Unmasking Diagnostic Error: Overdiagnosis and Misdiagnosis of Borderline Personality Disorder in Women with the Female Autism Phenotype

The Female Autism Phenotype (FAP) represents a subtle and often overlooked presentation of autism in women. Unlike male-centered profiles, women with FAP frequently exhibit strong social motivation yet struggle with social intuition, pragmatic communication, and gender-normed restricted interests. Many engage in camouflaging, masking autistic traits to navigate societal expectations. These internalized and hidden features frequently lead to misdiagnosis, most commonly as Borderline Personality Disorder (BPD), anxiety, or depression. This study employed a retrospective cross-sectional analysis and systematic literature review to examine the prevalence and mechanisms of BPD overdiagnosis in women with undiagnosed ASD. Findings highlight the need for gender-sensitive diagnostic tools and neurodivergence-affirming therapeutic adaptations to mitigate harm and improve diagnostic equity.