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Abstract

Research shows that borderline personality disorder (BPD) is a common co-occurring diagnosis and the most frequently perceived misdiagnosis in adult-diagnosed autistic women and people assigned female at birth (women and AFAB people). One potential area of overlap between autism and BPD is identity disruption, which is closely associated with BPD and has also been linked to autistic camouflaging. This mixed-methods study compared experiences of identity disruption in autistic women and AFAB people and women and AFAB people with a BPD diagnosis. We performed a secondary mixed-methods analysis of data from self-report questionnaires and qualitative interviews.
For the quantitative analysis, we examined scores on a measure of camouflaging, scores on a measure of identity disruption and its three subscales, and correlations between them in 51 autistic women and AFAB people and 51 women and AFAB people diagnosed with BPD, all with low traits of the comparator diagnosis. Autistic participants scored significantly lower on all domains of identity disruption. Three items measuring diffused/variable identity did not differ significantly between the two groups. This domain was significantly associated with camouflaging in participants diagnosed with BPD.
We performed a deductive framework analysis of 40 interviews with 13 diagnosed autistic participants, 14 participants diagnosed with BPD, and 13 participants diagnosed with BPD who were also diagnosed with autism or suspected they were autistic. Autistic participants generally described a strong underlying sense of self despite camouflaging/contextual shifts. Lack of identity appeared to be characteristic of BPD and was related to camouflaging in autistic and possibly autistic participants diagnosed with BPD.
Our findings suggest some differences in experiences of identity disruption between autism and BPD. Camouflaging emerged as a transdiagnostic phenomenon linked to identity disruption, though it appeared more deliberate in autistic participants. Researchers and clinicians should be mindful of these areas of overlap.

Publication Type:	Article
Additional Information:	© 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Publisher Keywords:	Autism; Borderline personality disorder; Identity; Camouflaging; Misdiagnosis
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery School of Health & Medical Sciences > Department of Population Health & Policy
SWORD Depositor:	Symplectic Administrator

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