Sex bias in clinical diagnosis of Borderline Personality Disorder and Autism Spectrum Disorder

[IwantToRetire]

... these results provide a number of avenues for future research and highlight the need for clinicians to consider neurodevelopmental assessment for patients diagnosed with BPD, particularly women, in order to investigate and address potential gender-based diagnostic bias.

https://www.repository.cam.ac.uk/items/f7a7cda1-f69b-4fb1-a81d-91d7fc179c24

Document is under embargo, no reason given.

I assumed that it would be something to do with it not being officially accepted or something.

But they are letting people know they have done the research and think what the results have shown are if not important, at least interesting.

Although I suspect that in any branch of medicine and related research, there has been and still is a tendency to focus on men.

Do we think this going to say that we’re misdiagnosing autistic women with BPD?

MiL was diagnosed with bipolar 50 odd years ago. She’s been on heavy duty drugs, had ECT, in and out of hospital. The impact of the medication and treatment has been huge, and she took a leap forward health wise when a consultant took her off everything and started again.

Looking at the extended family now, she’s almost certainly autistic.

That was what I inferred from it.

Along with recent reports that women have been under diagnosed compared to men with having autism.

And of course the long history of women with all sorts of issues, ie not just medical but social, being diagnosed as have some sort of medical health issue (thanks Freud and others) and in earlier history would have been seen as witches or something.

Not meaning any of this to be about your MiL, but part of the reason I started this thread was that this sounds so familiar.

I hope she continues to do well.

I think you're right.
I think the embargo is just publishing protocols not making it freely available yet.
Abstract
Background:
Autism Spectrum Disorder (ASD) and Borderline Personality Disorder (BPD) share overlapping clinical features including social cognitive differences, interpersonal difficulties, emotional dysregulation and alexithymia. The two conditions show different gender prevalence patterns, and it has been suggested that gender bias may exist in diagnostic patterns of ASD and BPD, with females being preferentially diagnosed with BPD in lieu of ASD.
Methods:
In this analysis of real-world clinical records from n = 417,752 adults receiving secondary mental health care, we use natural language processing methodology to assess the subsequent incidence of ASD in cohorts diagnosed with BPD, and the incidence of BPD in cohorts diagnosed with ASD. To examine the possibility of gender-based diagnostic bias, we assess for an association between gender and the sequence and timing of diagnoses.
Results:
Results showed substantial rates of concurrent ASD and BPD; 5-year cumulative incidence of later ASD diagnosis among people with BPD was 3.02% [95% CI: 2.62, 3.43] and of later BPD diagnosis among people with ASD was 3.84% [3.08, 4.60]. Consistent with predictions of unidirectional gender-based diagnostic bias, the typical association between male gender and ASD diagnosis was reduced in cohorts first diagnosed with BPD, whereas the association between female gender and BPD remained in those first diagnosed with ASD. In addition, the interaction between gender and diagnostic sequence was associated with the length of delay between diagnoses, such that women waited longer for an ASD diagnosis (relative to a BPD diagnosis) compared to men.
Conclusion:
Together, these results provide a number of avenues for future research and highlight the need for clinicians to consider neurodevelopmental assessment for patients diagnosed with BPD, particularly women, in order to investigate and address potential gender-based diagnostic bias.

I have a daughter who has been given all sorts of diagnoses over the years. She is adopted - the professionals we saw all assessed and diagnosed within their own speciality. Seems to me that if you are diagnosed with autism young enough, you will get help and people are often very understanding and forgiving of asd behaviours. But if you are not diagnosed, you reach adulthood with no understanding or help whatsoever and if behaviours start to cause problems, you may well go down a mental health route.

Thanks that's great. Not the result obviously!

I was originally diagnosed with asd in my teens but a higher up psychiatrist overruled my diagnosis, he literally scored out the ASD and wrote "girls cannot have autism it must be BPD". That diagnosis of BPD followed me around for years and its spent a ridiculous amount of time trying to fix myself, it was only when my son that I was so obviously asd that the drs diagnosing him referred me to adult services for diagnosis, after a full assessment I was given the correct diagnosis of asd and I was told about what had happened as a teen.
Its a well-known open secret that women with asd are often misdiagnosed as bpd, this is because women/girls with asd tend to present differently to men/boys and until 1989 autism was considered to only effect males, ASD in females wasn't widely accepted by the psychiatric community until the mid 90s. All standard ASD tests are designed around standard male presentation and its only been in the last 10 year's that they have started to design asd test around standard female presentation but nobody uses them.

I was coming in to say similar.

I think some presentations of undiagnosed ASD can present (particularly in men) as what to all intents and purposes appears to be NPD if you are at the receiving end of it and in women that comes across as BPD.

Since they don’t get a chance to rerun life then that means that they almost become comorbidities. The drives and motivations might be different but the behaviour patterns are so similar to be almost identical.

It’s been known anecdotally for ages that many women misdiagnosed with BPD are actually autistic. Glad they are finally researching it.

Interesting. When I fostered, we had trouble getting a diagnosis of anything other than attachment disorder. And perhaps FASD

Yes, we went down the attachment disorder route for a long time. If you see adoption specialists, they will tend towards attachment. My daughter ended up in Camhs where she saw regular therapists and they diagnosed autism. But I still never understood who was right. But she had intensive attachment therapy and a lot of her issues went, leaving a core that didn't shift. We think this was the autistic stuff. She had a lot of very clear autistic traits and met the criteria for a diagnosis but it is definitely tricky to pull the two apart.

It's been known for a long time that EUPD and BPD are often misdiagnosed and over diagnosed in women, whilst men are diagnosed with ASD when time then tells they most probably have NPD.

Saying this though many women with BPD do have a tendancy to shape shift and diagnosis chase with what ever the current diagnostic 'trend' is - IE EUPD, to CPTSD to DID to Trans to FND to ADHD to AuADHD

However I don't believe anyone should be told their personality is disordered but definitely not when their brains are still developing.

It will be to do with the publishing model and open access - nothing particularly nefarious about it apart from academic publisher's being conniving bastards of weasels who have managed to create a model where you not only pay to access content but pay to publish it

I have encountered many people with trans and autistic identities who I consider highly likely to have a cluster B personality disorder.

Whilst it is likely the case that some autistic women have been wrongly diagnosed with a PD, I think autism and trans advocacy groups are awash with people who either hide their PD diagnosis, have been wrongly diagnosed with autism or simply self identify as autistic.