“I Don’t Think Anyone’s Ever Asked Me About the Two Before” : Making Sense of Co-occurring Autism and BPD in Inpatient Mental Health Settings

Woods, K. and Dunn, R. and Smith, I. and Di Basilio, D. (2025) “I Don’t Think Anyone’s Ever Asked Me About the Two Before” : Making Sense of Co-occurring Autism and BPD in Inpatient Mental Health Settings. Journal of Autism and Developmental Disorders. ISSN 0162-3257

Abstract

Autistic individuals and individuals with borderline personality disorder (BPD) are both more likely than the general population to require access to mental health services, specifically inpatient services. Both groups of individuals have reported difficulties when accessing inpatient services including stigma, lack of understanding and lack of adaptations. Recent research has suggested having diagnoses of both autism and BPD is becoming more common and that individuals with both diagnoses may be more at risk of suicidal thoughts and self-harm behaviours. The aim of this study is to understand the experiences of accessing inpatient mental health services for individuals with a diagnosis of autism and BPD. Semi-structured interviews were conducted with participants. The data were analysed using reflexive thematic analysis. Seven participants were interviewed. Six themes were developed: (i) Never fully understood, (ii) Intense need for care and connection, (iii) Prisoner or patient? When care and punishment are intertwined, (iv) Necessary evil, (v) System always wins, (vi) Responsible for own care. Autistic individuals with BPD require personalised care that integrates both their diagnoses into their identities. To provide this, staff on inpatient wards need appropriate support including reflective spaces and clinical supervision. Inpatient systems also need to shift away from prioritising the needs of the system and towards prioritising the needs of the individual, including adaptations for autistic individuals. [Abstract copyright: © 2025. The Author(s).]