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Understanding Autism in Assigned Female at Birth Individuals: Navigating Misdiagnosis and EUPD

Updated: Apr 26

Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition that presents uniquely across individuals. For those Assigned Female at Birth (AFAB), the journey with autism is often riddled with unique challenges and widespread misunderstandings, most notably the prevalent misdiagnosis of Emotionally Unstable Personality Disorder (EUPD) instead of recognizing underlying autistic traits.

The Complex Interplay of EUPD and Autism in AFAB Individuals: EUPD, also identified as Borderline Personality Disorder (BPD), is characterized by unstable moods, behaviors, and relationships. Its symptomatology can significantly overlap with autism, making the diagnostic process for AFAB individuals particularly challenging. This difficulty is compounded by societal stereotypes and expectations, which often lead to autistic traits being misunderstood or overlooked entirely, pushing towards a EUPD misdiagnosis.

Symptom Characteristics

Autism Spectrum Disorder (ASD)

Emotionally Unstable Personality Disorder (EUPD/BPD)

Emotional Regulation

Challenges with emotional regulation; may experience intense emotions but the source is often internal or due to sensory or environmental overwhelm.

Intense emotional swings; emotions can be very reactive to interpersonal stressors or perceived rejection.

Social Interaction

Difficulties with social cues and communication; might prefer solitary activities due to social exhaustion or misunderstanding.

Intense relationships characterized by a pattern of instability; fears of abandonment may influence social interactions.

Behavioral Patterns

Repetitive behaviors or restricted interests; routines are often important and disruptions can be distressing.

Impulsive behaviors, potentially harmful, in response to emotional distress; may include spending sprees, reckless driving, binge eating, etc.


Challenges with social identity might arise from feeling different or not fitting in; special interests may become a part of one's identity.

Unstable self-image or sense of self; feelings about oneself can fluctuate significantly, often influenced by external interactions.

Response to Change

Resistance to change; preference for predictable environments and routines. Changes can cause significant stress or discomfort.

While not inherently resistant to change, instability in personal life and relationships can cause recurrent stress and turmoil.


Literal interpretation of language; difficulties with understanding subtleties such as sarcasm or indirect hints.

Communication style may be influenced by emotional state; might have no trouble with language subtleties but can express in an intense or unstable manner.

Sensitivity to Sensory Input

Heightened or reduced sensitivity to sensory input; specific sensory preferences and aversions.

Sensory sensitivity is not a core symptom, but individuals may experience intensified sensory processing during emotional distress.

Navigating the Common Pitfalls of Misdiagnosis:

  1. Social Masking: AFAB autistics frequently adopt "social masking" strategies, concealing their autism to blend into their social surroundings. This camouflage contributes to a clinical oversight, where underlying autism is overshadowed by symptoms that superficially align more closely with EUPD.

  2. Gender Bias in Diagnosis: The historical bias towards diagnosing autism predominantly in males has skewed the understanding and identification of autism in AFAB individuals, funneling them towards alternate diagnoses like EUPD.

  3. Symptom Overlap: Emotional dysregulation, impulsivity, and social relational difficulties are shared between EUPD and autism, complicating their differentiation, especially in AFAB cases.

The Overdiagnosis of EUPD in AFAB Individuals: The trend towards overdiagnosing EUPD in AFAB individuals deserves critical examination, as it often stems from deep-seated systemic biases and a lack of nuanced understanding within mental health frameworks. Factors contributing to this overdiagnosis include societal and cultural expectations, diagnostic criteria bias, and a pervasive under recognition of autism. This trend not only obscures the actual needs of autistic individuals but also limits their access to appropriate support and resources, emphasizing the necessity for a more informed and sensitive diagnostic approach.

The Consequences of Misdiagnosis: Incorrectly diagnosing EUPD in AFAB autistics can severely delay the provision of proper support and interventions, exacerbating mental health struggles and distress. Inappropriately applied treatments for EUPD may prove ineffective or even harmful for those with autism, underscoring the critical importance of accurate diagnosis.

Towards Greater Understanding and Support: Combatting the misdiagnosis issue requires a concerted effort towards raising awareness and enhancing the understanding of the AFAB autistic experience. Training for healthcare professionals is crucial, emphasizing the recognition of autism's gender-specific presentations and the critical importance of differential diagnosis. Moreover, fostering a supportive and inclusive environment is essential for allowing AFAB autistics to safely express their authentic selves.

Conclusion: The misdiagnosis of EUPD in AFAB individuals with autism underscores the urgent need for a more nuanced and gender-inclusive understanding of autism. Addressing this challenge head-on promises not only to rectify the misdiagnosis issue but also to ensure that AFAB autistics receive the recognition and support they rightly deserve, paving the way for better mental health outcomes and a more inclusive understanding of autism across the spectrum.

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