What's the Difference Between BPD, PTSD, Bipolar and Autism?

The problem with diagnosis is it only captures a small piece of the picture

She came to me after being told she had borderline personality disorder.

But what she actually had was twenty years of relational trauma, a sensitive nervous system, and a lifetime of trying to survive a world that didn’t understand her.

That’s the problem with diagnosis. It only captures a small piece of the picture.

AI generated image by Vilkasss

The Diagnostic and Statistical Manual, DSM-5, gives us crisp categories—bipolar disorder, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), autism—as if these human experiences can be sorted into tidy boxes.

But people don’t come in boxes.

We are messy, brilliant, sensitive, and layered.

What looks like a mood disorder may actually be trauma. What’s labeled as a personality disorder might be a coping strategy learned in a chaotic home. What presents as intractable depression could turn out to be autistic burnout after years of masking.

Diagnosis isn’t definition. It’s a flashlight in the dark.

I’ve seen it again and again: people misdiagnosed, misunderstood, and mistreated.

Not because their providers didn’t care, but because our diagnostic tools are limited and a well formulated diagnosis takes time, especially when conditions overlap.

Getting the diagnosis right isn’t about labeling someone but about understanding the root cause of the problem so we can treat it effectively.

Because when we get it wrong, it’s not just a delay. It can be a detour into deeper suffering. Misdiagnosis can result in inappropriate medication, misguided therapy leading to worsening of symptoms and a profound sense of personal failure when the assigned label just doesn’t fit.

When Diagnoses Overlap

Someone walks into therapy: they’re not sleeping, emotionally raw, overwhelmed by relationships, bouncing between worthlessness and grandiosity. Their thoughts race. They feel out of control. They might have difficulty trusting anyone, including themselves.

Is it bipolar disorder? BPD? PTSD?

Could be any of them. Could be all of them.

These conditions share common traits:

• Intense emotional states

• Boundary challenges

• Suicidality or self-harm

• Cognitive disruption (racing thoughts, poor focus, dissociation)

• Sleep disturbance

• Internal chaos

Now let’s add autism to the list. Especially in those socialized as female, autism often flies under the radar or is misdiagnosed as something else. Not because it’s rare, but because it doesn’t look like the stereotype we have of autism.

Heres the thing… if you’ve met one autistic person, you’ve met one autistic person.

Generalizing does not work.

Instead of the stereotype of rigid routines or flat affect, it might look like:

• Emotional hyperempathy and intensity

• Social burnout

• Sensory overwhelm

• A chronic sense of being out of sync with the world

In short, non-stereotypical or atypical autism can look like a host of other things. And so, it’s often missed or mislabeled. Worse, these people are often told they are "too sensitive" or "overreacting," compounding their shame and isolation and leading to further wounding through traumatic invalidation.

Let’s take a closer look at each of these diagnoses…

Bipolar Disorder

Bipolar Disorder is a brain-based condition marked by episodes of depression and mania or hypomania. It has strong genetic roots and is considered a neurochemical imbalance that alters mood, energy, and behavior.

In mania, someone might:

• Sleep little

• Talk fast

• Take big risks

• Feel euphoric or agitated

In depression:

• Energy drops

• Despair rises

• Pleasure disappears

• Thoughts may become dark and intrusive

These changes in mood are not a trauma response (though trauma can worsen them). Bipolar is a neurobiological condition that typically requires a combination of medication and therapy. And when left untreated, it can cause progressive damage and physical brain changes.

With bipolar treatment, medication lays the foundation and therapy helps build a life on top of it. Lifestyle stability, regular sleep, and stress management are essential for maintaining stability. Getting the right support is critical.

Borderline Personality Disorder (BPD)

BPD is often misunderstood and unfairly stigmatized. It is sometimes referred to as a “garbage pail diagnosis” because any mental health problem that doesn’t fit cleanly within a different category can be assigned to BPD. It's one of the most emotionally painful conditions, and also very responsive to the right treatment.

BPD is associated with:

• Intense emotions

• Fear of abandonment

• Self-harm

• Relationship turbulence

• Rapid shifts in self-image

At its core, BPD is a relational adaptation that stems from early attachment wounds and invalidation. Studies show that 75% of people with BPD report childhood abuse or neglect, but I believe that is a low estimate.

But contrary to old thinking, BPD is not a life sentence. BPD is learned, and what’s learned can be unlearned. People with BPD can absolutely move from chaos to clarity, from survival to a life they love.

Dialectical Behavior Therapy (DBT), created by Dr. Marsha Linehan, is the gold standard treatment for BPD and offers tools for:

• Emotional regulation

• Distress tolerance

• Mindfulness

• Interpersonal skills

DBT is about building a life worth living, not just managing symptoms, and its effectiveness isn’t limited to BPD. DBT is effective for anyone who struggles with intense emotions and wants to improve how they relate to themselves and others.

Post-Traumatic Stress Disorder (PTSD)

PTSD is a disorder of nervous system dysregulation where the system is stuck in fight-flight-freeze.

Flashbacks, nightmares, dissociation, shutdown, hypervigilance that are characteristic of PTSD are biological responses to trauma, normal responses to a not-so-normal situation.

What makes PTSD tricky is how it mirrors other diagnoses. It can look like bipolar or it can mimic BPD. But unlike those problems, PTSD is past-tense: the nervous system reacts as if danger is still present.

Trauma lives in the body. And talk therapy alone often isn’t enough.

Effective treatment of PTSD must go beyond the story and into felt experience.

Modalities like EMDR, somatic experiencing, parts work, and ketamine-assisted psychotherapy help the body and brain integrate what happened and come back to safety.

When someone begins to heal from PTSD, they often say things like, "I finally feel like myself again" because trauma disconnects us from our own center. And healing brings us home.

Autism

First and foremost, autism isn’t an illness, it’s a neurotype. I really dislike that the DSM5 refers to it as “autism spectrum disorder” rather than what it is. But in a neurotypical (non-autistic) world, autistic people (especially those raised as females) learn to mask their autism and that causes great harm over the long run, and sometimes leads to PTSD, further complicating diagnosis.

Autistic Masking can look like:

• People-pleasing

• Perfectionism

• Emotional suppression

• Social hypervigilance

Eventually, this leads to autistic meltdown or worse, autistic burnout.

Many autistic adults are misdiagnosed as bipolar. Or borderline. Or told they are “too sensitive.” This is unhelpful and may drive the person right out of therapy that could have helped them if it was the right approach.

Autism doesn’t need fixing. It needs understanding. Autistic people benefit from:

• Sensory accommodations

• Clear and respectful communication

• Time to process

• Nervous system attunement

When given this support, they flourish but because they’ve been accommodated and accepted, not corrected.

Why We Get It Wrong

Mental health professionals are often required (by insurance companies) to assign a diagnosis after only one session, which honestly is nuts.

That’s not how healing works. (But insurance is not in the business of healing.)

Trauma isn’t always obvious. Autism often hides in plain sight. And PTSD survival strategies can look like symptoms.

Discovering the truth takes time, trust, curiosity and patience. It requires us to slow down, listen deeply, and hold space for complexity.

I’m not saying we should getting rid of diagnoses, but we need to recognize their limits and use them wisely, and always always always remember the person underneath.

What to Do If You Think You’ve Been Misdiagnosed

If something about your diagnosis has never quite felt right, it’s okay to revisit it or challenge it. If your provider isn’t listening, it’s OK to get a second opinion. You’re allowed to seek clarity.

Misdiagnosis is common, especially for women, neurodivergent folks, and trauma survivors.

Here’s what I want you to know:

• A diagnosis is a tool, not a definition.

• It can guide next steps, but it’s not the whole story.

• You’re allowed to revisit it, question it, or ask for a second opinion.

Whether your path involves medication, therapy, community support, sensory accommodations, or all of the above, what matters most is that the care you receive fits who you are.

Not who someone assumed you were based on a checklist.

You are not your diagnosis. You are a layered, brilliant, feeling, sacred being worthy of nuanced care.

And good clinicians know: we treat the person. That’s when true healing begins.

🌿✨

Want to Go Deeper?

Here are a few books written by people with lived experience:

• What My Bones Know by Stephanie Foo

• Divergent Mind by Jenara Nerenberg

• Unmasking Autism by Devon Price

• Buddha and the Borderline by Kiera Van Gelder

• An Unquiet Mind by Kay Redfield Jamison

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© Linnea Butler 2025