Understanding Borderline Personality Disorder (BPD) in Clients with Autism Prepared by Samantha Easton, LCSW | July 2025

What is Borderline Personality Disorder (BPD)? 

Borderline Personality Disorder, or BPD, is a serious mental health condition that usually shows up in late teenage years or early adulthood. It's marked by really strong and quick changes in feelings, rocky relationships, a twisted sense of self, acting on impulse, and hurting oneself. If someone also has Autism Spectrum Disorder (ASD), it can make dealing with their emotions and behaviors even trickier. It is important to note that Borderline Personality Disorder (BPD) cannot be formally diagnosed in individuals under the age of 18.

Why It Matters for Clients with Autism 

Clients with ASD who also show signs of BPD might have a tough time handling their feelings, especially when their usual routines get messed up. They might find it hard to tell the difference between what they're feeling inside and what's happening around them. They often have a very intense fear of being left alone, whether it's real or just in their head. This can lead to acting on impulse, getting aggressive, or hurting themselves. Plus, they might take neutral feedback as criticism, which can set off angry outbursts.

Key Insights from Recent Research (Leichsenring et al., 2011)

The good news is that Borderline Personality Disorder (BPD) can be treated, and talking to a therapist (psychotherapy) is especially helpful. Two well-known ways to do this are Dialectical Behavior Therapy (DBT) and Mentalization-Based Therapy (MBT). The intense ups and downs in emotions that people with BPD experience come from a mix of things: their genes, traumatic experiences in childhood, and their surroundings. Catching BPD early and getting consistent therapy are important for improving their overall quality of life.

Supporting Our Clients: What Parents & Providers Can Do

• Help them learn about emotions by teaching and showing them how to recognize and name feelings using tools like feelings charts or by acting things out.

• Try to keep things predictable and avoid sudden changes. Let clients know in advance if something is going to be different.

• Set clear but understandable rules. Being consistent helps avoid confusion and big emotional swings.

• Don't say things that make their feelings seem unimportant. Instead of "You're overreacting," try saying, "It makes sense you feel overwhelmed right now."

• Encourage therapy and look for mental health professionals who are skilled at working with both ASD and BPD.

Want to Learn More?

Leichsenring, F. et al. (2011). Borderline Personality Disorder. The Lancet.

Reach out to your behavior specialist with questions or to request specific supports!