Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited – a review-update on common grounds and subtle distinctions

Abstract

Background Overlap in symptom domains particularly in the field of impulsivity and emotional dysregulation in attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have stimulated further research activities since our last review from 2014. Main body Disentangling features of impulsivity in ADHD and BPD revealed that impulsivity is a feature of both disorders with patients suffering from both ADHD and BPD having highest impulsivity ratings. BPD individuals have more problems using context cues for inhibiting responses and their impulsivity is stress-dependent, whereas ADHD patients have more motor impulsivity and therefore difficulties interrupting ongoing responses. For emotion regulation difficulties the ranking order ranges from ADHD to BPD to the comorbid condition, again with the patients suffering from both, ADHD and BPD, having the most pronounced emotion regulation problems. Environmental influences namely adverse childhood events were shown to be linked to both ADHD and BPD. Traumatic experiences seem independently linked to impulsivity features. Thus, some authors point to the risk of misdiagnosis during childhood and the necessity to screen for traumatic experiences in both patient groups. Genetic research confirmed genetic overlap of BPD with bipolar disorder (BD) and schizophrenic disorders, as well as genetic overlap of BD and ADHD. A population-based study confirmed the high co-occurrence and familial co-aggregation of ADHD and BPD. Interesting questions in the field of gene-environment-interactions are currently dealt with by genetic and epigenetic research. Few studies have investigated treatment strategies for the comorbid condition, though the issue is highly important for the management of patients suffering from both disorders and presenting with the highest symptom scores. Conclusion Research on the different impulsivity features might point to a necessity of disorder-specific treatment strategies in the field of impulse control. Future research is needed to base treatment decisions for the comorbid condition on an evidence basis.

Prevalence of Personality Disorders in Adults With Attention Deficit Hyperactivity Disorder (ADHD)

“…However, despite some common symptoms, such as impulsivity, and emotional dysregulation, attentional problems are more evident in those with ADHD compared to those with borderline PD (Koerting et al, 2016; O’Malley et al, 2016). It has also been proposed that the impulsivity of ADHD reflects a neurocognitive disorder while the impulsivity of borderline PD is characterized as more behavioral (Ditrich et al, 2021). Further exploration of these characterizations of impulsivity are required to allow a determination of the validity or otherwise of this conceptualization.…”

An exploratory study of functional brain activation underlying response inhibition in major depressive disorder and borderline personality disorder

“…Finally, it also important to recognize that attention deficit hyperactivity disorder (ADHD) was not included as part of the structured diagnostic assessment of the participants in the present study. This limitation may pose further challenges for the interpretation of our results because the differences between impulsivity related to ADHD versus BPD are not yet well established [95]. Future research should consider how comorbid ADHD might play a role in response inhibition processes in BPD and related pathological personality traits.…”

Not Only Excessive Daytime Sleepiness but Also Depression Symptoms, Chronological Age and Onset-Age Were Associated with Impulsivity in Narcolepsy Type 1 Patients

“…Impulsivity is a feature of actions out of spontaneous impulses without thinking about consequences. 4 Impulsivity is a heterogeneous personality and behavioral construct, presenting in the general population and several psychiatric disorders. 4,5 It should be noted that greater impulsivity is a known risk factor for the development of addiction and substance abuse.…”

“…4 Impulsivity is a heterogeneous personality and behavioral construct, presenting in the general population and several psychiatric disorders. 4,5 It should be noted that greater impulsivity is a known risk factor for the development of addiction and substance abuse. 6 Insufficient nocturnal sleep has been associated with poor impulsivity control and emotional dysfunction, 7 possibly due to the interaction between sleep deprivation and the lack of inhibitory brain control.…”