ADHD in adolescents with borderline personality disorder

Abstract

BackgroundThe aims of this study were to assess the prevalence of a comorbid Attention Deficit Hyperactivity Disorder (ADHD) diagnosis in Borderline Personality Disorder (BPD), and its impact on the clinical presentation of BPD in adolescents, and to determine which type of impulsivity specifically characterizes adolescents with BPD-ADHD.MethodsADHD diagnoses were sought in a sample of 85 DSM-IV BPD adolescents drawn from the EURNET BPD. Axis-I and -II disorders were determined with the K-SADS-PL and the SIDP-IV, respectively. Impulsivity was assessed with the BIS-11.Results11% (N = 9) of BPD participants had a current ADHD diagnosis. BPD-ADHD adolescents showed higher prevalence of Disruptive disorders (Chi2 = 9.09, p = 0.01) and a non-significant trend for a higher prevalence of other cluster B personality disorders (Chi2 = 2.70, p = 0.08). Regression analyses revealed a significant association between Attentional/Cognitive impulsivity scores and ADHD (Wald Z = 6.69; p = 0.01; Exp(B) = 2.02, CI 95% 1.19-3.45).ConclusionsComorbid ADHD influences the clinical presentation of adolescents with BPD and is associated with higher rates of disruptive disorders, with a trend towards a greater likelihood of cluster B personality disorders and with higher levels of impulsivity, especially of the attentional/cognitive type. A subgroup of BPD patients may exhibit developmentally driven impairments of the inhibitory system persisting since childhood. Specific interventions should be recommended for this subsample of BPD adolescents.

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

“…BPD in adolescents demarcates a group with high psychiatric comorbidity and low psychosocial functioning [30,[62][63][64]. Compared to psychiatric inpatients without BPD, borderline adolescents are significantly more likely to meet criteria for psychiatric disorders in the area of externalizing problems (attention-deficit/hyperactivity disorder, oppositional and conduct disorders), substance abuse/dependence problems, and internalizing disorders including mood and anxiety disorders (obsessive-compulsive disorder, posttraumatic stress disorder, separation anxiety disorder and social phobia) [30,47,64].…”

Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden

“…It is well established that ADHD is overrepresented in individuals diagnosed with BPD (e.g., [33,34]); similarly, Black et al [22] found that 42% of inmates with BPD had comorbid ADHD, compared to 16% of those without.…”

Sleep-Wake Patterns of Adolescents with Borderline Personality Disorder and Bipolar Disorder

“…Assessing BPD patients without depressive disorders allows determining what sleep disturbances are more specific to this personality disorder, therefore improving knowledge about its aetiology. Although the rate of a cormobid DSM-IV mood disorder is high (55.3-58.7 %) in BPD adolescents [11,12], they do not all have major depressive disorder or dysthymia. Even if BPD and major depressive disorder show overlap of symptoms, they are two distinct conditions which do not respond to antidepressant medication in a similar way [13].…”