City Research Online

Abstract

Objectives
The features of autism and borderline personality disorder (BPD) overlap; autistic adult females are at particular risk of having an autism diagnosis missed and/or being misdiagnosed with BPD. This research aimed to explore perceptions of what triggers emotional distress and dysregulation (EDD) amongst people assigned female at birth (PAFAB) with BPD and autism from their own frames of reference.

Methods
An in-depth qualitative study is presented, in which participants assigned to one of three groups according to their pre-existing diagnoses (Autism, Autism + BPD, or BPD) took part in a semi-structured interview. Data was analysed with inductive content analysis, and the number of participants mentioning each code was also counted.

Results
In participants’ experience, multiple triggers often act together to cause immediate emotional distress and possibly emotion dysregulation while various factors affect whether this escalates into a longer-term response involving further emotion dysregulation. Participants described EDD triggers relating to internal experiences, interaction with others, and external environments. The findings provide preliminary suggestion that some triggers—such as sensory overwhelm or feeling ‘abnormal or unacceptable to others’—may be a more common cause of EDD for autistic PAFAB in comparison to BPD-only participants.

Conclusions
While limitations of the study necessitate further research, hypotheses have been generated to guide larger-scale studies concerned with differential diagnosis. Clinicians will also likely benefit from the richness of these findings regarding the EDD triggers of greater prominence for autistic PAFAB and those with BPD, for the purposes of clinical formulation and treatment.

Publication Type:	Article
Additional Information:	This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher Keywords:	Autism, ASD, Borderline personality disorder, Differential diagnosis, Emotion dysregulation, Triggers of emotional distress
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Population Health & Policy
SWORD Depositor:	Symplectic Administrator

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