Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions.

INITIAL CASE PRESENTATION Brittany, a 21-year-old woman with borderline personality disorder (BPD), was referred to our specialist personality disorder service, with a presentation distinguished by high-lethality suicidal behaviors including ingestion of toxic substances and dangerous objects. She frequently ran to train stations and bridges. Brittany also engaged in daily cutting. Due to her high level of risk, she was increasingly restricted within her family home. She was not allowed into the backyard for fear that she would elope and engage in high lethality behavior. Brittany is an only child, conceived via in vitro fertilization. Diagnosed with Asperger’s Syndrome at age six, Brittany displayed early restricted interests, desire for routine, and sensory difficulties, accompanied by a high level of social interest. Multi-disciplinary assessments showed pragmatic language impairment and social difficulties that included inflexibility and egocentricity in her play. Brittany demonstrated difficulty with sharing, losing in games, and when not able to take first turn. High levels of emotional distress were reported when she did not get what she wanted. Brittany worked with a speech pathologist during this childhood period. She was subsequently diagnosed with obsessive compulsive disorder (OCD) and generalized anxiety. Restricted eating and self-injurious behaviors began in her early teen years.