Lampe K, Konrad K, Kroener S, Fast K, Kunert HJ, Herpertz SC. Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychol Med 37: 1717-1729

Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital, Rostock, Germany.
Psychological Medicine (Impact Factor: 5.94). 01/2008; 37(12):1717-29. DOI: 10.1017/S0033291707000517
Source: PubMed


Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness.
The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups.
ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole.
Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.

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    • "Nigg, Silk, Stavro, and Miller (2005) examined the performance of ADHD patients and individuals from a community sample using tasks for response inhibition and found, that subjects presenting with symptoms of BPD were correlated with response inhibition even after controlling for the overlap of stop inhibition with ADHD, anti-sociality and other Axis II disorder symptoms, underlining the possible implications of the emotional reactivity in BPD, which could challenge the capacities of the executive control system. Lampe et al. (2007) "
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    ABSTRACT: Attention Deficit/Hyperactivity Disorder (ADHD) symptoms overlap with Borderline Personality Disorder (BPD). Since ADHD presents earlier than BPD, ADHD might be either a risk factor or a prodromal stage in the development of BPD or in the reinforcement of its symptoms. However, despite the similar phenomenological origin of the two disorders, ADHD and BPD patients often present discrete profiles. The present study reviews literature data of the clinical, neuropsychological and structural convergences and divergences of ADHD and BPD. A total of 185 studies were identified that address the association of ADHD and BPD and relate to clinical, neuropsychological and structural parameters. The total number of articles included was 45. ADHD exhibits a more outwardly expressed symptomatology, with difficulties in inhibition control and dysfunction in ventrolateral prefrontal regions. BPD presents a more mixed picture of externalizing and interrelating clinical features with emotionally conditioned cognitive disturbances and dysfunction in the orbitofrontal and dorsolateral prefrontal regions. When considering the three abovementioned parameters there is no unique clear-cut point that can differentiate the two disorders in a definitive way. Both disorders share impulsivity, emotional dysregulation, deficits in attention and decision making, brain volume reductions and connectivity impairments in prefrontal and limbic areas.
    Personality and Individual Differences 11/2015; 86:438-449. DOI:10.1016/j.paid.2015.06.049 · 1.95 Impact Factor
    • "Accordingly, in self-rated measures such as the Barratt Impulsiveness Scale (Patton et al., 1995) and the UPPS Impulsive Behavior Scale (Whiteside and Lynam, 2001) BPD patients usually yield significantly higher values as compared to healthy controls or other patient groups (except attention-deficit/hyperactivity disorder, ADHD) (e.g. Berlin et al., 2005; Domes et al., 2006; Lampe et al., 2007; Völker et al., 2009; Jacob et al., 2013; Krause-Utz et al., 2013; Cackowski et al., 2014; Bøen et al., 2015). "
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    ABSTRACT: Impulsivity is central to borderline personality disorder (BPD). Response inhibition, addressing the ability to suppress or stop actions, is one aspect of behavioral impulse control which is frequently used to assess impulsivity. BPD patients display deficits in response inhibition under stress condition or negative emotions. We assessed whether response inhibition and its neural underpinnings are impaired in BPD when tested in an emotionally neutral setting and when co-morbid attention-deficit/hyperactivity disorder (ADHD) is excluded. To this end, we studied response inhibition in unmedicated BPD patients and healthy controls (HC) in two independent samples using functional magnetic resonance imaging during Simon-, Go/nogo-, and Stopsignal tasks. BPD patients and HC did not differ significantly in their performance in the Go/nogo and the Stopsignal tasks. Response interference in the Simon task was increased in BPD patients in one sample, but this could not be replicated in the second sample. In both samples, no significant differences in brain activation patterns during any of the tasks were present while the neural impulse control network was robustly activated during the inhibition tasks in both groups. Our results provide evidence that under emotionally neutral conditions response inhibition is not impaired in patients with BPD without co-occurring ADHD.
    Psychiatry Research: Neuroimaging 09/2015; DOI:10.1016/j.pscychresns.2015.09.017 · 2.42 Impact Factor
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    • "By measuring how reaction times are influenced by alerting cues, spatial cues, and flanking stimuli (a central arrow was flanked by two arrows pointing either in the same direction or in the opposite direction as the central arrow), the test measures the three attentional networks cited above. This task has determined that executive attention is impaired in adults with ADHD (see [36]), although other studies have shown no impairment [25]. Because a large body of data has shown that performance in this task is clearly related to different brain systems and regions that regulate attention, impairment can indicate physiological changes in brain functioning (see [31] [32]) that cannot be tapped by alterations on subjective measures such as questionnaires. "
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    ABSTRACT: Objective: Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention. Mood in ADHD can be improved by mindful awareness practices (MAP), but results are mixed regarding the enhancement of attentional performance. Here we evaluated MAP-induced changes in quality of life (QoL), mood, and attention in adult ADHD patients and controls using more measures of attention than prior studies. Methods: Twenty-one ADHD patients and 8 healthy controls underwent 8 weekly MAP sessions; 22 similar patients and 9 controls did not undergo the intervention. Mood and QoL were assessed using validated questionnaires, and attention was evaluated using the Attentional Network Test (ANT) and the Conners Continuous Performance Test (CPT II), before and after intervention. Results: MAP enhanced sustained attention (ANT) and detectability (CPT II) and improved mood and QoL of patients and controls. Conclusion: MAP is a complementary intervention that improves affect and attention of adults with ADHD and controls.
    BioMed Research International 07/2015; 2015. DOI:10.1155/2015/962857 · 1.58 Impact Factor
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