A person can have one of these conditions, two, or all three. And when one or two are present, it can be hard to tell them apart.
Table of Contents
Co-Occurring Borderline Personality Disorder, ADHD, and Autism
BPD co-occurs with ADHD and autism at higher rates than in the general population. Personality disorders in general appear more common among ADHD and Autistic adults. Some research also suggests we may be more vulnerable to developing PTSD after trauma, and to developing personality disorders, including BPD, in the aftermath of traumatic childhoods.
This higher prevalence makes sense for several reasons:
- Many of us have more sensitive nervous systems and sensory systems, so our bodies may respond more intensely to trauma.
- We experience more victimization, discrimination, and ableism.
Misdiagnosis of Borderline Personality Disorder
Beyond co-occurrence, BPD is also a common misdiagnosis for Autistic and ADHD people, particularly women and gender-expansive people. Several ADHD traits (impulsivity, hyperactivity, difficulty regulating emotions) can look like BPD. To an untrained eye, common experiences for Autistic people who mask a lot can also look like BPD: a diffuse sense of self from masking, sensory overload that looks like angry outbursts, and difficulty with emotions and relationships.
Before looking at the overlap, here is a refresher on each condition.
Borderline Personality Disorder Defined
Borderline personality disorder (BPD) is a personality disorder marked by a pervasive pattern of instability in relationships, self-image, emotions, and behavior (impulsivity). One leading model, Marsha Linehan’s biosocial theory, proposes that BPD develops from a combination of a sensitive temperament and a dismissing or invalidating environment.
A large U.S. survey (Grant et al., 2008) estimated that about 5.9% of adults meet criteria for BPD at some point in their lives. Most people diagnosed in clinical settings are women, but that survey found similar rates in men (5.6%) and women (6.2%).
BPD is characterized by:
- Intense difficulties in interpersonal relationships
- An unstable self-concept
- Impulsivity, disinhibition, and risk-taking behaviors
- Difficulty managing painful emotions
For a deep dive into borderline personality disorder, see my DSM in pictures post here.
Attention Deficit Hyperactivity Disorder (ADHD) Defined
Attention-deficit/hyperactivity disorder (ADHD) is classified as a neurodevelopmental condition, meaning it is present in childhood and has a strong genetic component. The DSM-5 describes three presentations of ADHD (you’ll often still see them called types): ADHD-Inattentive (ADHD-I), ADHD-Hyperactive/Impulsive (ADHD-H), and ADHD-Combined (ADHD-C).
- ADHD-I is characterized by difficulties regulating attention.
- ADHD-H is characterized by impulsive and hyperactive behavior.
- ADHD-C is characterized by both inattention and hyperactivity/impulsivity.
For a deep dive into the DSM criteria for ADHD, see my DSM in pictures post here.
Autism Defined
Autism, like ADHD, is classified as a neurodevelopmental condition. Autism is characterized by a distinct social-communication style that is often misunderstood by allistic people. Many Autistic people find comfort in routine, structure, repetition, and categorization, and many of us orient our identity around our special interests and values. For a deep dive into the DSM-5 criteria for autism, you can see my DSM in pictures post here.
Borderline Personality Disorder and ADHD
Prevalence of Borderline Personality Disorder among ADHDers
- In a large U.S. survey, about a third of ADHD adults (33.7%) also met criteria for BPD, compared with about 5% in the general population (Bernardi et al., 2012).
- In a Swedish study of about 2 million people, those diagnosed with ADHD had about 19 times higher odds of also having a BPD diagnosis (Kuja-Halkola et al., 2021).
- One study that followed hyperactive children into young adulthood found that 14% had developed BPD, compared with 3% of the comparison group (Fischer et al., 2002).
- Studies estimate that 18–34% of ADHD adults also have BPD (Weiner et al., 2019).
Prevalence of ADHD among People with Borderline Personality Disorder
- In a 2021 review, Ditrich and colleagues noted that studies have found ADHD in 30–60% of people with BPD.
- One study found that about 60% of people with BPD had childhood ADHD symptom scores above the screening cut-off (Fossati et al., 2002).
Similarities Between Borderline Personality Disorder and ADHD
BPD and ADHD can be hard to tell apart. They share many traits and struggles.
The key clinical symptom overlap includes impulsivity and emotional dysregulation. Beyond that, both conditions are also associated with interpersonal struggles and temperamental similarities (Weiner et al., 2019).
Impulsivity
For both groups, impulsivity can result in: financial strain, addiction, gambling, unsafe sex practices, eating disorders, and risky behavior (Littman, 2021).
Emotional Regulation
People with BPD and ADHD both struggle with regulating emotions. This can result in people feeling isolated, unsupported, ashamed, depressed, panicked, and overwhelmed with a sense of despair (Littman, 2021).
ADHD and BPD share several personality traits, particularly novelty seeking and harm avoidance (Weiner et al., 2019).
Novelty Seeking
Novelty seeking (a strong interest in having new experiences) is high among both groups. In one study of women, the highest scores were in the group with both ADHD and BPD (van Dijk et al., 2012).
Harm Avoidance
Both groups also tend to score high on harm avoidance (Weiner et al., 2019). Harm avoidance is characterized by excessive worrying, pessimism, shyness, fearfulness, doubt, and being easily fatigued.
Differences Between Borderline Personality Disorder and ADHD
To spot the difference between BPD and ADHD, it is important to get at the person’s internal experience. For example, people with either condition can experience executive functioning difficulties, emotional regulation difficulties, and impulsivity.
For ADHD, these experiences are part of the person’s baseline and show up across contexts. For BPD, they are often triggered by attachment injuries and relationship stress.
Diagnostic criteria for the two conditions also define impulsivity differently. In BPD, impulsivity means acting on impulse in at least two areas that can cause harm, such as spending, sex, substance use, reckless driving, or binge eating. Self-harm and suicidal behavior are a separate criterion. In ADHD, impulsivity typically refers to interrupting others, having difficulty waiting for one’s turn, and talking over people (Ditrich et al., 2021). Impulsive self-harm can occur in the context of ADHD as well; however, it is not part of the diagnostic criteria and is not always present.
Studies looking at impulsivity using neuropsychological assessments found some interesting differences (summarized in Ditrich et al., 2021):
- Impulsivity in people with BPD was more stress-dependent (it becomes worse under stress). ADHDers had more motor impulsivity (difficulty stopping an action already in motion).
- Earlier studies found impaired inhibition to be a core feature of adult ADHD but not of BPD. In BPD, inhibition difficulties have mainly been observed under stress.
This suggests different pathways to impulsivity. ADHD impulsivity tends to be more trait-like and tied to inhibition differences, while BPD impulsivity seems more closely tied to emotion dysregulation (Weiner et al., 2019).
To learn more about the similarities and differences between BPD and ADHD, you can read my post on it here or check out the ebook.
Borderline Personality Disorder and Autism
BPD is a common misdiagnosis for Autistic people who mask a lot, particularly Autistic women and gender-expansive people. The two share many overlapping traits and experiences. Autistic masking can result in a diffuse sense of self and a sense of emptiness, which can look like BPD. And emotions related to sensory overload can look like the emotional regulation difficulties often seen in BPD.
BPD and autism also co-occur at high rates. Given how many Autistic people who mask a lot remain undiagnosed, it is difficult to know the true rate of co-occurring BPD and autism.
Borderline Personality Disorder and Autism Similarities
Sensitivity to Abandonment
Rejection sensitivity is common among Autistic people. It is an intense sensitivity to rejection or perceived rejection. In a 2025 qualitative study, Autistic adults described overwhelming, exhausting emotions when anticipating or perceiving rejection. People with rejection sensitivity often go to great lengths to avoid situations where they might feel rejected, and they can react strongly when they do. This can look similar to the fear of abandonment and abandonment reactions seen in BPD.
A Diffuse Sense of Self
A core feature of BPD is a “diffuse sense of self” or unstable self-identity, often rooted in early childhood experiences and trauma. Autistic people who mask a lot often learn to socialize by copying others and becoming chameleons, and they can also lose track of their own identity. In one study of camouflaging, Autistic adults described copying socially successful people and feeling they had lost track of who they really are.
Chronic Feelings of Emptiness
Chronic emptiness is a core feature of BPD. Clinically, I saw this often among Autistic adults who mask a lot too. Many described a sense of emptiness during burnout and when not engaged in something meaningful. This may be related to the diffuse identity that can come with long-term masking.
Emotional Dysregulation
Emotional dysregulation is a core feature of BPD. Many Autistic people also struggle with emotional regulation, related to differences in how the Autistic brain and nervous system process emotion. Sensory overload and sensory meltdowns can also lead to emotional dysregulation.
Relationship Difficulty
Relationships can be challenging for both groups. This can be due to differences in social cognition, social interaction, and maintaining long-term relationships.
Sexual and Gender Identity
People with BPD often describe an unstable sense of self, and identity disturbance in BPD can include shifts in goals, values, and sexual identity (Biskin and Paris, 2012). Separately, gender expansiveness appears more common among Autistic people. In BPD, research on gender identity is limited and mixed. These are co-occurrence findings. They don’t mean gender expansiveness is a symptom of either.
- People who don’t identify with the sex they were assigned at birth are 3–6 times more likely to be Autistic than cisgender people (Warrier et al., 2020).
- Autistic people are more likely than allistic people to be non-heterosexual (Weir et al., 2021).
- In one community study, sexual minority teens scored higher on borderline features than heterosexual teens (Reuter et al., 2016). A study of 100 women with BPD found none met criteria for gender dysphoria, though bisexual and lesbian participants reported more gender dysphoria symptoms (Singh et al., 2011).
Depersonalization and Derealization
Depersonalization involves the sensation that one’s body or self is unreal or altered in a strange way.
Derealization involves the experience of the external world being bizarre, unreal, or dream-like.
Both can be a response to trauma, and they can also be a response to sensory overload, as the body shuts down to keep from taking in more sensory information. Dissociation is common in BPD, affecting about two-thirds of people in some estimates (Korzekwa et al., 2009). It can also show up in Autistic people. I write more about this in Autism, ADHD, and Dissociation: Why We Fog Out.
Borderline Personality Disorder and Autism Differences
To tease out the difference between Autistic traits and BPD symptoms, it is important to understand the person’s internal experience. Here are a few places I focused on when assessing.
Criterion B of autism
While BPD and autism share a lot of overlap, many aspects of Criterion B for autism are distinct from BPD. For example, the presence of special interests, strict adherence to routine, and self-soothing through repetition are distinct Autistic experiences.
Social Differences
While both groups experience social and relationship difficulties, the origins differ. For BPD, they are attachment-based and often revolve around unstable relationships and idealization and devaluation dynamics. For Autistic people, they are related to differences in social initiation, small talk, and allistic communication. Autistic people often do better when socializing with other Autistic people or connecting around shared interests.
Attachment Style Differences
BPD is associated with insecure attachment, most often unresolved, preoccupied, or fearful styles (Agrawal et al., 2004). Insecure attachment is also common among Autistic people, but it may lean more avoidant. In one study of university students, higher Autistic traits were linked with avoidant attachment but not with anxious attachment (Gallitto and Leth-Steensen, 2015).
Personality Differences
One study compared the personality traits of Autistic adults with those of adults with BPD and other personality disorders (Strunz et al., 2015). Autistic adults scored lower on extraversion and openness to experience, and higher on inhibitedness and compulsivity, than all the other groups.
To learn more about the similarities and differences between autism and borderline personality disorder, you can check out my post on it here or check out the ebook.
ADHD and Autism
ADHD and autism are both neurodevelopmental conditions, meaning they have strong genetic roots and are present from childhood. They overlap at high rates and share many similarities. The overlap between ADHD and autism is poorly understood, partly because until the DSM-5 was released in 2013, a clinician couldn’t diagnose both ADHD and autism (Taurines et al., 2012).
Co-Occurrence of ADHD and Autism
Studies show significant genetic and neurobiological overlap between ADHD and autism (Sokolova et al., 2017).
- An estimated 22–83% of Autistic children meet criteria for ADHD (Sokolova et al., 2017).
- Approximately 30–65% of ADHD children have significant Autistic traits (Sokolova et al., 2017).
- Twin, family, and genetic studies consistently show that ADHD and autism share a large part of their genetic roots (Mattheisen et al., 2022).
While co-occurrence is common, it is also common to see elevated ADHD traits in Autistic people, or elevated Autistic traits in ADHDers. A person may not meet criteria for both and still have significant trait overlap.
Genetic Overlap
There are various hypotheses about why ADHD and autism co-occur so often. Leitner (2014) describes a shared genetic origin as one leading explanation.
Twin and genetic studies support this idea: ADHD and autism share a large part of their genetic roots (Rommelse et al., 2010; Mattheisen et al., 2022). This helps explain why ADHD and autism so often run together within individuals and families.
Evidence also points to neurobiological overlap. Sokolova and colleagues (2017) suggest that pathways involved in attentional control (inattention and task-switching difficulty) may be a key factor in understanding the overlap between these conditions.
Similarities Between ADHD and Autism
Both affect executive functioning, attention, and sensory processing. Here are some of the main overlaps.
Executive Functioning Difficulties
Executive functioning challenges are core features of both ADHD and autism. Challenges may include difficulty organizing tasks, object permanence, memory, focus, decision-making, and regulating attention. (Note: People with BPD also experience executive functioning challenges when emotionally overwhelmed, often triggered by attachment injuries).
Social Difficulties
Both groups often struggle with picking up social cues but often for different reasons. For ADHDers, this may be related to inattention and impulsivity. For Autistic people, it is more often related to differences in intuitively reading social cues, body language, and pretense and difficulty with task switching (social communication involves considering multiple tasks at one time). (Note: people with borderline personality disorder also experience relationship differences often due to intense interpersonal relationships characterized by idealization and devaluation).
Interoception Issues
Interoception, sometimes called the “8th sensory system,” refers to the ability to sense internal signals, such as hunger, thirst, the need to use the bathroom, and emotions. Interoception is integral to the ability to regulate emotions.
A person with interoception differences may have more difficulty registering and responding flexibly to their internal states and emotions. A 2023 meta-analysis found interoceptive differences among Autistic people. Findings for ADHDers are more mixed (Bruton et al., 2025). For ADHDers, it is unclear whether the signals themselves are weaker or whether attention regulation makes it harder to notice them.
Time Perception
Partly associated with interoception, ADHDers and Autistic people often experience time perception challenges (Vicario et al., 2020).
Sensory Sensitivities
Sensory sensitivities are common in both ADHD and autism and are related to how the brain processes sensory input. (Note: People with BPD may also experience heightened sensory reactivity; see Rosenthal et al., 2011.)
Hyperactivity/Repetitive Movement (Stimming)
Stimming (repetitive movement) to regulate is common among both Autistic people and ADHDers. ADHD fidgeting can also look like Autistic stimming.
Hyperfixation and Special Interests
Hyperfixation and hyperfocus, especially around our passions and special interests (sometimes described as an interest-based nervous system), are common among both ADHDers and Autistic people. ADHD hyperfocus can look a lot like Autistic hyperfixation, and ADHD passions can look a lot like special interests.
Emotional Regulation
For many reasons, including interoception differences and sensory processing, ADHDers and Autistic people can struggle to regulate and soothe intense emotions. Difficulty regulating emotions can also be associated with sensory meltdowns and sensory overload.
Rejection Sensitive Dysphoria
Rejection Sensitive Dysphoria is common among both ADHDers and Autistic people. Note this can look similar to BPD’s fear of abandonment.
Differences Between ADHD and Autism
Here are a few of the places I focused on when teasing out the differences between autism and ADHD.
Social Differences
While both groups experience social difficulties, they differ in nature. Here are some things to consider:
- What are the underlying mechanisms behind the social difficulties? Sokolova and colleagues (2017) suggest that for ADHDers, impulsivity and inattention may lead a person to miss social cues. For Autistic people, social challenges are more connected to differences in intuitively interpreting social cues. ADHDers can often read social cues when they can focus. Autistic people tend to have more inherent difficulty doing this intuitively.
- Other social differences may include: ADHDers are more likely to talk excessively, interrupt others, and miss what is being said, while Autistic people are more likely to find back-and-forth conversation hard and to use language in repetitive ways (Sokolova et al., 2017).
Disruptions to Routine
Many of the items in Criterion B for autism can look like ADHD (sensory sensitivities, special interests can look like hyper-fixation, and repetitive movement can look like hyperactivity). One of the things that distinguishes autism from ADHD is how the person adapts to change (Criterion B, item 2).
To understand the Autistic experience, it’s important to consider the experience of self-initiated change (the person decided to change their routine) vs. change that comes from an external source (a forced or unexpected change).
For Autistic people, unexpected change that comes from outside of us can cause intense irritability, anxiety, and stress. The ADHD brain often seeks dopamine, excitement, and change. The Autistic brain craves similarity, routine, and repetition.
To learn more about the similarities and differences between autism and ADHD you can read my post on it here, or check out the ebook.
Summary
ADHD and autism are linked with higher rates of personality disorders, including BPD. BPD is also a common misdiagnosis for Autistic and ADHD people, and I suspect it is a particularly common misdiagnosis for AuDHDers. All three conditions share genetic, temperamental, and trait overlap. They also share many psychosocial risks, such as victimization, substance use, disordered eating, mood disorders, PTSD, self-harm, and more. Even for seasoned clinicians who know these conditions well, it can be difficult to tell them apart.
BPD, ADHD, and Autism FAQs
Can you have BPD, ADHD, and autism at the same time?
Yes. A person can have one of these conditions, two, or all three. BPD co-occurs with ADHD and autism at higher rates than in the general population, and when one or two are present, it can be hard to tell them apart.
Is autism misdiagnosed as BPD?
BPD is a common misdiagnosis for Autistic people who mask a lot, particularly Autistic women and gender-expansive people. Autistic masking can result in a diffuse sense of self and a sense of emptiness, which can look like BPD. And emotions related to sensory overload can look like the emotional regulation difficulties often seen in BPD.
What is the difference between BPD and ADHD?
People with either condition can experience executive functioning difficulties, emotional regulation difficulties, and impulsivity. For ADHD, these experiences are part of the person’s baseline and show up across contexts. For BPD, they are often triggered by attachment injuries and relationship stress.
How common is BPD in ADHD adults?
In a large U.S. survey, about a third of ADHD adults (33.7%) also met criteria for BPD, compared with about 5% in the general population.
Additional Resources
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