BPD or ASD/ADHD?
Doctors interpreted every one of my actions and attributed motives to me that I never had. My sincere tears from sensory overload were called “demonstrative hysteria,” my attempts to explain the logic of my actions were labeled “manipulation,” and when I begged for help, I was told I was just seeking attention. For years I was treated for BPD, until at thirty it turned out that I had autism and ADHD. I was being treated for the wrong thing, and no one even tried to hear me.
Unfortunately, this is a very common picture. When a seasoned psychiatrist, stubbornly unwilling to delve into the subtleties of female masking, gives you a diagnosis of BPD (borderline personality disorder).
Today, BPD has turned into a kind of diagnostic dumping ground. Without much thought, they throw into it everything that does not fit within the framework of convenient, socially accepted behavior, just as was once done with Hysteria.
According to studies published in the journal Autism (for example, Slater et al., 2022), autistic women live for years with incorrect diagnoses, among which BPD leads by a huge margin. Women still remain invisible to classical medicine, which is used to evaluating neurodivergence by criteria derived from the behavior of boys.
So what is BPD?
Borderline personality disorder (BPD) — a mental illness characterized by problems with emotion regulation, impulsive behavior, and difficulties in relationships.
The development of BPD is determined by a combination of genetic predisposition and environmental influence. Genetics plays an enormous role in the emergence of BPD, comparable to neurodivergences, but BPD is not a purely neurodevelopmental disorder like ASD or ADHD. At the core of BPD lies the so-called biosocial theory, which states that the disorder is born at the intersection of two factors: an innate vulnerability of the nervous system and the impact of a “chronically invalidating environment” in childhood, when close people ignore, mock, or punish a child for their feelings for years.
- Genetics: A person is born with a sensitive nervous system. Genes determine the characteristics of how the amygdala functions, causing it to react too intensely to stress, and also influence serotonin deficiency. Such a child naturally feels pain, fear, shame, and joy more acutely.
- Environment: This innate vulnerability is overlaid by an invalidating environment or early trauma. This may be abuse, rejection, neglect, or chronic dismissal of the child’s emotions by adults (“don’t cry,” “you’re making things up,” “stop throwing tantrums”).
Growing up, such a person faces three main troubles: total emotional instability, a blurred, diffuse “self,” and a panicked, paralyzing fear of loneliness.
What do BPD, ADHD, and ASD have in common, and how do they differ?
“The horror of rejection” versus “Sensory hell.” In BPD, any emotional shock is triggered by the feeling (even if imagined) that you will be abandoned or are not loved. In ASD/ADHD, a severe emotional breakdown (meltdown) is caused by cognitive or sensory overload (from noise, bright light, and crowds), or a sudden change of plans.
The mystery of self-harm. In BPD, self-harm most often happens following a breakup or conflict as an attempt to cope with the pain caused by fear of abandonment. In ASD, self-harm may be an extreme way of grounding (stimming), helping a person survive overload.
Roller coasters in relationships.
It is very important to pay attention to the differences in interpersonal relationships.
BPD and the “Favorite Person” phenomenon. Because of unbearable, gaping inner emptiness and a blurred “self,” a person finds a “Favorite Person” (FP) and literally falls into total fusion with them. The FP is instantly idealized, becoming the center of the universe. Through this fusion, the borderline person finally begins to feel alive, protected, and “good,” temporarily patching the hole in their soul.
At the same time, the partner is unconsciously expected to provide unconditional, absolute acceptance and care, a kind of ideal, never-leaving parent for a frightened little child.
Why does the rupture happen?
Another person is physically incapable of bearing the titanic burden of such responsibility and suffocating fusion. Besides, a real partner always turns out to be an ordinary person, not the flawless deity that the person with BPD sees. The moment they show the slightest autonomy (reply the “wrong” way, want to be alone), the illusion collapses. Despair turns into rage, devaluation, and a wild fear of abandonment.
ADHD and relationships as dopamine stimulation. In people with ADHD, the brain exists in a state of chronic dopamine hunger. New relationships, flirting, the honeymoon period — all of this is an incredibly powerful fountain of dopamine. At this stage, a person with ADHD may be maximally engaged, passionate, and eager to be ideal.
Why does the rupture happen?
As soon as the novelty wears off and ordinary, predictable daily life begins, the dopamine tap shuts off. The relationship turns into a routine that the ADHD brain physically cannot tolerate, perceiving it as mental boredom and grayness. Interest fades on its own. Here, the breakup often happens not because of dramatic grievances or fear of loneliness, but because the partner simply stopped being a source of stimulation.
ASD, Hyperfixation, and Limerence. In autism, a person can also become fanatically fixated on someone, falling into a state of limerence — obsessive, blinding infatuation. But unlike BPD, where a “favorite person” is needed as a crutch for self-esteem and salvation from emptiness, in ASD the partner becomes a special interest (hyperfixation). The autistic person makes the partner part of their worldview, their routine, and their way of emotional regulation.
Why does the rupture happen? Difficulties begin when the partner invades the autistic person’s rigid boundaries or violates their rules. The autistic “all or nothing” mindset and intolerance of change and unpredictability force a sharp withdrawal when the person with ASD feels a sensory or cognitive encroachment on their space.
Diffuse “self”
The feeling of losing one’s own identity, the sense that I do not understand who I am — this is a shared pain, but it is experienced through completely different internal mechanisms.
- BPD: Emptiness and Chameleonism. A person with BPD has no stable inner core. Their sense of self depends entirely on who is beside them at the moment. This is expressed in constant changes of values, political views, clothing styles, and even life goals following a new environment.Example: While dating an athlete, a girl sincerely starts running in the mornings, eating healthy, and sharing his philosophy. Six months later, after breaking up with him and ending up in a circle of musicians, she may quit sports, start smoking, listen to rock, and sincerely wonder how she could ever have lived differently before. Without external reflection in the eyes of a significant other, she feels a frightening, icy emptiness, as if she does not exist at all.
- ASD: Exhausting Masking. The autistic “self” does not disappear anywhere, but it ends up buried alive under tons of protective social masks. From early childhood, an autistic girl understands that her natural reactions seem “strange” to people, so she turns on analytical copying: she memorizes how to smile, how to hold her posture, what phrases to use for small talk.This masking becomes automatic, but it consumes all resources. The tragedy of identity here is that you get so used to this role for survival that you no longer understand who you are without it, and you begin to believe that the real you definitely will not be accepted and will be rejected.”
- ADHD: A Graveyard of Hobbies and Impostor Syndrome. In ADHD, the identity crisis is born from the peculiarities of the dopamine system. The ADHD brain instantly lights up with a new idea: buying an expensive guitar, sewing courses, landscape design, programming in Python, learning Spanish. In that moment, it feels like: “This is it, my calling! This is Me!” But as soon as the brain gets saturated with the first easy information, dopamine drops, interest fades, and the hobby gets thrown onto the scrap heap.As a result, by adulthood a person accumulates a huge graveyard of abandoned interests behind them. Since they have not gone deeply enough into anything, they develop a total sense of their own incompetence. Brutal impostor syndrome kicks in: “I know a little bit about everything, but I’m not a pro at anything. I am nobody. I have nothing to rely on, there is no single stable identity, I am just a set of chaotic, unfinished impulses.”
And what is shared with C-PTSD?
Complex post-traumatic stress disorder (C-PTSD) is another “twin” of BPD, confusion with which ruins lives. C-PTSD develops as a result of prolonged, repeated traumatization that was impossible to escape (emotional or physical abuse in childhood).
Both conditions produce furious emotional flashbacks, wild irritability, chronic feelings of guilt and shame, and deep problems in relationships. Moreover, they often coexist, since a vulnerable neurodivergent nervous system (ASD/ADHD) tolerates stress much worse, and autistic children, because of their differences, are subjected to bullying and abuse many times more often than neurotypicals.
What is the fundamental difference? A person with BPD desperately seeks fusion in relationships in order to save themselves from emptiness, and their main horror is rejection and abandonment.
A person with C-PTSD seeks first and foremost safety in relationships, and their main horror is threat, violation, and engulfment of their personality. A “borderline” person, at the slightest threat of rupture, will scream, beg, and try to hold on. A person with C-PTSD, as tension rises, will simply disappear into deep dissociation, shut themselves in a room, or break contact preemptively to protect themselves (“fight or flight”). They do not divide people into “saints and monsters”; they have a basic distrust of the world as a source of danger.
The dark side of dysregulation: Eating disorders, addictions, and adrenaline
Another zone of diagnostic confusion is self-destructive behavior. In both BPD and AuDHD, people often suffer from addictions, but the functions of these actions are different:
- In BPD: Bulimia, anorexia, alcohol, gambling, and adrenaline-fueled risk are a reaction to an unbearable wave of pain from fear of abandonment or emptiness. Substances or risk are used as instant anesthesia to mute this hell right now.
- In AuDHD: For ADHD, alcohol, impulsive shopping, risk, and overeating are a way to get more dopamine, to stimulate a bored brain. For ASD, alcohol often becomes the only way to survive in society, relieve intense social stress, and mute the sensory nightmare all around. And eating disorders in autism are often connected with sensory selectivity regarding food texture or a rigid need to control routine.
The stigma of inadequacy: Stigma that kills
And here we come to the heaviest side of this diagnostic confusion. BPD is an incredibly stigmatized diagnosis. In medical and psychological settings, it is treated with enormous prejudice. Instead of compassion, a woman receives the label of being volatile, inadequate, and manipulative. Professional gaslighting kicks in, and people stop hearing you, dismissing any sincere tears as “just another borderline game.”
“When I tried to tell my psychotherapist that antidepressants were not helping, and that the sounds outside gave me a headache, he smiled condescendingly and wrote in his notebook: ‘The patient is seeking attention, demonstrating borderline resistance, and manipulating.’ My BPD diagnosis became the perfect excuse for doctors not to look into what was actually happening to me at all”.**(From the blogs of neurodivergent women)
If misunderstood autism or ADHD had been hiding for years under the mask of BPD, the consequences become tragic. A person locked in the cage of someone else’s diagnosis and an endless sense of guilt for their own “brokenness” inevitably falls into the most severe burnout and depression.
The lack of adequate help and isolation lead to terrifying statistics: both groups share the highest level of suicidal risk. Autistic girls without intellectual disabilities die by suicide 13 times more often than neurotypical girls, simply because no one heard or understood them.
Therefore, if for a long time you have felt that therapy is not helping you, and that the diagnoses you are being given do not fully describe the picture of your experience, then perhaps it is worth looking toward an assessment for neurodivergence.
I hope that someday the situation will change and women will not have to live until 30–40–50 years old suffering from not understanding what is happening to them, trying to survive without receiving the right diagnosis and support.
For now, I can only say that I am glad this is gradually changing, that more and more people are talking about it and more specialists are working in this area. And I’m making my own small contribution through my blog 🫶