"It Was Like the Final Piece in the Puzzle for Me": A Qualitative Study on the Experiences of Autistic Women Initially Diagnosed with Borderline Personality Disorder.

Background: Women who self-harm and experience complex mental health difficulties are frequently diagnosed with borderline personality disorder (BPD), also known as emotionally unstable personality disorder. Emerging research suggests that self-harm may often be better explained through the lens of autism, and that greater consideration should be given to the clients' motivations for self-harm. How time alone is experienced may also be a differentiating factor. The objective of this study was to investigate individuals' perceptions of a change in diagnosis, experiences of self-harm, and fear of real or imagined abandonment, with the aim of improving the accuracy of initial diagnosis. Method: Eight women, first diagnosed with BPD, then autism, and with a history of self-harm and multiple admissions to a psychiatric hospital, underwent a semistructured interview, which was recorded, transcribed, and analyzed using thematic analysis. Results: Three main themes and 11 subthemes were identified. Theme one centers around participants' "Journey through the diagnostic and therapeutic jungle." Theme two is entitled "Self-harm as a developed and systematic way of coping." Theme three is entitled "Alone is not abandoned." Conclusions: Better awareness and understanding of the subtle differences between BPD and autism are essential, as misdiagnosis leads to misinformed treatments, which are often contraindicative. Recognition of these specific, differentiating traits is most evident with a detailed neurodevelopmental history. This study suggests two potential factors for consideration in a neurodevelopmental history: first, the triggers and functions of self-harm, which often starts early in childhood, and second, limited awareness or absence of feelings of fear of abandonment alongside contentment with spending time alone.