Misdiagnosed & Overlapping Conditions
One of the things I spend a lot of time doing with my clients is helping them figure out what's what. Is it ADHD? Autism? Trauma? Depression? Anxiety? Or is there more than one thing going on?
I love this part of my work because I often see how much it means to someone when their experiences finally start making sense. Many of the adults I work with have spent years trying to understand themselves. Some have been given diagnoses that never quite fit, while others are just beginning to consider whether they might be neurodivergent.
The tricky part is that these things aren't always as separate or as black and white as we'd like them to be. ADHD, autism, trauma, and mental health concerns can look similar, influence one another, and exist together. Sometimes it's not a matter of figuring out which one is the right answer.
I've gathered these resources to help you explore some of the similarities and differences. Reading them won't give you everything you need to diagnose yourself or rule out a diagnosis, but they can be a helpful starting point for recognizing patterns and asking questions.
Working with a neurodivergent-affirming therapist who understands both neurodivergence and mental health can help you untangle these experiences. Sometimes it's less about finding one explanation for everything and more about understanding yourself better, recognizing your needs, and figuring out what kind of support would actually help.
Misdiagnosis and Personality Disorders
Borderline Personality Disorder (BPD) vs. Autism
Bipolar Disorder vs. Autism/ADHD
Narcissism vs. Autism
Trauma, Depression, and Anxiety
Autism and Trauma
ADHD and Trauma
Autism, Depression, and Burnout
ADHD and Depression
Autism and Social Anxiety
ADHD and Anxiety
OCD and Repetitive Thinking
OCD vs. Autism
OCPD vs. Autism
Pure O, Rumination, and Neurodivergence
Other Neurodivergent and Physical Health Overlaps
If you feel overwhelmed - reach out and I can help you break this down.
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Borderline vs. Autism: Why Are They Sometimes Confused?
Some autistic adults, particularly women and people who have spent years masking, are diagnosed with borderline personality disorder (BPD) before anyone considers autism.
Emotional intensity, sensitivity to rejection, and relationship difficulties can be part of either experience. But autistic overwhelm, communication differences, and the effects of repeated misunderstanding aren't necessarily the same as the intense fears of abandonment, unstable self-image, and relationship patterns often associated with BPD.
A careful assessment should consider someone's developmental history, trauma experiences, and the possibility that both diagnoses may apply.
Misdiagnosis Monday
BPD vs. Autism: Why Misdiagnosis Happens and Why It Matters – Dr. Megan Anna Neff
Articles
Differentiating Between Borderline Personality Disorder (BPD) and Autism – Existing resource on this page; retain its original external link.
Podcasts
Autism Diagnosis vs. BPD and CPTSD: Misdiagnosis and Its Consequences – The Hidden 20%, with Dr. Alison Lennox (2025)
Autism and Misdiagnosis: Personality Disorders – Autism in the Adult, Dr. Theresa Regan (2022)
Journal Article
Overlapping and Differentiating Clinical Features of Autism and Borderline Personality Disorder in Women and People Assigned Female at Birth – Barnicot and colleagues (2026)
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Bipolar vs. Autism/ADHD: What's Different About Mood Changes?
Not every period of intense emotion, impulsivity, or fluctuating energy is a bipolar mood episode.
With bipolar disorder, clinicians look for distinct periods of depression, mania, or hypomania that represent a noticeable change from someone's usual functioning. These episodes may involve changes in sleep, energy, activity, and mood.
ADHD-related emotional shifts and autistic responses to overwhelm tend to follow different patterns. Someone may also have bipolar disorder alongside ADHD or autism, so it's important to consider both longstanding traits and changes that occur in episodes.
Misdiagnosis Monday
Bipolar vs. Autism: Understanding the Differences and Overlap – Dr. Megan Anna Neff
ADHD vs. Bipolar Disorder: Differences, Overlap, and Misdiagnosis – Dr. Megan Anna Neff
Podcasts
Autism and Misdiagnosis: Bipolar and Depression – Autism in the Adult, Dr. Theresa Regan (2022)
ADHD and Bipolar: Untangling the Overlap – Inside Bipolar, Gabe Howard and Dr. Nicole Washington (2025)
When Bipolar and ADHD Overlap: Diagnosis – The Carlat Psychiatry Podcast (2024)
Autism vs. Narcissism: Why Are They Sometimes Mistaken for Each Other?
An autistic person might miss an unspoken social expectation, talk at length about something they're interested in, or struggle to respond in the way someone else expects. These behaviors can sometimes be interpreted as selfishness or a lack of empathy.
But narcissistic personality disorder (NPD) involves a broader pattern of entitlement, a need for admiration, and difficulties in relationships. Autism involves differences in communication, social processing, and other aspects of development.
Of course, autistic people can behave hurtfully, and being autistic doesn't rule out NPD. The important thing is not to assume someone's intentions based on how their behavior appears from the outside.
Articles
How Can You Tell the Difference?
8 Ways Autism Is Different from Covert Narcissism
Autism and Covert Narcissism in Relationships: 8 Real-Life Examples
Why Do Some Autistic People Seem Self-Absorbed?
Am I Just an Asshole? The Difference Between Autism and Narcissism and Why It Matters
Differences Between Autism and Narcissism
A Narcissism and Autism Connection? One Family's Experience
Narcissism Questionnaires and Self-Reflection Tools
These questionnaires may help you reflect on certain personality traits or relationship patterns, but they aren't a reliable way to diagnose narcissistic personality disorder. Having some narcissistic traits doesn't necessarily mean someone has NPD, and a diagnosis requires a much broader assessment.
3 Minute Closet Narcissism Test
23 Signs You're Secretly a Narcissist Masquerading as a Sensitive Introvert
Pathological Narcissism Inventory
Interactive Narcissistic Personality Inventory
Podcasts
Challenging Stereotypes About Autism and Narcissism – Divergent Conversations with Dr. Megan Anna Neff and Patrick Casale (2023)
Aly Rae on Autism and Narcissism – Poema Podcast (2025)
Narcissism or Neurodivergent? – Beyond Survival with Katie McKenna (2026)
Video
Autism and Trauma: Is It Autism, Trauma, or Both?
What happens when someone has been autistic their entire life but has also experienced trauma from an early age?
It can be difficult to recognize which experiences are related to autism, which developed in response to trauma, and how they've influenced each other. Sensory sensitivity, shutdowns, emotional overwhelm, and relationship difficulties may be part of that complicated picture.
For some autistic adults, years of masking, bullying, exclusion, or having their needs dismissed have also been traumatic. Recognizing autism doesn't erase those experiences, and addressing trauma doesn't eliminate someone's autistic support needs.
Understanding Autism and Trauma
PTSD vs. Autism: Overlapping Signs and Support Strategies – Dr. Megan Anna Neff, Misdiagnosis Monday
Autistic Traits vs. Trauma – Trauma Geek (printable infographic; paid download)
Post-Traumatic Stress Disorder in Autistic People – Dr. Freya Rumball, National Autistic Society (2022)
Masking and Trauma
Autism, Discrimination and Masking: Disrupting a Recipe for Trauma
Podcasts
The Untold Overlap of Autism, ADHD, and Complex Trauma – Trauma Rewired with Dr. Megan Anna Neff (2025)
Am I Too Sensitive or Traumatized? PTSD, Bullying, Masking and Recovery – Adulting with Autism, Dr. Christal Badour (2026)
Video
Journal Articles
The Comorbidity Between Autism Spectrum Disorder and Post-Traumatic Stress Disorder Is Mediated by Brooding Rumination – Golan and colleagues (2022)
Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events – Rumball and colleagues (2020)
What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem – Evans and colleagues (2024)
ADHD and Trauma: When Is It ADHD, PTSD, or Both?
ADHD and trauma can both affect concentration, memory, emotional regulation, and the ability to manage everyday life. ADHD involves lifelong differences in attention and executive functioning, while trauma can create similar difficulties through hypervigilance, stress, or feeling unsafe.
For some adults, years of living with unidentified ADHD, criticism, or feeling like they're constantly falling short can also leave lasting emotional wounds. And sometimes ADHD and trauma are both part of the picture.
Misdiagnosis Monday
ADHD vs. PTSD, or ADHD and PTSD? How to Tell Them Apart – Dr. Megan Anna Neff
Articles
Does Trauma Cause ADHD? And Vice Versa? – Dr. Nicole M. Brown (2025)
Podcasts
ADHD and Trauma – ADHD Aha! with Dr. Monica Johnson (2024)
ADHD, Trauma & Reclaiming Self-Trust – ADHDifference with Karen Dwyer-Tesoriero (2026)
Journal Article (Optional)
ADHD and Childhood Trauma: Implications for Differential Diagnosis Among Adult Clinical Patients – Winbush-Fairley and colleagues (2026)
Autism and Depression: Is It Depression, Autistic Burnout, or Both?
When you're completely exhausted, withdrawing from people, or struggling to manage things that used to feel easier, it can be hard to know whether you're depressed, experiencing autistic burnout, or both.
Autistic burnout often develops after prolonged masking, sensory overload, or demands that exceed your capacity. Depression may involve persistent sadness, emotional numbness, or losing interest in things you normally enjoy.
And sometimes burnout turns into depression. That's important to recognize because reducing demands and accommodating your needs may help with burnout, but depression may also need treatment.
Misdiagnosis Monday
Autistic Burnout vs. Depression: How to Tell the Difference and Why It Matters – Dr. Megan Anna Neff
Articles
When Neurodivergent Burnout Turns Into Depression – Dr. Christine Henry (2026)
Depression in Autistic People – National Autistic Society
Podcasts
Autistic Burnout Part 2: A Deep Dive Into the Diversity of Burnout – Divergent Conversations (2024)
Healing Autistic Burnout: Why Rest Alone Isn't Enough – Adult Autism: A Spectrum of Uniqueness, with Sharon O'Connor (2026)
Journal Articles
Rumination and Perceived Impairment Associated With Depressive Symptoms – Gotham and colleagues (2014)
Camouflage, Burnout-Exhaustion, and Depression in Autistic Adults – Benatov and colleagues (2025/2026)
ADHD or Depression? Why They Can Look Alike and How They Overlap
Many adults spend years being treated for depression before discovering that ADHD may be part of the picture. Difficulty concentrating, low motivation, exhaustion, and struggling with everyday tasks can look like depression, especially when ADHD has gone unrecognized for years.
But the reverse can also be true. Depression itself can affect attention, memory, motivation, and executive functioning, even when someone doesn't have ADHD. And sometimes both are present.
Looking at when these difficulties started, how they've changed over time, and what makes them better or worse can help you figure out what's actually going on.
Misdiagnosis Monday
ADHD vs. Depression: Overlap, Co-Occurrence, and Misdiagnosis – Dr. Megan Anna Neff
Articles
ADHD and Depression: Risks, Overlap, and Support – Dr. Megan Anna Neff (2026)
Study Examines ADHD Symptoms in Adult Women With Recurrent Depression – Duke University
Depression: Symptoms, Causes, and Treatment – National Institute of Mental Health
When ADHD Understimulation Feels Like Depression
Sometimes understimulation can leave you feeling flat, exhausted, restless, or unable to get started on anything. You might even wonder whether you're depressed, especially when your energy and interest return as soon as something engages your brain.
Understimulation and depression aren't mutually exclusive, though, and a temporary improvement in mood doesn't rule out depression.
When Depression Co-occurs with ADHD – CHADD
A Guide to Understimulated ADHD – Attention Deficit Disorder Association
Podcasts
Something Felt Off: ADHD, Depression, and Slow Processing Speed – ADHD Aha! (2026)
ADHD and Depression: Josh's Story – ADHD Aha! (2023)
ADHD and the Boredom Spiral – The ADHD Channel for Women (2026)
Journal Article
What About Perimenopause?
If you're in your late 30’s, 40s or 50s and suddenly struggling more with concentration, motivation, memory, or mood, perimenopause may also be part of the picture. Hormonal changes can make existing ADHD challenges more noticeable, but they can also cause difficulties that resemble ADHD or depression, even if you've never experienced them before.
Autism and Anxiety: When Is It Social Anxiety, Sensory Overwhelm, or Both?
Social anxiety often involves a fear of being judged, embarrassed, or rejected. But for autistic people, anxiety in social situations may also come from sensory overload, communication differences, uncertainty about what's expected, or the exhaustion of masking.
Of course, autistic people can experience social anxiety too. Years of being misunderstood, criticized, or excluded can contribute to a very real fear of negative judgment.
For some autistic adults, reducing anxiety isn't just about managing anxious thoughts. It's also about creating environments, routines, and relationships that don't leave them constantly overwhelmed.
My Social Anxiety Is Not Disordered
Understanding Autism and Anxiety
Anxiety Specific to Autism Linked to Amygdala Differences
Social Anxiety vs. Autism: Understanding the Differences and Overlap
Podcast
Is It Anxiety or Is It Autism? Why Girls and Other High-Masking Individuals Are Often Misdiagnosed – Neuroversity with Dr. Megan Anna Neff
Autism and Misdiagnosis: Anxiety, Trauma, and OCD – Autism in the Adult, Dr. Theresa Regan
Neurodivergent Perspectives on Routine Disruptions – Divergent Conversations
Videos
Autism: How Anxiety Affects Everything – Sarah Hendrickx
Autism vs. Social Anxiety (Why Social Anxiety Differs from Autism)
ADHD and Anxiety: When Worry Becomes a Way to Manage ADHD
For some adults with ADHD, anxiety has become the thing that keeps them organized, on time, or from forgetting important responsibilities. You may have spent years relying on worry and pressure to get things done without realizing how exhausting that is.
ADHD and anxiety can also look similar, with difficulties concentrating, restlessness, procrastination, and feeling overwhelmed. Sometimes these experiences come from ADHD, sometimes from anxiety, and sometimes both.
Recognizing what's driving your struggles can help you find ways to manage ADHD without having to rely so heavily on stress and fear.
When ADHD and Anxiety Occur Together
The Adult ADHD and Anxiety Workbook
Misdiagnosis Monday
ADHD vs. Anxiety: How They Overlap, Differ, and Co-Exist
Podcast
Understanding the ADHD and Anxiety Overlap with Dr. Mona Potter – Hacking Your ADHD
OCD vs. Autism: When Are Routines More Than Routines?
Two people might repeat the same action every day, but experience it very differently.
An autistic person may find comfort, enjoyment, or sensory regulation in repetition. Someone with OCD might repeat an action to reduce distress, respond to an intrusive thought, or feel certain that something is okay.
The distinction isn't always obvious. Autistic routines can become distressing, OCD compulsions aren't always visible, and someone can experience both autism and OCD. Rather than focusing only on what a behavior looks like, it helps to understand what the person experiences when doing it and what happens when they can't.
Misdiagnosis Monday
OCD vs. Autism: Overlap, Differences, and the Power of And – Dr. Megan Anna Neff
Articles
OCD and Autism: Understanding the Differences and Overlap – International OCD Foundation
Podcasts
OCD Part 3: Differentiating OCD, Autism, and Tourette's Behaviors – Divergent Conversations with Dr. Stacy Greeter (2024)
Autism and Misdiagnosis: Anxiety, Trauma, and OCD – Autism in the Adult with Dr. Theresa Regan (2022)
NOCD offers free educational resources, articles, and tools to help you better understand OCD, along with a directory to connect with therapists who specialize in OCD treatment, including exposure and response prevention (ERP).
OCPD or Autism? Understanding the Need for Routine, Rules, and Control
Maybe you need things done in a particular order, become upset when plans change, or have a hard time letting go of how you expected something to happen. Someone else might describe you as rigid or controlling without understanding why those things matter to you.
For autistic people, routines and predictability can help manage sensory demands, uncertainty, or the effort of navigating everyday life. Obsessive-compulsive personality disorder (OCPD), on the other hand, involves a broader pattern of perfectionism, orderliness, and control that can interfere with flexibility and relationships.
These experiences aren't mutually exclusive, but needing routines or struggling with change doesn't automatically mean someone has a personality disorder.
Misdiagnosis Monday
OCPD vs. Autism: How to Spot the Differences and Avoid Misdiagnosis – Dr. Megan Anna Neff
Additional Article
OCD vs. OCPD: Key Differences (Plus the Autism Overlap) – Dr. Megan Anna Neff
Podcast
Obsessive Compulsive Personality Disorder (OCPD) – The OCD Stories with Dr. Anthony Pinto and Dr. Michael Wheaton (2026)
Journal Article
Underrecognition of Autism and Implications for Adult Psychiatric Practice – 2026
Pure O, Rumination, and Neurodivergence: Why Does My Brain Get Stuck on a Thought?
Replaying conversations, analyzing what someone meant, worrying about whether you said something wrong, or going over the same question again and again can be exhausting.
For autistic people, this may involve difficulty shifting attention or needing more time to process experiences. With ADHD, emotionally significant or unresolved situations can be especially hard to move on from. Years of masking, criticism, or feeling misunderstood can also contribute to these patterns.
Sometimes repetitive thinking is connected to OCD, including what's commonly called Pure O. Although Pure O isn't an official diagnosis or separate type of OCD, the term describes experiences where compulsions are mostly mental, such as reviewing memories, checking thoughts, or repeatedly searching for certainty.
The important distinction is whether you're processing an experience, having difficulty shifting your attention, or feeling compelled to keep thinking in an attempt to relieve distress. These experiences can overlap, but they may call for different kinds of support.
Articles
Does Pure O Exist? – OCD-UK
How Do I Stop Thinking About This? What to Do When You're Stuck Playing Mental Ping Pong – International OCD Foundation
Ruminating on Ruminations: Mental Compulsions and What to Do About Them – International OCD Foundation
Podcasts
OCD: I-CBT and Neurodivergent Approaches to OCD – Divergent Conversations with Brittany Goff
How to Manage Mental Compulsions: Free Six-Part Podcast Series – Your Anxiety Toolkit with Kimberley Quinlan
Book
"Pure O" OCD: Letting Go of Obsessive Thoughts with Acceptance and Commitment Therapy – Chad LeJeune, PhD (2023)
Journal Article
Insistence on Sameness, Repetitive Negative Thinking and Mental Health in Autistic and Non-Autistic Adults – Cooper and Russell (2024)
If you're trying to make sense of your experiences and aren't sure whether it's ADHD, autism, a mental health concern, or some combination, you don't have to figure it all out on your own. I'd be happy to help you explore what's going on and what kind of support might be helpful.
Autism and ADHD (AuDHD): When Your Neurotypes Pull in Opposite Directions
Having both ADHD and autism can sometimes feel like your brain wants two opposite things. You might crave novelty but need predictability, love making plans but struggle to follow through, or want social connection but become easily overwhelmed.
Sometimes ADHD and autistic traits seem to cancel each other out, but they're both still there. One may mask the other, or they may create competing needs that are difficult to balance. This can make AuDHD harder to recognize, especially in adults who weren't identified until later in life.
Misdiagnosis Monday
ADHD vs. Autism: How to Tell the Difference (or Both) – Dr. Megan Anna Neff
Articles
AuDHD Diagnostic Overshadowing: 6 Ways ADHD Hides Autism – Dr. Megan Anna Neff (2026)
Revisiting Monotropism – Patrick Dwyer
Podcasts
Autism + ADHD = AuDHD – Neurodiversity Podcast with Emily Kircher-Morris and Mattia Maurée (2024)
The Routine Paradox: Why Autistic Brains Feel Safe with Structure and ADHD Brains Feel Trapped by It – Late Bloomers (2026)
Understanding AuDHD: Executive Functioning and Daily Life – The AuDHD Psych Podcast (2026)
Giftedness and ADHD or Autism: Why Are So Many Twice-Exceptional Adults Identified Late?
If you were identified as gifted growing up, people may have assumed you couldn't possibly have ADHD or be autistic. You might have done well academically while struggling with organization, friendships, sensory needs, or everyday responsibilities that seemed easier for everyone else.
Giftedness is often considered a form of neurodivergence, although whether it's a distinct neurotype is still debated. When giftedness exists alongside ADHD, autism, or a learning disability, it's often called twice-exceptionality (2e).
For many adults, their strengths helped them compensate for difficulties that nobody recognized. Being gifted doesn't mean you can't also have genuine disabilities or need accommodations.
Understanding Giftedness and Twice-Exceptionality
What Is Twice-Exceptional (2e)? – Neurodivergent Insights
Gifted Adults: Resources for Self-Exploration – Giftedness.online
Gifted and Dyslexic: Identifying the Twice-Exceptional Person – International Dyslexia Association
Understanding Twice-Exceptionality: Misdiagnosis and Masking – Twice Exceptional educational guide
Visual Comparison
Updated Autism / ADHD / Giftedness Venn Diagram – Katy Higgins Lee, MFT
Podcasts
Gifted, ADHD, and Twice-Exceptional: Rewriting the Shame Story for Neurodivergent Adults – ADHD Alchemy with Dr. Matt Zakreski (2026)
Autism, Not Attitude: Embracing Neurodivergence at Work and in Relationships – Gifted Unleashed (2026)
Late-Diagnosed Autism, ADHD, and Giftedness: Of Masking, Burnout, and a GPS for Life – NeuroRebel Podcast (2025)
Gifted and Distractible: 2e – Twice Exceptional Podcast with Julie Skolnick (2024)
Giftedness Part 1: Defining Giftedness Beyond High IQs – Divergent Conversations with Emily Kircher-Morris (2024)
Giftedness Part 2: You're a Zebra, Not a Weird Horse – Divergent Conversations with Dr. Matt Zakreski (2024)
Journal Article
Giftedness, ADHD, and Overexcitabilities: The Possibilities of Misinformation – Elizabeth Mika (2006)
Research suggests that some physical health conditions are more common among autistic and ADHD adults, including sleep problems, chronic pain, digestive issues, and certain hormonal concerns.
I also see how much physical health can affect mental health, energy, and everyday functioning. Sometimes what looks like burnout or emotional overwhelm may also involve a medical concern that deserves attention.
I'm a psychologist, not a medical doctor, so diagnosing and treating these medical conditions is outside my scope. I've gathered resources to help you explore possible connections and have more informed conversations with your healthcare providers.
General health connections
Constellation of Chronic Medical Conditions Commonly Seen in Autistic & ADHD Adults | All Brains Belong, clinician guide
Increased Rates of Chronic Physical Health Conditions Across All Organ Systems in Autistic Adolescents and Adults | Research study
Risk of Physical Health Comorbidities in Autistic Adults | Research article
Specific health conditions
EDS and Hypermobility
Autism, Joint Hypermobility, and Ehlers-Danlos Syndromes: A Systematic Review
POTS and Dysautonomia
POTS: A Little Known Cause of Extreme Fatigue | Johns Hopkins Medicine
MCAS
Diagnosis and Management of MCAS in Canada: A Practical Approach
PMDD and ADHD
Increased Risk of Provisional PMDD Among Females with ADHD
Sleep Disorders
Sleep in Adults with Autism and ADHD: A Systematic Review and Meta-Analysis
Gastrointestinal Problems, Chronic Pain, and Fatigue
Adding To This Page…
I am continuously adding to this page as I get new information so come check back to see new additions. If you have any resources that you have found helpful but are not listed please email me as I would love to add them: henry@therapyforpetpeople.com
Please forgive any typos or broken links. As an ADHDer it’s a challenge for me to keep up but I am making it a priority as this page is truly a labor of love. Be sure to forward the link to others in your life who may benefit from this information. Bring some food and water as this is a deep deep dive into all things neurodivergent.
Explore More Resources
Questions? Need Support?
If you have questions or need support, please reach out to me! This journey can be difficult, but you don’t have to walk it alone.