doing much better now. I don't remember the name, but it is some treatment targeted towards people with BPD. She has a stable job and is in a stable relationship. She also went back to college and completed her degree, so she is doing very well.

Dialectical Behavioral Therapy (?)

Yup, that's it.

First of all, no one (at least not the author of this post) is saying that people with BPD are definitely going to resemble aspies most of the time - only that there are some interesting similarities (and complementary differences) between the two that could one day prompt scientists to conclude that the two disorders have something in common.



The DSM-IV, just like the modern science of psychology in general, is flawed. A few symptoms listed as a most basic guide for diagnosing someone with a complex mental disorder/syndrome is hardly a basis for understanding what's going on here with AS and BPD or with any other question in the science of psychology, in my opinion. Does a list of the symptoms of schizophrenia really "get to the heart" of what schizophrenia is all about? Not at all in my opinion.

Let's look at it this way. Depression and anxiety are clearly very different from AS and BPD in the way that they are defined in the DSM-IV. If I had to summarize very briefly what anxiety and depression are all about, my summary would be "an extreme mood (sadness and anxiety, respectively) and an associated group of extreme behaviors, not all of which will be present in every case)." BPD and AS are both very different. Both involve extremes in behavior and mood (I suppose not always with AS, although anxiety and meltdowns affect many people with AS), but those are clearly secondary to the way in which these people perceive the world. I'm sure people with depression and anxiety perceive the world differently, too, but the complexity of BPD and AS, with their general "extremeness" of thought, low ability to feel socially fulfilled, idiosyncrasies and even possible benefits (high emotional and intellectual intelligence, respectively), are strikingly similar. Perhaps it's just that they are two of the most poorly understood disorders/syndromes in psychology, or perhaps I simply don't know personally enough of either group to judge, but to me the connection is undeniable.

Of course, as you point out, there are many symptoms of AS that seem to have nothing to do with BPD, but I don't think this is a real argument against the kind of connection I am asserting. Tons of mental illnesses are marked by black and white thinking. Most mental illnesses have genetic and environmental triggering factors. I think the key thing to focus on is the difference between comparing BPD/AS and things like anxiety and depression. Anxiety and depression are very clear cut illnesses related to a specific mood and a relatively specific list of behaviors. AS and BPD are much more similar to each other than to those disorders in that they are both complex and in my opinion boil down to a general difference in perception, in large part when it comes to relationships, that often MANIFESTS in the form of but is not DEFINED BY the symptoms of mood disorders.