Emotion dysregulation is heightened in autistic females: A comparison with autistic males and borderline personality disorder

Abstract

Background: Emotion dysregulation is increasingly recognized as highly prevalent and impairing in autistic individuals. Yet, a large majority of studies have considered emotion dysregulation in youth only, and most of them did not consider sex differences in emotion dysregulation manifestation. Objectives: In the present study, we aim to investigate sex differences relative to emotion dysregulation in autistic adults without intellectual disability as well as its relationship with different factors potentially involved in emotion dysregulation (e.g. camouflaging, alexithymia, suicidality, quality of life). Self-reported emotion dysregulation will be assessed in autistic adults but also in females with borderline personality disorder, given that emotion dysregulation is particularly enhanced in this population. Design: Cross-sectional, prospective, controlled. Methods: Twenty-eight autistic females, 22 autistic males and 24 females with borderline personality disorder were recruited from a dialectical behavior therapy program waiting list. They completed several self-report questionnaires measuring emotion dysregulation, alexithymia, suicidality, quality of life, camouflaging borderline symptoms and autism severity. Results: Most emotion dysregulation subscale scores and alexithymia scores were heightened in autistic females compared to females with borderline personality disorder and, to a lesser extent, compared to autistic males. Independently of borderline personality disorder symptoms, emotion dysregulation was related to alexithymia and poorer psychological health in autistic females, whereas it was mostly related to autism severity, poorer physical health and living conditions in autistic males. Conclusion: Our results suggest that emotion dysregulation is a major difficulty of autistic adults without intellectual disability eligible for dialectical behavior therapy, and this is especially the case for autistic females. There seem to be different sex-specific factors involved in emotion dysregulation found in autistic adults, which highlight the need to target-specific domains (e.g. alexithymia) in the treatment of emotion dysregulation in autistic females. ClinicalTrials.gov Identifier: NCT04737707 https://clinicaltrials.gov/ct2/show/NCT04737707

The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls

“…Alexithymia ranked second in the SHAP value plots for ASD, while emotional vulnerability ranked second for BPD. Thus, although alexithymia has been pinpointed by several studies as a transdiagnostic process involved in ED [e.g., 27,130], this suggests that alexithymia might be particularly central to ED in ASD. ASD-related factors, on the other hand, did not predict ED in the ASD group compared to the BPD group, contrary to our hypotheses (H6 and H7).…”

“…Autistic women in particular have been reported to be at greater risk of developing severe ED compared to autistic men [24,25,26], which suggests that gender-related factors might be involved in ED in ASD [27].…”

The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls

“…This suggests that ED is a risk factor for suicidality and self-harm in ASC, and that autistic people may develop capability for suicide through self-harm [ 14 , 23 ]. Autistic women in particular have been reported to be at greater risk of developing severe ED compared to autistic men [ 24 – 26 ], which suggests that gender-related factors might be involved in ED in ASC [ 27 ]. Beyond the fact that ASC and BPD may share ED and ED-related dysregulated behaviours, it is worth noting that ASC and BPD may also co-occur with a pooled prevalence of BPD in ASC of 4% [95% CI 0–9%] and of 3% [95% CI 1–8%] for ASC in BPD [ 28 ].…”

“…hypersensitivity, hyperreactivity and slow return to emotional baseline) [ 58 ], theory of mind (ToM) peculiarities, sensory sensitivity, lack of cognitive flexibility, change-related anxiety and repetitive behaviours have been associated with ED in ASC [ 11 , 50 ]. Alexithymia, prevalent in ASC, has also been reported to be linked to ED in autistic adults [ 20 ], especially in autistic women [ 27 ]. Moreover, ASC-related difficulties seem to interfere directly with the ability to self-regulate [ 10 , 11 , 50 ], but also contribute to high levels of anxiety and fatigue making emotion regulation costly for autistic people [ 11 , 50 , 59 ].…”

“…We also expected ED to be a predictor of the presence of self-harm and/or suicidal behaviours in both clinical groups (H3). Additionally, in the autistic group only, we expected to observe gender differences, with autistic women presenting with higher ED than autistic men (H4) [ 27 ]. Regarding ED predictors, we hypothesized that emotional vulnerability, impulsivity and invalidation—which are direct measures of the biosocial model—would predict ED in both clinical groups, but ASC-related factors would be specific predictors of ED in the ASC group compared to the BPD group (H5).…”