Autism and Emotionally Unstable Personality Disorder (EUPD) - Overlaps & Misdiagnosis.

From my own experience of being diagnosed with EUPD and then autism, and from my many conversations with others in similar positions, I often question the reliability of diagnoses when it comes to autism and EUPD together.

Many autistic people who don't have a diagnosis of autism are at first misdiagnosed with EUPD, before discovering that they are in fact autistic.

Let me tell you a little bit about my experience.

I was diagnosed with EUPD as soon as I turned 18. Autism had been questioned in the months leading up to my 18th birthday, but my limited and stereotypical views of what autism is meant that I quickly shut this idea down, as there was no way I could possibly be autistic.

I went years believing I had EUPD, but never felt like it quite fit or described me. I wasn't diagnosed with autism until after multiple sectioned hospital admissions, where the focus had always been on the fact that I had EUPD. I couldn't understand why any treatment wasn't working (they were all tailored to EUPD), and it wasn't until my mum fought tooth and nail to get me assessed for autism that things started to change.

I think there is a huge lack of understanding of both Autism and EUPD.

Autism isn't widely understood, especially in girls. Many autistic traits present similarly to the symptoms of EUPD. Autism is classified as a developmental condition; it is not an illness. Someone is born autistic. This is different to EUPD, which is classified as an illness. To be diagnosed with autism, the person has to have experienced autistic traits in childhood. The problem is, many autistic people go undiagnosed; they may, like me, not presented steretypically - this is especially common in girls -, so it is not seen to be autism. This can lead to an EUPD misdiagnosis.

In order to be diagnosed with EUPD, you only need to meet 5 out of the 9 criteria.

The criteria includes:

1. Chronic feelings of emptiness.

2. Intense, unstable emotions.

3. Efforts to avoid abandonment.

4. Unstable self-image or sense of self.

5. Impulsive behaviour.

6. Intense anger.

7. Difficulty making and keeping relationships.

8. Recurrent suicidal behaviour and self-harm.

9. Experiencing paranoia and dissociation.

   
   

Personally, I don't think it is difficult to meet 5 out of the 9 criteria if you are depressed. Even more so if you are autistic and depressed. Autistic people may struggle with self-image. They may find it hard to regulate emotions, particularly anger due to an extremely strong sense of injustice. Autistic people, especially those who also have ADHD (which is 30-80%), may struggle with impulsivity. Making friends and keeping friends can be hard due to some finding socialising difficult. Efforts to avoid abandonment may conflict with the fact autistic people often struggle immensely with change. If you mix that with them being depressed, it is no wonder they easily meet this criteria to be diagnosed with EUPD.

Autistic people can be seen as having EUPD symptoms. but these may be a response due to being autistic.

For example, emotional mood swings may be caused by a sudden change in routine which many autistic people find difficult to deal with, or a meltdown because they aren't able to engage with their special interest which helps them regulate. Their presentation of behaviour matches the symptoms of a personality disorder, but it is occurring because they are autistic.

Many autistic traits and EUPD experiences overlap.For example, sensitivity, distress, anxiety, self-destructive behaviour, black and white thinking and feeling misunderstood.

Many autistic people who begin to present with mental health issues, especially if they are suicidal and admitted to hospital, are then diagnosed with EUPD. Some may have EUPD too, but I don't believe they all do. Their distressed presentation, often a result of autistic traits enhanced due to the hospital environment and a lack of familiarity/routine/control, combined with depression, appears like EUPD to professionals.

My conclusion is that it is all very complicated.I don't identify as having EUPD even though I am diagnosed with it, and I relate to those who discuss their experiences of it. But I think I relate to their experiences because a lot of the time they are similar to autistic traits and experiences too.The confusion of those misdiagnosed with either condition does raise uncertainty about the validity of diagnoses. Both ASD and EUPD are often misunderstood and complex conditions. More research into this is definitely needed.