What Triggers Emotional Distress and Dysregulation Amongst Autistic Females and Could These Help To Differentiate Autism From Borderline Personality Disorder? An Exploratory Study with Inductive Content Analysis

Abstract Objectives The features of autism and borderline personality disorder (BPD) overlap; autistic adult females are at particular risk of having an autism diagnosis missed and/or being misdiagnosed with BPD. This research aimed to explore perceptions of what triggers emotional distress and dysregulation (EDD) amongst people assigned female at birth (PAFAB) with BPD and autism from their own frames of reference. Methods An in-depth qualitative study is presented, in which participants assigned to one of three groups according to their pre-existing diagnoses (Autism, Autism + BPD, or BPD) took part in a semi-structured interview. Data was analysed with inductive content analysis, and the number of participants mentioning each code was also counted. Results In participants’ experience, multiple triggers often act together to cause immediate emotional distress and possibly emotion dysregulation while various factors affect whether this escalates into a longer-term response involving further emotion dysregulation. Participants described EDD triggers relating to internal experiences, interaction with others, and external environments. The findings provide preliminary suggestion that some triggers—such as sensory overwhelm or feeling ‘abnormal or unacceptable to others’—may be a more common cause of EDD for autistic PAFAB in comparison to BPD-only participants. Conclusions While limitations of the study necessitate further research, hypotheses have been generated to guide larger-scale studies concerned with differential diagnosis. Clinicians will also likely benefit from the richness of these findings regarding the EDD triggers of greater prominence for autistic PAFAB and those with BPD, for the purposes of clinical formulation and treatment.