Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder

Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Germany.
The British Journal of Psychiatry (Impact Factor: 7.99). 03/2008; 192(2):118-23. DOI: 10.1192/bjp.bp.107.035782
Source: PubMed


Clinical experience suggests that people with borderline personality disorder often meet criteria for attention-deficit hyperactivity disorder (ADHD). However, empirical data are sparse.
To establish the prevalence of childhood and adult ADHD in a group of women with borderline personality disorder and to investigate the psychopathology and childhood experiences of those with and without ADHD.
We assessed women seeking treatment for borderline personality disorder (n=118) for childhood and adult ADHD, co-occurring Axis I and Axis II disorders, severity of borderline symptomatology and traumatic childhood experiences.
Childhood (41.5%) and adult (16.1%) ADHD prevalence was high. Childhood ADHD was associated with emotional abuse in childhood and greater severity of adult borderline symptoms. Adult ADHD was associated with greater risk for co-occurring Axis I and II disorders.
Adults with severe borderline personality disorder frequently show a history of childhood ADHD symptomatology. Persisting ADHD correlates with frequency of co-occurring Axis I and II disorders. Severity of borderline symptomatology in adulthood is associated with emotional abuse in childhood. Further studies are needed to differentiate any potential causal relationship between ADHD and borderline personality disorder.

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Available from: Bernd Feige, Oct 07, 2015
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    • "ADHD is another disorder marked by impulse and anger control problems, which can lead to impairments in social functioning (Sacchetti and Lefler, 2014; Wender et al, 2001). As BPD and ADHD often co-occur, this may further increase the likelihood of increased impulsivity in BPD (Davids and Gastpar, 2005; Krause-Utz et al, 2013; Philipsen et al, 2008). A recent study (Krause-Utz et al, 2013) demonstrated that "
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    ABSTRACT: Borderline Personality Disorder (BPD) and Attention Deficit Hyperactivity Disorder (ADHD) are both characterized by high impulsivity and difficulties in controlling anger and aggression. In BPD, comorbid ADHD may further increase impulsivity. For both disorders, altered MR spectroscopy levels of the neurotransmitters glutamate and GABA as well as some correlations with impulsivity were previously reported. The objective of this study was to investigate the neurotransmitters glutamate and GABA in relation to impulsivity and aggression as expressed in the anterior cingulate cortex (ACC) in groups of female patients with BPD and ADHD, respectively. Associations of glutamate and GABA levels with further BPD (symptom severity) and ADHD aspects (hyperactivity and inattention) were exploratively evaluated. 1H MRspectra were acquired at 3 T to determine glutamate to total creatine ratios (Glu/tCr) and GABA levels from the ACC in a BPD group (n=26), an ADHD group (n=22), and a healthy control (HC) group (n=30); all participants were females. Both patient groups showed higher scores on self-reported impulsivity, anger, and aggression compared to HCs. ACC GABA levels were significantly lower in ADHD than HC. While measures of impulsivity were positively related to glutamate and negatively to GABA, for aggression only a negative correlation with GABA could be demonstrated. These data provide human in vivo evidence for the role of ACC Glu/tCr and GABA in impulsivity and aggression. If distinct associations of Glu/tCr and GABA for BPD and ADHD can be confirmed in future studies, this might yield implications for more specific pharmacological treatments.Neuropsychopharmacology accepted article preview online, 04 June 2015. doi:10.1038/npp.2015.153.
    Neuropsychopharmacology 06/2015; DOI:10.1038/npp.2015.153 · 7.05 Impact Factor
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    • "Borderline Personality Disorder is also known to share some affect regulation and impulse control features with attentiondeficit/hyperactivity disorder (ADHD) and ADHD may be comorbid with BPD (Philipsen, 2006). Additionally, ADHD may be a risk factor for the development of BPD in adulthood (Philipsen et al., 2008). However, it is possible that attentional control problems may underlie both conditions, constituting the shared processes of each condition, and that the emergence of one disorder rather than the other, or one main disorder with ADHD co-morbidity, is driven by the selective constellation of personality, developmental and familial factors combined with attentional control problems. "
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    ABSTRACT: Self-injurious behavior (or self-harm) is a frequently reported maladaptive behavior in the general population and a key feature of borderline personality disorder (BPD). Poor affect regulation is strongly linked to a propensity to self-harm, is a core component of BPD, and is linked with reduced attentional control abilities. The idea that attentional control difficulties may provide a link between BPD, negative affect and self-harm has yet to be established, however. The present study explored the putative relationship between levels of BPD features, three aspects of attentional/executive control, affect, and self-harm history in a sample of 340 non-clinical participants recruited online from self-harm forums and social networking sites. Analyses showed that self-reported levels of BPD features and attentional focusing predicted self-harm incidence, and high attentional focusing increased the likelihood of a prior self-harm history in those with high BPD features. Ability to shift attention was associated with a reduced likelihood of self-harm, suggesting that good attentional switching ability may provide a protective buffer against self-harm behavior for some individuals. These attentional control differences mediated the association between negative affect and self-harm, but the relationship between BPD and self-harm appears independent.
    Frontiers in Behavioral Neuroscience 08/2014; 8:274. DOI:10.3389/fnbeh.2014.00274 · 3.27 Impact Factor
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    • "Therefore a relevant overlap of symptoms seems to be present in BPD and ADHD, whereas still there is a serious difference according to clinical appearance, severity of impairment and prognosis. Also high rates of comorbidity between BPD and ADHD are reported for childhood ADHD as well as for adult ADHD (Philipsen et al., 2008). "
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    ABSTRACT: Shame is related to several mental disorders. We assume that facets of shame, namely bodily, cognitive and existential shame, may occur in typical patterns in mental and personality disorders. An excessive level of shame may lead to psychopathological symptoms. However, a lack of shame may also lead to distress, for instance as it may facilitate violation of social norms and thus may promote interpersonal problems. In this study we investigated facets of shame in females suffering from various mental disorders and personality disorders presumably associated with specific aspects of shame. Women suffering from borderline personality disorder (BPD, n= 92), attention deficit hyperactivity disorder (ADHD, n= 86), major depressive disorder (MDD, n= 17), social anxiety disorder (SAD, n=33), and a community sample (COM, n= 290) completed the SHAME questionnaire, which is a newly developed instrument to assess adaptive and maladaptive aspects of shame. BPD patients reported the highest level of existential shame compared to all other groups. Compared to the controls, SAD patients displayed stronger bodily and cognitive shame, and ADHD showed lower bodily shame. As assumed, specific aspects of shame were found in different patient groups. It may be important to specifically address these specific aspects of shame in psychotherapy.
    Psychiatry Research 08/2014; in press(1-2). DOI:10.1016/j.psychres.2014.07.062 · 2.47 Impact Factor
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