Co-existing autism and personality disorder needs in adult inpatient services: prevalence and demographic profiling

Purpose Evidence suggests a complex relationship between autism and personality disorder, including overlap and co-occurrence of symptomology and aetiology. Yet, missed and misdiagnosis remain key challenges, particularly within secure care. This study aims to profile those with and without co-existing autism and personality disorder diagnoses, for the purpose of identifying potential disparities in care and ensuring access to holistic care pathways and better outcomes. Design/methodology/approach A retrospective file review of data was conducted to ascertain the prevalence of autism and personality disorder diagnoses, independently and concurrently, in 226 service users admitted to inpatient mental health services. Findings Overall, 9.7% of participants were autistic with a co-occurring personality disorder diagnosis. Participants more commonly had a personality disorder diagnosis without autism (29.2%), autism without a personality disorder diagnosis (16.4%), or neither diagnosis (44.7%). Gender was predictive of diagnostic group, with females more commonly having a personality disorder diagnosis (65.2% vs 20.1%) or co-existing diagnoses (15.2% vs 7.8%). Males were more commonly diagnosed with autism only (19.6% vs 4.3%). Membership of this diagnostic group was also significantly predicted by ethnicity (white). Practical implications The findings pose implications regarding the need for integration of routine screening of autism and personality disorder needs, development of service models and care pathways that are responsive to both diagnoses, guidance for differential diagnosis and improved identification of demographic nuances in symptoms. Originality/value The current study explores diagnostic complexity in an understudied population of secure inpatient mental health service users.