Could She Be Autistic? Exploring Gender Differences in Camouflaging and Pragmatics in Autism and Borderline Personality Disorder

This study explores the relationship between social camouflaging and pragmatic competence in adults diagnosed with autism spectrum disorder (ASD) and borderline personality disorder (BPD), with a particular focus on gender. It is based on the hypothesis that camouflaging contributes to under or misdiagnosis, especially in women and gender-diverse individuals. A total of 225 adults participated in a cross-sectional online survey, completing the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Pragmatic Awareness Questionnaire (PAQ). Participants were grouped based on clinical diagnosis (ASD or BPD) and self-identified gender (women, men and gender-diverse). Among women, no significant differences in camouflaging scores were found between the ASD and BPD groups, suggesting the use of similar adaptation strategies that may obscure clinical differentiation. In contrast, among men, camouflaging and pragmatic deficits were more distinctly associated with autistic traits. No substantial differences were observed among gender-diverse participants, highlighting the influence of contextual and identity-related factors. Findings emphasize the importance of integrating detailed pragmatic assessments and adopting gender-sensitive approaches in the differential diagnosis of ASD and BPD. Such strategies may help reduce misdiagnosis and improve recognition of autistic traits, particularly in populations that tend to camouflage more effectively.