The Misdiagnosis Dilemma of Autistic Women: Why Are They Labeled as "Difficult"? Psychologists Reveal Gender Bias in Diagnosis

Real Cases of Misdiagnosis

Imagine feeling since childhood that the world is like a radio turned up too loud, social rules are instruction manuals written in an alien language, and sudden changes to plans feel like the end of the world. To calm down, you secretly pinch yourself or cut your arms, and the doctor declares after a quick look: "This is classic borderline personality disorder! You self-harm because you're afraid of abandonment!"

Treatment becomes increasingly confusing until one day the doctor suddenly says: "Wait, you might be autistic!" This is truly hard to accept. This is the real experience of eight autistic women.

A recent UK study found that these "misdiagnosis victims" were labeled with an average of 7 different psychiatric diagnoses (from depression to schizophrenia), struggled for 16 years before receiving an autism diagnosis, and some were even hospitalized in psychiatric wards up to 8 times.

Core Characteristics of Autism

**Social and Communication Differences**: Autistic individuals have difficulty understanding social rules and nonverbal signals (such as eye contact, body language). They may exhibit "social masking," covering their difficulties by imitating others' behaviors.

**Sensory Abnormalities**: Over-sensitivity to sensory inputs like sound, light, and touch (such as noise triggering meltdowns) or under-responsiveness (like insensitivity to pain). Sensory overload is a common trigger for self-harm in autistic individuals.

**Repetitive Behaviors and Restricted Interests**: Intense and narrow interests, reliance on fixed routines and plans, extreme anxiety about changes or uncertainty.

Essential Differences in Self-Harm

Research found that BPD diagnosis often hinges on one key word: self-harm. But autistic girls' "self-harm history" starts surprisingly early—some scratch their faces or bang their heads at age 5, escalating to planned cutting during adolescence.

For them, self-harm isn't "acting out" or "seeking attention," but a hardcore coping mechanism for sensory overload. For example, when the environment is noisy, plans change suddenly, or social interactions fail, cutting can feel like "pressing the reset button for the brain."

In contrast, BPD self-harm is more often a "cry for help" after arguments or fear of abandonment. Simply put, autistic self-harm aims to "regulate internal storms," while BPD self-harm attempts to "hold someone's hand."

The Vast Difference in Solitude Experience

BPD's core is "separation anxiety"—if someone doesn't reply to messages for half an hour, they're already imagining dramatic breakup scenarios like "They don't want me anymore!"

But autistic women unanimously say: "Solitude is my power bank!" Some enjoyed staying home so much during the pandemic they didn't want to go out, while others literally "kicked their boyfriends out to work."

Their confusion about "abandonment" is straightforward: "A friend called me 15 times in an hour asking if I hated her, and I was like ???" This difference in "social battery capacity" is a diagnostic watershed.

Doctors' Diagnostic Traps

Participants complained that doctors default to BPD when they see self-harm behavior, often without explaining their diagnostic reasoning. Some discovered their "BPD patient" diagnosis in medical records by accident and were shocked: Are you secretly labeling me?

Worse, the stigma of BPD makes them seen as "difficult patients," leading to completely wrong treatment directions. For example, dialectical behavior therapy teaches "tolerating distress," but for autism, the real issue might be "how to avoid triggering overload."

Only after receiving an autism diagnosis did they realize: "So I'm not flawed in character, just have a different brain default setting!"

Practical Survival Guide

**For Doctors**: Next time you encounter a woman who self-harms, don't rush to prescribe BPD treatment! First ask about her childhood history: When did self-harm start? Are the triggers social or sensory? Does she feel anxious or happy when alone?

**For Autistic Women**: Try a "sensory first aid kit"—noise-canceling headphones, cooling patches, weighted blankets, specifically for overload-induced self-harm. Also, communicate directly with family and friends: "I'm autistic, if you need to change plans, please notify me 24 hours in advance!"

**For General Public**: When encountering "moody" women, reduce mocking comments like "She's so dramatic" and instead ask more "Would you like to talk about your triggers?"—after all, she might be struggling with autism's version of world rules.

Misdiagnosis isn't about doctors being incompetent, but reflects the entire medical system's lag in understanding autistic women. After all, they might be "invisible geniuses"—skilled at social imitation while internally collapsing from "pretending to be normal."

So, next time someone tells you "I might be autistic," don't laugh at their self-diagnosis from TikTok, but offer this question: "Have you found the last piece of your puzzle?"