A-180: Untangling Diagnostic Overlap: Differentiating Borderline Personality Disorder From Autism Spectrum Disorder, Psychotic Disorder(s), and Trauma-Related Psychopathology

Abstract

Objective: This case highlights the interplay between trauma, environmental stressors, and psychiatric outcomes. Previous literature links childhood trauma to anxiety, depression, and functional impairment, compounded by social isolation. This case expands upon existing knowledge, detailing the progression from early trauma to complex psychiatric symptoms, including paranoia and sensory sensitivities, illustrating the impact of compounding stressors on functionality. Method/Data Selection: The patient experienced healthy early development, which shifted after trauma at a young age. Consequent anxiety and depressive symptoms worsened through adolescence, resulting in chronic school absences. The COVID-19 pandemic intensified social isolation, which persisted post-pandemic. Acute episodes of paranoia and perceptual disturbances occurred by age 18. The patient remains largely homebound, struggling with daily routines, sensory sensitivities, emotional dysregulation, social connectedness, self-injurious behaviors, and identity instability. Results/Data Synthesis: Neuropsychological testing revealed Low Average intellectual functioning, memory and processing speed vulnerabilities, and limited executive functioning. Personality and trauma assessments demonstrated symptom magnification and significant vulnerability, reflecting extreme internal distress. Projective measures illustrated an inconsistent coping style, simplistic reasoning, information withholding, and a propensity to misperceive human activity. Diagnoses included Borderline Personality Disorder and Social Anxiety Disorder. Diagnoses of Autism Spectrum Disorder and psychotic disorders were ruled out. Conclusions: Findings illustrate the complex interaction of personality pathology, trauma, and cognitive vulnerabilities. The case underscores the importance of distinguishing personality pathology from neurodevelopmental disorders to guide treatment recommendations.