McQuaid Goldie A, Strang John F, Jack Allison
Department of Psychology, George Mason University, Fairfax, Virginia, USA.
Gender and Autism Program, Children's National Hospital, Rockville, Maryland, USA.
Autism Adulthood. 2024 Dec 2;6(4):401-427. doi: 10.1089/aut.2023.0034. eCollection 2024 Dec.
Autism without intellectual disability is diagnosed later and with greater difficulty in girls/women relative to boys/men. For autistic girls and women, the journey to an autism diagnosis may include one or more misdiagnoses. Misdiagnosis with borderline personality disorder (BPD) or borderline traits may be particularly common, and characteristics often observed in autistic girls and women may contribute specifically to a risk of misdiagnosis with BPD. This review draws from a burgeoning literature on autism in girls and women to provide a detailed discussion of differential diagnosis of BPD and autism in cisgender girls/women, with a focus on phenotypic traits and/or their presentation that may be more common in autistic girls/women and that may be particularly prone to miscategorization as BPD. Distinctions between autism and BPD are identified, emphasizing the need for scrutiny of an individual's clinical presentation to tease apart differences between the autism and BPD phenotypes. We highlight instances in which similar phenotypic expressions may be driven by differing underlying factors. Implications for the distinction of autism and BPD/borderline traits in informing appropriate therapeutic intervention are discussed.
与男孩/男性相比，无智力障碍的自闭症在女孩/女性中诊断较晚且难度更大。对于患有自闭症的女孩和女性来说，获得自闭症诊断的过程可能包括一次或多次误诊。被误诊为边缘型人格障碍（BPD）或具有边缘型人格特质的情况可能尤为常见，而在患有自闭症的女孩和女性中经常观察到的特征可能特别会导致被误诊为BPD的风险。本综述借鉴了关于女孩和女性自闭症的新兴文献，详细讨论了顺性别女孩/女性中BPD和自闭症的鉴别诊断，重点关注在患有自闭症的女孩/女性中可能更常见且特别容易被误归类为BPD的表型特征和/或其表现形式。明确了自闭症和BPD之间的区别，强调需要仔细审查个体的临床表现，以区分自闭症和BPD表型之间的差异。我们强调了相似的表型表达可能由不同潜在因素驱动的情况。讨论了区分自闭症和BPD/边缘型人格特质对指导适当治疗干预的意义。
