Similarities, differences and intersection between EUPD and ASD
Research type
Research Study
Full title
Exploring professional’s perspectives of the similarities, differences and intersection of the presentation of individuals diagnosed with Emotionally Unstable Personality Disorder and Autism: A Q-Methodology study.
IRAS ID
348960
Contact name
Laura Vassell
Contact email
Sponsor organisation
University of Staffordshire
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Research Summary:
: Background and Aims In clinical practice, professionals often find it challenging to distinguish between autism and Emotionally Unstable Personality Disorder (EUPD), as some behavioural traits and emotional difficulties can appear similar. This can lead to diagnostic confusion, misdiagnosis, or inappropriate support for service users. While existing research often focuses on the patient perspective, little is known about how the healthcare professionals themselves navigate these diagnostic boundaries. The aim of this research was to systematically explore the different viewpoints held by clinical professionals regarding the similarities, differences, and intersection of autism and EUPD.
What We Did
We used a research approach called Q-methodology. This is a scientific way to study people's personal viewpoints, opinions, and experiences. We asked participants to rank a set of statements about autism and EUPD based on how much they agreed or disagreed with them. To ensure the study reflected real-world experiences, we involved Patient and Public Involvement (PPI). This means we worked collaboratively with patients, service users, or members of the public to design the study materials. A total of 21 clinical professionals took part, representing a wide range of roles across health and social care services.Key Results
The analysis showed that the professionals’ viewpoints clustered into three distinct viewpoints:Viewpoint 1 focused heavily on the unique biological and developmental differences of autism, emphasising the need for tailored, autism-specific environments and care.
Viewpoint 2 focused on the shared emotional and relationship challenges seen in both presentations, highlighting how trauma can affect people in both viewpoints.
Viewpoint 3 highlighted the practical and systemic challenges, focusing on how rigid healthcare pathways and diagnostic labels can sometimes restrict a person's access to the right care.
Conclusions and Clinical Impact
The study revealed that clinical decision-making is rarely a straightforward, purely technical process. Instead, professionals must constantly navigate a "value-practice tension." This is a conflict that occurs when a clinician's personal and professional values (such as wanting to provide flexible, person-centred care) clash with the rigid rules, limits, or pathways of the healthcare system. The findings highlight a clear need for more flexible service models and joint training. This will help staff better support individuals who sit at the intersection of autism and EUPD.Explanation of Terms and Acronyms
HRA (Health Research Authority): The UK organisation that protects and promotes the interests of patients and the public in health and social care research.EUPD (Emotionally Unstable Personality Disorder): A mental health diagnosis related to difficulties in regulating emotions and maintaining stable relationships.
Q-methodology: A qualitative and quantitative research method used to explore and systematically analyse human subjectivities, viewpoints, opinions, and perspectives.
PPI (Patient and Public Involvement): An active partnership between researchers and patients, service users, or the public to help shape and guide research.
Value-practice tension: The conflict felt by professionals when their clinical values do not align with the practical constraints of the system they work within.
This study will explore professionals in Multi-disciplinary Teams (MDTs) involved in diagnosing either or both Emotionally Unstable Personality Disorder and Autism, focusing on their perceptions of the similarities, differences and intersection between these two presentations. Previous research has focused on looking at the similarities, differences and intersections between Emotionally Unstable Personality Disorder and Autism from a position of understanding the symptoms or traits presented, and have done this as a systematic review and meta-analysis (May et al., 2012). Similarly, other studies have focused on how diagnostic manuals have characterised them (Linsey, 2019 cited in Gordon et al., 2020).
Participants in the main Q-study will be recruited from a range of core professions including; Psychiatrists, Clinical Psychologists, Speech and Language Therapists, Occupational Therapists, Nursing (Mental Health, Learning Disability, Non-prescribing, Advance Clinical Practice, Liaison Nurse) and from non-clinical/pre-qualified roles including; Assistant Psychologists, Clinical Psychologists in Training, Trainee Clinical Associate Psychologists and Health Care Assistants. All participants must have 1 years’ experience of working in teams involved in the diagnostic process with presentations that are consistent with a EUPD and ASD diagnosis. These experiences can be made up from working across several services. Participants do not need to be working in services where diagnostic decisions are made at the time of participating in the study.
This study is being carried out in fulfilment of the Professional Doctorate in Clinical Psychology programme, part of the School of Health, Science and Wellbeing. This study will be carried out from September 2023 - September 2026 at University of Staffordshire in Stoke-on-Trent.
REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
25/SW/0089
Date of REC Opinion
24 Jul 2025
REC opinion
Favourable Opinion