Childhood Attention-Deficit/Hyperactivity Disorder and the Emergence of Personality Disorders in Adolescence

Department of Psychology, University of Windsor, 401 Sunset Ave., Windsor, Ontario, Canada N9B 3P4.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 10/2008; 69(9):1477-84. DOI: 10.4088/JCP.v69n0916
Source: PubMed


Adults with attention-deficit/hyperactivity disorder (ADHD) experience considerable functional impairment. However, the extent to which comorbid Axis II personality disorders contribute to their difficulties and whether such comorbidities are associated with the childhood condition or the persistence of ADHD into adulthood remain unclear.
This study examined the presence of personality disorders in a longitudinal sample of 96 adolescents diagnosed with ADHD when they were 7 through 11 years old, as compared to a matched, never ADHD-diagnosed, control group (N = 85). Participants were between 16 and 26 years old at follow-up. On the basis of a psychiatric interview, the ADHD group was subdivided into those with and without persistent ADHD. Axis II symptoms were assessed by using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Data were analyzed using logistic regression, and odds ratios (ORs) were generated. The study was conducted from 1994 through 1997.
Individuals diagnosed with childhood ADHD are at increased risk for personality disorders in late adolescence, specifically borderline (OR = 13.16), antisocial (OR = 3.03), avoidant (OR = 9.77), and narcissistic (OR = 8.69) personality disorders. Those with persistent ADHD were at higher risk for antisocial (OR = 5.26) and paranoid (OR = 8.47) personality disorders but not the other personality disorders when compared to those in whom ADHD remitted.
Results suggest that ADHD portends risk for adult personality disorders, but the risk is not uniform across disorders, nor is it uniformly related to child or adult diagnostic status.

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    • "According to Fossati et al. (2002), BPD symptoms can better be understood on the basis of the persistent consequences of the ADHD symptoms , which means that ADHD in childhood may be considered a risk factor that predisposes to BPD in adults (Burke & Stepp, 2012; Philipsen et al., 2008). It is already established that there is a higher vulnerability for the development of PDs in patients with severe childhood ADHD (Fischer et al., 2002; Matthies et al., 2011; Stepp et al., 2012) and Miller et al. (2008) stressed the association with BPD; in their study patients with childhood ADHD had a high risk (odds ratio 13.2) of later developing BPD in adolescence. Furthermore ADHD symptoms' predictive attribute of borderline personality features was found to be significant, even after controlling the effects of some variables such as childhood, traumas, anxiety and depression symptoms, ADHD symptoms could still work as predictors of borderline personality features (Dalbudak & Evren, 2014). "
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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.
    Full-text · Article · Nov 2015 · Personality and Individual Differences
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    • "ADHD has been associated with different personality disorders, in particular borderline and antisocial personality disorder (ASPD; Kooij et al., 2012; Sobanski, 2006). However, other Clusters B and C personality disorders like narcissistic and avoidant personality disorders are also reported to be more common in adults with ADHD (Cumyn, French, & Hechtman, 2009; Matthies et al., 2011; Miller et al., 2008). In general, the TCI dimensions low Self-directedness and in particular low Cooperativeness indicate a personality disorder (Richter & Brandstrom, 2009). "
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    ABSTRACT: Objective: To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures. Method: Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI. Results: The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD). Conclusion: It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX).
    Full-text · Article · Nov 2013 · Journal of Attention Disorders
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    • "A total of 13.5% of the individuals with ADHD had co-occurring BPD in contrast to 1.2% of the control group. The co-occurrence of BPD and ADHD is associated with frequent substance abuse and a higher rate of suicidal behavior [Miller et al., 2008; Ferrer et al., 2010]. "
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    ABSTRACT: Previous research has established the comorbidity of adult Attention-Deficit Hyperactivity Disorder (ADHD) with different personality disorders including Borderline Personality Disorder (BPD). The association between adult ADHD and BPD has primarily been investigated at the phenotypic level and not yet at the genetic level. The present study investigates the genetic and environmental contributions to the association between borderline personality traits (BPT) and ADHD symptoms in a sample of 7,233 twins and siblings (aged 18-90 years) registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey (EFPTS) . Participants completed the Conners' Adult ADHD Rating Scales (CAARS-S:SV) and the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). A bivariate genetic analysis was performed to determine the extent to which genetic and environmental factors influence variation in BPT and ADHD symptoms and the covariance between them. The heritability of BPT and ADHD symptoms was estimated at 45 and 36%, respectively. The remaining variance in BPT and ADHD symptoms was explained by unique environmental influences. The phenotypic correlation between BPT and ADHD symptoms was estimated at r = 0.59, and could be explained for 49% by genetic factors and 51% by environmental factors. The genetic and environmental correlations between BPT and ADHD symptoms were 0.72 and 0.51, respectively. The shared etiology between BPT and ADHD symptoms is thus a likely cause for the comorbidity of the two disorders.
    Full-text · Article · Dec 2011 · American Journal of Medical Genetics Part B Neuropsychiatric Genetics
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