A Possible Explanation For BPD Diagnosis In Absence Of Child Trauma History

As we have seen from previous articles that I have published on this site, there is a very strong link between having suffered severe and protracted, interpersonal childhood trauma and later being diagnosed as suffering from borderline personality disorder (BPD) or, to put it more simply, there now exists overwhelming evidence that serious childhood trauma greatly increases a person’s risk of later being diagnosed with borderline personality disorder (BPD).

But what about people who are diagnosed as having BPD but do not report having experienced any significant childhood trauma? Possible reasons could include an individual’s not wishing to divulge their intimate childhood experiences due to a misplaced sense of shame or a lack of trust in the medical professional carrying out their psychiatric assessment, repression, or the fact that traumatic events took place when the BPD sufferer was extremely young (say, below the age of three years) and therefore unable to form permanent, conscious memories of these adverse experiences.

However, in this particular article, I want to focus on another possibility, namely the possibility that the individual diagnosed with BPD but has not experienced significant childhood trauma has been misdiagnosed and should, in some particular cases, instead have been diagnosed with an autism spectrum condition (ASC). Indeed, this is the theory put forward by Dudas et al., 2017 based on a study I shall outline below:

The study set out to investigate the degree of overlap between borderline personality disorder (BPD) and autism spectrum conditions (ASP) using questionnaires  intended to measure:

  1. ABILITY TO EMPATHIZE (Empathy Quotient)
  2. ABILITY TO SYSTEMIZE (Systemized Quotient Revised) [The ability to systemize can be defined as the ability to analyze, build and understand rule-based systems such as mathematics, chess, and music].



  • The ability to empathize as measured by the Empathy Quotient was NOT found to differ between those diagnosed with BPD and ‘normal’ individuals.
  • The ability to empathize as measured by the Empathy Quotient was found to be lower in those with an autism spectrum condition (ASC) than both those (referred to immediately above) with BPD and ‘normal’ individuals.


(The ability to systemize can be defined as the ability to analyze, build and understand rule-based systems such as mathematics, chess, and music).

  • The ability to systemize as measured by the Systemized Quotient Revised was found to be HIGHER in both those with BPD and those with ASC compared to ‘normal’ individuals.

A third questionnaire was also used in the study, namely the Autistic Spectrum Quotient (ASQ) in order to measure autistic traits in the participants.

  • AS would be expected, those with ACS scored highest on this questionnaire.
  • But it was ALSO found that those who had been given a diagnosis of BPD scored SIGNIFICANTLY MORE HIGHLY FOR AUTISTIC TRAITS THAN DID ‘NORMAL’ INDIVIDUALS as measured by the Autistic Spectrum Quotient (AQ).

Indeed, there was found to be no statistically significant difference in Autism Spectrum Quotient (AQ) scores between the autism spectrum condition (ASC) group and borderline personality disorder (BPD group in the study.


The researchers conclude that given the findings that scores of the individuals with borderline personality disorder and autistic spectrum conditions score similarly when measured on autistic traits and ability to systemize (and that both groups score more highly than ‘normal’ individuals on these measures) there is significant potential for the two diagnoses to be mixed up by professionals so it is possible that some individuals who have been diagnosed with BPD, particularly if they do not report having experienced significant childhood trauma may, in fact, instead be suffering from an autistic spectrum disorder). This is supported by other studies that have found that autism spectrum disorders have been under-diagnosed, particularly in the case of females whose ACT symptoms may manifest themselves differently between men and women.

REFERENCE: Dudas RB, Lovejoy C, Cassidy S, Allison C, Smith P, Baron-Cohen S. The overlap between autistic spectrum conditions and borderline personality disorder. PLoS One. 2017 Sep 8;12(9):e0184447. doi: 10.1371/journal.pone.0184447. Erratum in: PLoS One. 2018 Jan 2;13(1):e0190727. PMID: 28886113; PMCID: PMC5590952.

David Hosier BSc Hons; MSc; PGDE(FAHE).






This study was based upon Baron-Cohen’s (2009) Empathizing-Systemizing (E-S) theory of autism that is predicated on the notion that those with ASC have below-average ability to empathize but above average ability to systemize.