Could She Be Autistic? Exploring Gender Differences in Camouflaging and Pragmatics in Autism and Borderline Personality Disorder

TL;DR

The study finds that social camouflaging in women and gender-diverse individuals may lead to under or misdiagnosis of autism or borderline personality disorder, while pragmatic assessments are more useful for men.

Contribution

The study introduces gender-specific insights into how camouflaging and pragmatic skills affect the differential diagnosis of ASD and BPD.

Findings

Women with ASD and BPD show similar camouflaging scores, complicating clinical differentiation.

Men with ASD show more distinct pragmatic deficits compared to BPD, aiding diagnosis.

Gender-diverse individuals exhibit camouflaging influenced by sociocultural and identity factors.

Abstract

This study explores the relationship between social camouflaging and pragmatic competence in adults diagnosed with autism spectrum disorder (ASD) and borderline personality disorder (BPD), with a particular focus on gender. It is based on the hypothesis that camouflaging contributes to under or misdiagnosis, especially in women and gender‐diverse individuals. A total of 225 adults participated in a cross‐sectional online survey, completing the Camouflaging Autistic Traits Questionnaire (CAT‐Q) and the Pragmatic Awareness Questionnaire (PAQ). Participants were grouped based on clinical diagnosis (ASD or BPD) and self‐identified gender (women, men and gender‐diverse). Among women, no significant differences in camouflaging scores were found between the ASD and BPD groups, suggesting the use of similar adaptation strategies that may obscure clinical differentiation. In contrast, among men, camouflaging and pragmatic deficits were more distinctly associated with autistic traits. No substantial differences were observed among gender‐diverse participants, highlighting the influence of contextual and identity‐related factors. Findings emphasize the importance of integrating detailed pragmatic assessments and adopting gender‐sensitive approaches in the differential diagnosis of ASD and BPD. Such strategies may help reduce misdiagnosis and improve recognition of autistic traits, particularly in populations that tend to camouflage more effectively.

Social camouflaging can obscure the distinction between autism and borderline personality disorder, particularly among women, potentially contributing to underdiagnosis or misdiagnosis.Pragmatic language differences appear more pronounced in men, suggesting greater diagnostic value of pragmatic assessment in male populations.In gender‐diverse individuals, camouflaging may reflect sociocultural pressures and identity‐related factors rather than diagnostic profiles alone, underscoring the need for gender‐sensitive assessment approaches.Sole reliance on self‐report measures may miss underlying communication challenges; combining developmental history, observational data and multiple informants can enhance diagnostic accuracy.

Social camouflaging can obscure the distinction between autism and borderline personality disorder, particularly among women, potentially contributing to underdiagnosis or misdiagnosis.

Pragmatic language differences appear more pronounced in men, suggesting greater diagnostic value of pragmatic assessment in male populations.

In gender‐diverse individuals, camouflaging may reflect sociocultural pressures and identity‐related factors rather than diagnostic profiles alone, underscoring the need for gender‐sensitive assessment approaches.

Sole reliance on self‐report measures may miss underlying communication challenges; combining developmental history, observational data and multiple informants can enhance diagnostic accuracy.