Differential diagnosis of autism, attachment disorders, complex post-traumatic stress disorder and emotionally unstable personality disorder: A Delphi study

Rachel Sarr; Deborah Spain; Alice Quinton; Francesca Happe; Chris R. Brewin; Jonathan Radcliffe; Sally Jowett; Sarah Miles; Rafael A González; Idit Albert; Alix Scholwin; Marguerite Stirling; Sarah Markham; Sally Strange; Freya Rumball

doi:10.1111/bjop.12731

Differential diagnosis of autism, attachment disorders, complex post-traumatic stress disorder and emotionally unstable personality disorder: A Delphi study

Rachel Sarr, Deborah Spain, Alice Quinton, Francesca Happe, Chris R. Brewin, Jonathan Radcliffe, Sally Jowett, Sarah Miles, Rafael A González, Idit Albert, Alix Scholwin, Marguerite Stirling, Sarah Markham, Sally Strange, Freya Rumball

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Abstract

Individuals diagnosed with autism, attachment disorders, emotionally unstable personality disorder (EUPD) or complex post-traumatic stress disorder (CPTSD) can present with similar features. This renders differential and accurate diagnosis of these conditions difficult, leading to diagnostic overshadowing and misdiagnosis. The purpose of this study was to explore professionals' perspectives on the differential diagnosis of autism, attachment disorders and CPTSD in young people; and of autism, CPTSD and EUPD in adults. A co-produced three-round Delphi study gathered information through a series of questionnaires from 106 international professionals with expertise in assessing and/or diagnosing at least one of these conditions. To provide specialist guidance and data triangulation, working groups of experts by experience, clinicians and researchers were consulted. Delphi statements were considered to have reached consensus if at least 80% of participants were in agreement. Two hundred and seventy-five Delphi statements reached consensus. Overlapping and differentiating features, methods of assessment, difficulties encountered during differential diagnosis and suggestions for improvements were identified. The findings highlight current practices for differential diagnosis of autism, attachment disorders, CPTSD and EUPD in young people and adults. Areas for future research, clinical and service provision implications, were also identified.

Original language	English
Pages (from-to)	1-33
Number of pages	33
Journal	British Journal of Psychology
Volume	116
Issue number	1
Early online date	20 Sept 2024
DOIs	https://doi.org/10.1111/bjop.12731
Publication status	E-pub ahead of print - 20 Sept 2024

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Sarr, R., Spain, D., Quinton, A., Happe, F., Brewin, C. R., Radcliffe, J., Jowett, S., Miles, S., González, R. A., Albert, I., Scholwin, A., Stirling, M., Markham, S., Strange, S., & Rumball, F. (2025). Differential diagnosis of autism, attachment disorders, complex post-traumatic stress disorder and emotionally unstable personality disorder: A Delphi study. British Journal of Psychology, 116(1), 1-33. Advance online publication. https://doi.org/10.1111/bjop.12731

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title = "Differential diagnosis of autism, attachment disorders, complex post-traumatic stress disorder and emotionally unstable personality disorder: A Delphi study",

abstract = "Individuals diagnosed with autism, attachment disorders, emotionally unstable personality disorder (EUPD) or complex post-traumatic stress disorder (CPTSD) can present with similar features. This renders differential and accurate diagnosis of these conditions difficult, leading to diagnostic overshadowing and misdiagnosis. The purpose of this study was to explore professionals' perspectives on the differential diagnosis of autism, attachment disorders and CPTSD in young people; and of autism, CPTSD and EUPD in adults. A co-produced three-round Delphi study gathered information through a series of questionnaires from 106 international professionals with expertise in assessing and/or diagnosing at least one of these conditions. To provide specialist guidance and data triangulation, working groups of experts by experience, clinicians and researchers were consulted. Delphi statements were considered to have reached consensus if at least 80% of participants were in agreement. Two hundred and seventy-five Delphi statements reached consensus. Overlapping and differentiating features, methods of assessment, difficulties encountered during differential diagnosis and suggestions for improvements were identified. The findings highlight current practices for differential diagnosis of autism, attachment disorders, CPTSD and EUPD in young people and adults. Areas for future research, clinical and service provision implications, were also identified.",

author = "Rachel Sarr and Deborah Spain and Alice Quinton and Francesca Happe and Brewin, {Chris R.} and Jonathan Radcliffe and Sally Jowett and Sarah Miles and Gonz{\'a}lez, {Rafael A} and Idit Albert and Alix Scholwin and Marguerite Stirling and Sarah Markham and Sally Strange and Freya Rumball",

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Sarr, R , Spain, D , Quinton, A , Happe, F, Brewin, CR, Radcliffe, J, Jowett, S, Miles, S, González, RA, Albert, I, Scholwin, A, Stirling, M, Markham, S, Strange, S & Rumball, F 2025, 'Differential diagnosis of autism, attachment disorders, complex post-traumatic stress disorder and emotionally unstable personality disorder: A Delphi study', British Journal of Psychology, vol. 116, no. 1, pp. 1-33. https://doi.org/10.1111/bjop.12731

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AU - Spain, Deborah

AU - Quinton, Alice

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AU - Brewin, Chris R.

AU - Radcliffe, Jonathan

AU - Jowett, Sally

AU - Miles, Sarah

AU - González, Rafael A

AU - Albert, Idit

AU - Scholwin, Alix

AU - Stirling, Marguerite

AU - Markham, Sarah

AU - Strange, Sally

AU - Rumball, Freya

PY - 2024/9/20

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N2 - Individuals diagnosed with autism, attachment disorders, emotionally unstable personality disorder (EUPD) or complex post-traumatic stress disorder (CPTSD) can present with similar features. This renders differential and accurate diagnosis of these conditions difficult, leading to diagnostic overshadowing and misdiagnosis. The purpose of this study was to explore professionals' perspectives on the differential diagnosis of autism, attachment disorders and CPTSD in young people; and of autism, CPTSD and EUPD in adults. A co-produced three-round Delphi study gathered information through a series of questionnaires from 106 international professionals with expertise in assessing and/or diagnosing at least one of these conditions. To provide specialist guidance and data triangulation, working groups of experts by experience, clinicians and researchers were consulted. Delphi statements were considered to have reached consensus if at least 80% of participants were in agreement. Two hundred and seventy-five Delphi statements reached consensus. Overlapping and differentiating features, methods of assessment, difficulties encountered during differential diagnosis and suggestions for improvements were identified. The findings highlight current practices for differential diagnosis of autism, attachment disorders, CPTSD and EUPD in young people and adults. Areas for future research, clinical and service provision implications, were also identified.

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Differential diagnosis of autism, attachment disorders, complex post-traumatic stress disorder and emotionally unstable personality disorder: A Delphi study

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