Intersectionality and identity: Gender identity and ethnicity in autism and personality disorder

Research Aims

1. To explore how gender identity and ethnicity affect the labelling of people's experiences as autism or personality disorder

2. To explore how autistic people and people with a diagnosis of personality disorder experience their sense of self and identify themselves in relation to their diagnosis, and how this intersects with marginalised community identities Quantitative Hypotheses 1. Non-cis gender identity is more common amongst adults seeking and receiving an autism diagnosis, than in the general

population 2. Non-cis gender identity is more common amongst adults receiving a personality disorder diagnosis and particularly amongst those subsequently seeking an autism diagnosis and than it is in the general population 3. Ethnic minority status is less common amongst adults seeking and receiving an autism diagnosis, and amongst adults

receiving a personality disorder diagnosis, than in the general population Exploratory Questions

4. Do non-cis gendered individuals, and black and minority ethnic individuals, each experience their marginalised identity as contributing to misdiagnosis or misunderstanding of their experiences by mental health services?

5. Do autistic individuals identify more strongly with their diagnosis and diagnostic community than individuals diagnosed with a personality disorder? 6. How is self and community acceptance of a person's diagnosis influenced by community identity as a non-cis gendered community member or a black and minority ethnic community member?

7. Do autistic individuals and those diagnosed with a personality disorder struggle with achieving a coherent sense of self for different underlying reasons? Design. Mixed-methods, cross-sectional, drawing on audit data and qualitative interviews. Methods 1. Systematic review of the association between ethnicity, gender identity and personality disorder/ autism in adults .

2. Audit of diagnostic rates and journey through mental health services of people referred to adult autism and personality

disorder services, by ethnicity, gender identity, and sex assigned at birth, drawing on our existing collaborations with these services in Berkshire Healthcare NHS Foundation Trust and Leeds Partnership NHS Foundation Trust.

3. Ethnographic study of how diagnostic decisions and differential diagnosis of autism and personality disorder are made by clinicians in relation to non-cis gender and black and minority ethnic individuals.

4. Qualitative interviews with people assigned female at birth who identify as black or minority ethnic, or as gender diverse,

and who are autistic and/or have a personality disorder diagnosis. Interviews will explore how individuals feel their ethnicity

and gender identity affected the labelling of their experiences as autism or personality disorder, how they experience their

sense of self, and how they identify themselves in relation to their diagnosis. These interviews will be supplemented with interviews with mental health clinicians to understand their views and experiences of these issues. Outcomes and Impact

1. This PhD will help to uncover health inequalities for people from two marginalised groups: non-cis gendered individuals

and black and minority ethnic individuals, and for people with two marginalised diagnoses: personality disorder and autism. 2. This PhD will generate better understanding of why autism is sometimes missed or misdiagnosed amongst people given a personality disorder diagnosis. 3. Following on from impact 2, this PhD has the potential to contribute to reduced missed and misdiagnoses of autism.

4. This in turn has the potential to enable more autistic individuals to understand themselves better and to make needed adaptations in their lives, as well as enabling them to access needed support