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Characterizing adult attention-deficit/hyperactivity-disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors

Published online by Cambridge University Press:  23 March 2020

G.K. O’Malley ,
L. McHugh ,
N. Mac Giollabhui  and
J. Bramham
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Abstract

Objective

To characterize adults with comorbid attention-deficit/hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) with regard to ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors.

Method

A between-group design compared a group of individuals diagnosed with ADHD (n = 40) with a group diagnosed with BPD and who also met the criteria for ADHD (ADHD + BPD) (n = 20).

Results

Significant differences were observed for both childhood and current impulsivity symptoms, whereby ADHD + BPD exhibited increased impulsivity; no differences on self-report and cognitive measures of impulsivity were reported. The ADHD + BPD group scored significantly higher on measures of depression, anxiety and numerous other axis I and II conditions. The ADHD + BPD group scored significantly lower on most measures of intellectual functioning and attention, however largely not on those relating to response inhibition. Furthermore, group differences were observed for psychosocial factors, including education, substance use and criminal record.

Conclusion

Comorbid ADHD and BPD is characterized by more symptoms of impulsivity, additional psychopathology, comparatively lower intellectual and attentional functioning and increased psychosocial difficulties.

Keywords

Attention-deficit–hyperactivity-disorder (ADHD)Borderline personality disorderComorbidCognitivePsychosocialNeuropsychological
Type
Original article
Information
European Psychiatry , Volume 31 , January 2016 , pp. 29 - 36
Copyright
Copyright © European Psychiatric Association 2015

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Footnotes

Abbreviations Attention-deficit/hyperactivity-disorder, ADHD Borderline personality disorder BPD Comorbid ADHD and BPD ADHD + BPD

References

Advokat, C, Lane, SM, Luo, CCollege students with and without ADHD: comparison of self-report of medication usage, study habits, and academic achievement. J Atten Disord 2011;15(8):656–666.CrossRefGoogle ScholarPubMed
Bagge, C, Nickell, A, Stepp, S, Durrett, C, Jackson, K, Trull, TJBorderline personality disorder features predict negative outcomes 2 years later. J Abnorm Psychol 2004;113(2):279–288.CrossRefGoogle ScholarPubMed
Barkley, RABehavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997;121(1):65–94.CrossRefGoogle ScholarPubMed
Barkley, RA, Murphy, KRAttention-deficit hyperactivity-disorder: a clinical workbook 2nd ed.New York: Guilford Press; 1998.CrossRefGoogle Scholar
Barkley, RA, Fischer, M, Smallish, L, Fletcher, KThe persistence of attention-deficit/hyperactivity-disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 2002;111:279–289.CrossRefGoogle ScholarPubMed
Biederman, J, Mick, E, Faraone, SVDepression in attention-deficit hyperactivity-disorder (ADHD) children: “True” depression or demoralization?. J Affect Disord 1998;47(1):113–122.CrossRefGoogle ScholarPubMed
Biederman, J, Monuteaux, MC, Mick, E, Spencer, T, Wilens, TE, Silva, JM, et al.Young adult outcome of attention-deficit hyperactivity-disorder: a controlled 10-year follow-up study. Psychol Med; 2006;36:167–179.CrossRefGoogle ScholarPubMed
Black, DW, Gunter, T, Allen, J, Blum, N, Arndt, S, Wenman, G, et al.Borderline personality disorder in male and female offenders newly committed to prison. Compr Psychiatry; 2007;48(5):400–405.CrossRefGoogle Scholar
Burgess, PW, Shallice, TResponse suppression, initiation and strategy use following frontal lobe lesions. Neuropsychologia 1996;34(4):263–272.CrossRefGoogle ScholarPubMed
Burgess, PW, Shallice, TBizarre responses, rule detection and frontal lobe lesions. Cortex 1996;32(2):241CrossRefGoogle ScholarPubMed
Cackowski, S, Reitz, A, Ende, G, Kleindienst, N, Bohus, M, Schmahl, C, et al.Impact of stress on different components of impulsivity in borderline personality disorder. Psychol Med 2014;44(15):3329CrossRefGoogle ScholarPubMed
Cairns, E, Cammock, TDevelopment of a more reliable version of the Matching Familiar Figures Test. Dev Psychol 1978;14(5):555–560.CrossRefGoogle Scholar
Clark, JW, Schneider, HG, Cox, RLInitial evidence for reliability and validity of brief screening inventory for personality traits. Psychol Reps 1998;82(3):1115–1120.CrossRefGoogle ScholarPubMed
Coolidge, FL, Thede, LL, Young, SEHeritability and the comorbidity of attention-deficit hyperactivity-disorder with behavioral disorders and executive function deficits: a preliminary investigation. Dev Neuropsychol 2000;17(3):273–287.CrossRefGoogle ScholarPubMed
Corbisiero, S, Stieglitz, R, Retz, W, Rösler, M. Is emotional dysregulation part of the psychopathology of ADHD in adults? ADHD attention-deficit and hyperactivity-disorders 2013; 2012;5(2):83–92.Google ScholarPubMed
Davids, E, Gastpar, MAttention-deficit hyperactivity-disorder and borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2005;29(6):865–877.CrossRefGoogle ScholarPubMed
Davidson, MLiterature review: ADHD in adults. J Atten Disord 2008;11:628–641.CrossRefGoogle ScholarPubMed
Dikmen, SS, Heaton, RK, Grant, I, Temkin, NRTest-retest reliability and practice effects of expanded Halstead-Reitan Neuropsychological Test battery. J Int Neuropsychol Soc 1999;5:346–356.CrossRefGoogle ScholarPubMed
Dowson, JH, McLean, A, Bazanis, E, Toone, B, Young, S, Robbins, TW, et al.The specificity of clinical characteristics in adults with attention-deficit/hyperactivity-disorder: a comparison with patients with borderline personality disorder. Eur Psychiatry; 2004;19(2):72–78.CrossRefGoogle ScholarPubMed
Evenden, JLVarieties of impulsivity. Psychopharmacology 1999;146(4):348–361.CrossRefGoogle ScholarPubMed
Ferrer, M, Andión, O, Matalí, J, Valero, S, Navarro, JA, Ramos-Quiroga, JA, et al.Comorbid attention-deficit/hyperactivity-disorder in borderline patients defines an impulsive subtype of borderline personality disorder. J Pers Disord; 2010;24(6):812–822.CrossRefGoogle ScholarPubMed
Fossati, A, Novella, L, Donati, D, Donini, M, Maffei, CHistory of childhood attention-deficit/hyperactivity-disorder symptoms and borderline personality disorder: a controlled study. Compr Psychiatry 2002;43(5):369–377.CrossRefGoogle ScholarPubMed
Garcia, CR, Bau, CHD, Silva, KL, Callegari-Jacques, SM, Salgado, CAI, Fischer, AG, et al.The burdened life of adults with ADHD: impairment beyond comorbidity. Eur Psychiatry 2010;27(5):309 [2012]CrossRefGoogle ScholarPubMed
Gibertini, M, Brandenburg, NA, Retzlaff, PDThe operating characteristics of the Millon Clinical Multiaxial Inventory. J Pers Assess 1986;50(4):554–567.CrossRefGoogle ScholarPubMed
Hervey, AS, Epstein, JN, Curry, JFNeuropsychology of adults with attention-deficit/hyperactivity-disorder: a meta-analytic review. Neuropsychology 2004;18(3):485–503.CrossRefGoogle ScholarPubMed
IBM SPSS Inc., PASW Statistics 18. 0 New York: IBM SPSS Inc.; 2010Google Scholar
Jacob, CP, Romanos, J, Dempfle, A, Heine, M, Windemuth-Kieselbach, C, Kruse, A, et al.Comorbidity of adult attention-deficit/hyperactivity-disorder with focus on personality traits and related disorders in a tertiary referral center. Eur Arch Psychiatry Clin Neurosci; 2007;257(6):309–317.CrossRefGoogle Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, et al.The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry; 2006;163(4):716–723.CrossRefGoogle ScholarPubMed
Krause-Utz, A, Sobanski, E, Alm, B, Valerius, G, Kleindienst, N, Bohus, M, et al.Impulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity-disorder: an exploratory study. J Nerv Ment Dis; 2013;201(2):116–123.CrossRefGoogle ScholarPubMed
Krause-Utz, A, Sobanski, E, Alm, B, Valerius, G, Kleindienst, N, Bohus, MImpulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity-disorder: an exploratory study. J Nerv Ment Dis 2013;201(2):116–123.CrossRefGoogle ScholarPubMed
Lampe, K, Konrad, K, Kroener, S, Fast, K, Kunert, HJ, Herpertz, SCNeuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychol Med 2007;37(12):1717–1729.CrossRefGoogle ScholarPubMed
Lezak, MDNeuropsychological assessment New York: Oxford University Press; 1983Google Scholar
Malloy-Diniz, L, Fuentes, D, Leite, WB, Correa, H, Bechara, AImpulsive behavior in adults with attention-deficit/hyperactivity-disorder: characterization of attentional, motor and cognitive impulsiveness. J Int Neuropsychol Soc 2007;13(4):693–698.CrossRefGoogle ScholarPubMed
Martel, MMResearch review: a new perspective on attention-deficit/hyperactivity-disorder: emotion dysregulation and trait models. J Child Psychol Psychiatry 2009;50(9):1042CrossRefGoogle ScholarPubMed
Matthies, SD, Philipsen, ACommon ground in attention-deficit hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) – review of recent findings. Bord Pers Disord Emot Dysreg 2014;1(1):3–12.CrossRefGoogle ScholarPubMed
Matthies, S, van Elst, LT, Feige, B, Fischer, D, Scheel, C, Krogmann, E, et al.Severity of childhood attention-deficit hyperactivity-disorder – a risk factor for personality disorders in adult life?. J Pers Disord; 2011;25(1):101–114.CrossRefGoogle ScholarPubMed
Miller, CJ, Flory, JD, Miller, SR, Harty, SC, Newcorn, JH, Halperin, JMChildhood attention-deficit/hyperactivity-disorder and the emergence of personality disorders in adolescence: a prospective follow-up study. J Clin Psychiatry 2008;69(9):1477–1484.CrossRefGoogle ScholarPubMed
Millon, T, Millon, C, Davis, R, Grossman, SMCMI-III manual 4th ed.Minneapolis: Pearson Assessments; 2009.Google Scholar
Moeller, FG, Barratt, ES, Dougherty, DM, Schmitz, JM, Swann, ACPsychiatric aspects of impulsivity. Am J Psychiatry 2001;158(11):1783–1793.CrossRefGoogle ScholarPubMed
Owens, EB, Hinshaw, SPPerinatal problems and psychiatric comorbidity among children with ADHD. J Clin Child Adolesc 2013;42(6):762CrossRefGoogle ScholarPubMed
Philipsen, ADifferential diagnosis and comorbidity of attention-deficit/hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) in adults. Eur Arch Psychiatry Clin Neurosci 2006;256(S1):i42–i46.CrossRefGoogle ScholarPubMed
Prada, P, Hasler, R, Baud, P, Bednarz, G, Ardu, S, Krejci, I, et al.Distinguishing borderline personality disorder from adult attention-deficit/hyperactivity-disorder: a clinical and dimensional perspective. Psychiatry Res 2014;217(1–2):107–114.CrossRefGoogle ScholarPubMed
Rasmussen, P, Gillberg, CNatural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry 2000;39(11):1424–1431.CrossRefGoogle ScholarPubMed
Robertson, IH, Ward, T, Ridgeway, V, Nimmo-Smith, IThe test of everyday attention Bury St Edmunds: Thames Valley Test Company; 1994Google Scholar
Rogers, R, Salekin, RT, Sewell, KWValidation of the Millon Clinical Multiaxial Inventory for axis II disorders: does it meet the Daubert standard?. Law Hum Behav 1999;23(4):425–443.CrossRefGoogle ScholarPubMed
Ruocco, ACThe neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Res 2005;137(3):191–202.CrossRefGoogle ScholarPubMed
Ryan, JJ, Brown, KIEnhancing the clinical utility of the Wasi: reliabilities of discrepancy scores and supplemental tables for profile analysis. J Psychoeduc Assess 2005;23(2):140–145.CrossRefGoogle Scholar
Sagvolden, T, Johansen, EB, Aase, H, Russell, VAA dynamic developmental theory of attention-deficit/hyperactivity-disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behav Brain Sci 2005;28(3):397–419.CrossRefGoogle ScholarPubMed
Sandberg, SThe biopsychosocial context of ADHD. Behav Brain Sci 2005;28(3):441–442.CrossRefGoogle Scholar
Skodol, AE, Gunderson, JG, Pfohl, B, Widiger, TA, Livesley, WJ, Siever, LJThe borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biol Psychiatry 2002;51(12):936CrossRefGoogle ScholarPubMed
Speranza, M, Revah-Levy, A, Cortese, S, Falissard, B, Pham-Scottez, A, Corcos, MADHD in adolescents with borderline personality disorder. BMC Psychiatry 2011;11(1):158–168.CrossRefGoogle ScholarPubMed
Stepp, SDDevelopment of borderline personality disorder in adolescence and young adulthood: introduction to the special section. J Abnorm Child Psychol 2012;40(1):1–5.CrossRefGoogle Scholar
Stepp, SD, Burke, JD, Hipwell, AE, Loeber, RTrajectories of Attention-deficit hyperactivity-disorder and oppositional defiant disorder symptoms as precursors of borderline personality disorder symptoms in adolescent girls. J Abnorm Child Psychol 2012;40(1):7–20 [2011]CrossRefGoogle ScholarPubMed
Torok, M, Darke, S, Kaye, SAttention-deficit hyperactivity-disorder and severity of substance use: the role of comorbid psychopathology. J Addict Behav 2012;26(4):974–979.CrossRefGoogle ScholarPubMed
Trennery, MR, Crossen, B, DeBoe, J, Leber, WRStroop Neuropsychological Screening Test manual Odessa: Psychological Assessment Resources, Inc; 1989Google Scholar
van den Berg, E, Nys, GM, Brands, AM, Ruis, C, van Zandvoort, MJ, Kessels, RPThe Brixton Spatial Anticipation Test as a test for executive function: validity in patient groups and norms for older adults. J Int Neuropsychol Soc 2009;15(5):695–703.CrossRefGoogle ScholarPubMed
van Dijk, F, Lappenschaar, M, Kan, C, Verkes, RJ, Buitelaar, JLifespan attention-deficit/hyperactivity-disorder and borderline personality disorder symptoms in female patients: a latent class approach. Psych Res 2011;190(2–3):327–334.CrossRefGoogle ScholarPubMed
van Dijk, F, Schellekens, A, van den Broek, P, Kan, C, Verkes, RJ, Buitelaar, JDo cognitive measures of response inhibition differentiate between attention-deficit/hyperactivity-disorder and borderline personality disorder?. Psych Res 2014;215(3):733–739.CrossRefGoogle ScholarPubMed
van Merrienboer, JJ, Jelsma, OThe Matching Familiar Figures Test: computer or experimenter controlled administration?. Educ Psychol Meas 1988;48(1):161–164.CrossRefGoogle Scholar
Wechsler, DWechsler Adult Intelligence Scale 3rd ed.San Antonio: Psychological Corporation; 1997.Google Scholar
Wechsler, DWechsler Abbreviated Scale of Intelligence (WASI) San Antonio: Harcourt Assessment; 1999Google Scholar
Wilson, ST, Fertuck, EA, Kwitel, A, Stanley, MC, Stanley, BImpulsivity, suicidality and alcohol use disorders in adolescents and young adults with borderline personality disorder. Intl J Adolesc Med Health 2006;18(1):189–196.CrossRefGoogle Scholar
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