Borderline Personality Disorder and ADHD… Similar?

Introduction

Borderline Personality Disorder (BPD) and Attention-deficit/hyperactivity disorder (ADHD) are two diagnosis not often thought about together. They also have two very different frontline treatments. BPD is often treated with Dialectical Behavior Therapy (DBT) and ADHD is often treated with medication, but they may have more in common than you think. Before we dive deeper let’s cover the basics.

Infographic Credit: Dr. Neff

Borderline Personality Disorder (BPD)

The Mayo Clinic defines Borderline Personality Disorder like this: “a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships” (Mayo Clinic) They go on to list several symptoms, I have listed below.

• A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn't care enough or is cruel

• Rapid changes in self-identity and self-image that include shifting goals and values, and seeing yourself as bad or as if you don't exist at all

• Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours

• Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship

• Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection

• Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety

• Ongoing feelings of emptiness

• Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

Attention-deficit/hyperactivity disorder (ADHD)

The Mayo Clinic defines ADHD like this: “a mental health disorder that includes a combination of persistent problems, such as difficulty paying attention, hyperactivity and impulsive behavior. Adult ADHD can lead to unstable relationships, poor work or school performance, low self-esteem, and other problems.” (Mayo Clinic). They go on to list several symptoms, I have listed below.

• Impulsiveness

• Disorganization and problems prioritizing

• Poor time management skills

• Problems focusing on a task

• Trouble multitasking

• Excessive activity or restlessness

• Poor planning

• Low frustration tolerance

• Frequent mood swings

• Problems following through and completing tasks

• Hot temper

• Trouble coping with stress

The Problem

Just by doing a simple comparison of the symptoms you can see that there are many similarities . For example unstable relationships and impulsivity are common between the two. Dr, Megan Anna Neff made a fantastic infographic depicting the similarities and differences of the two diagnosis (see below).

It’s important to be familiar with these similarities so that clients receive the right diagnosis and treatment. BPD can be confused with ADHD and the reverse is true as well. Moreover, these two diagnosis are not entirely exclusive. A person could have both.

The issue I want to highlight in this article is that DBT as a treatment for ADHD is not often considered as a frontline treatment, yet considering the similarities that ADHD has with BPD, it has the potential to be an effective, non-medication based treatment. Research is beginning to show this as well. (See below for links to research articles)

Conclusion

When treating a client providers must be diligent to consider both BPD and ADHD. Moreover, if a client has ADHD you may want to consider DBT as a non-medication based treatment.

Research about DBT and ADHD

1. Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults by Alexandra Philipsen M.D

2. Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review by Carlos López-Pinar  Sonia Martínez-Sanchís, Enrique Carbonell-Vayá  Javier Fenollar-Cortés  Julio Sánchez-Meca

3. The Effectiveness of Dialectical Behavior Therapy in Decreasing High Risk Behaviors Among Students Suffering From Attention Deficit / Hyperactivity Disorder by Nasser Sobhi Gharamaleki, Saeed Pourabdol, Ramin Saravani , Shahzad Saravani

4. Adult ADHD Treatment Based on Combination of Dialectical Behavior Therapy (DBT) and Transcranial Direct Current Stimulation (tDCS) as Measured by Subjective and Objective Scales by Nooshin Basiri, Habib Hadianfard

Next steps…

At PRGRS Therapy we specialize in the treatment of ADHD as well as DBT Therapy. Call us today to schedule a free 15 minute phone consultation. We are an all virtual practice in NY and NJ. We accept most major insurances and can help with out of network benefits. Read more about our approach to DBT therapy as well as ADHD therapy.

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