Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults

  • Alexandra PhilipsenEmail author


Attention-deficit/hyperactivity disorder (ADHD) in adults and borderline personality Disorder (BPD) share some similar clinical features (e. g. impulsivity, emotional dysregulation, cognitive impairment). ADHD in childhood has been reported to be highly associated with the diagnosis of BPD in adulthood and adult ADHD often co-occurs with BPD. Treatment studies revealed an efficacy of dialectical behavioral therapy (DBT) and DBT-based psychotherapy, respectively, in BPD and adult ADHD as well as neuroimaging and psychopharmacological studies showed some evidence for a potential common neurobiological dysfunction suggesting the hypothesis that ADHD and BPD may not be two distinct disorders, but represent at least in a subgroup of patients two dimensions of one disorder.

Key words

attention-deficit hyperactivity disorder borderline personality disorder comorbidity emotional dysregulation impulsivity 


  1. 1.
    Agarwal V, Sitholey P, Kumar S, Prasad M (2001) Double-blind, placebo-controlled trial of clonidine in hyperactive children with mental retardation. Ment Retard 39:259–267PubMedCrossRefGoogle Scholar
  2. 2.
    Barnow S, Ruge J, Spitzer C, Freyberger HJ (2005) Temperament and character in persons with borderline personality disorder. Nervenarzt 76:839–848PubMedCrossRefGoogle Scholar
  3. 3.
    Berlin HA, Rolls ET (2004) Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients. J Personal Disord 18:358–378PubMedCrossRefGoogle Scholar
  4. 4.
    Biederman J (2004) Impact of comorbidity in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry 65 (Suppl 3):3–7PubMedGoogle Scholar
  5. 5.
    Biederman J, Faraone SV (2005) Attention-deficit hyperactivity disorder. Lancet 366:237–248PubMedCrossRefGoogle Scholar
  6. 6.
    Bush G, Valera EM, Seidman LJ (2002) Functional neuroimaging of attention-deficit/hyperactivity disorder: a review and suggested future directions. Biol Psychiatry 57:1273–1284CrossRefGoogle Scholar
  7. 7.
    Ceumern-Lindenstjerna IA, Brunner R, Parzer P, Fiedler P, Resch F (2002) Borderline personality disorder and attentional biases, Theoretical models and empirical findings. Fortschr Neurol Psychiatr 70:321–330PubMedCrossRefGoogle Scholar
  8. 8.
    Coccaro EF, Lee R, McCloskey M (2003) Norepinephrine function in personality disorder: Plasma free MHPG correlates inversely with life history of aggression. CNS Spectr 8:731–736PubMedGoogle Scholar
  9. 9.
    Dowson J, Bazanis E, Rogers R, Prevost A, Taylor P, Meux C, Staley C, Nevison-Andrews D, Taylor C, Robbins T, Sahakian B (2004) Impulsivity in patients with borderline personality disorder. Compr Psychiatry 45:29–36PubMedCrossRefGoogle Scholar
  10. 10.
    Ebert D, Berger M, Hesslinger B (2002) ADHD as a risk factor for delinquency and personality disorders? Recognizing the patient at risk. MMW Fortschr Med 144 (47):31–33PubMedGoogle Scholar
  11. 11.
    Ernst M, Kimes AS, London ED et al. (2003) Neural substrates of decision making in adults with attention deficit hyperactivity disorder. Am J Psychiatry 160:1061–1070PubMedCrossRefGoogle Scholar
  12. 12.
    Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E, Doyle AE (2000) Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry 48:9–20PubMedCrossRefGoogle Scholar
  13. 13.
    Fossati A, Donati D, Donini M, Novella L, Bagnato M, Maffei C (2001) Temperament, character, and attachment patterns in borderline personality disorder. J Personal Disord 15:390–402PubMedCrossRefGoogle Scholar
  14. 14.
    Fossati A, Novella L, Donati D, Donini M, Maffei C (2002) History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study. Compr Psychiatry 43:369–377PubMedCrossRefGoogle Scholar
  15. 15.
    Friedel RO (2004) Dopamine dysfunction in borderline personality disorder: a hypothesis. Neuropsychopharmacology 29:1029–1039PubMedCrossRefGoogle Scholar
  16. 16.
    Hesslinger B, Thiel T, Tebartz van Elst L, Hennig J, Ebert D (2001) Attention-deficit disorder in adults with or without hyperactivity: Where is the difference? A study in humans using short echo (1)H-magnetic resonance spectroscopy. Neurosci Lett 304:117–119PubMedCrossRefGoogle Scholar
  17. 17.
    Hesslinger B, Tebartz van Elst L, Nyberg E, Dykierek P, Richter H, Berner M, Ebert D (2002) Psychotherapy of attention deficit hyperactivity disorder in adults—a pilot study using a structured skills training program. Eur Arch Psychiatry Clin Neurosci 252:177–184PubMedGoogle Scholar
  18. 18.
    Hesslinger B, Tebartz van Elst L, Thiel T, Haegele K, Hennig J, Ebert D (2002) Frontoorbital volume reductions in adult patients with attention deficit hyperactivity disorder. Neurosci Lett 328:319–321PubMedCrossRefGoogle Scholar
  19. 19.
    Hesslinger B, Philipsen A, Richter H (2004) Psychotherapy in adult ADHD. Hogrefe, GöttingenGoogle Scholar
  20. 20.
    Hunt RD, Minderaa RB, Cohen DJ (1986) The therapeutic effect of clonidine in attention deficit disorder with hyperactivity: a comparison with placebo and methylphenidate. Psychopharmacol Bull 22:229–236PubMedGoogle Scholar
  21. 21.
    Itami S, Uno H (2002) Orbitofrontal cortex dysfunction in attention-deficit hyperactivity disorder revealed by reversal and extinction tasks. Neuroreport 13:2453–2457PubMedCrossRefGoogle Scholar
  22. 22.
    Juengling FD, Schmahl C, Hesslinger B, Ebert D, Bremner JD, Gostomzyk J, Bohus M, Lieb K (2003) Positron emission tomography in female patients with borderline personality disorder. J Psychiatr Res 37:109–115PubMedCrossRefGoogle Scholar
  23. 23.
    Koerner K, Linehan MM (2000) Research on dialectical behavior therapy for patients with borderline personality disorder. Review (54 Refs). Psychiatr Clin North Am 23:151–167PubMedCrossRefGoogle Scholar
  24. 24.
    Krakowski M (2003) Violence and serotonin: Influence of impulse control, affect regulation, and social functioning. J Neuropsychiatry Clin Neurosci 15:294–305PubMedGoogle Scholar
  25. 25.
    Krause J, Krause KH (2005) ADHD in Adults. Schattauer, StuttgartGoogle Scholar
  26. 26.
    Lee JS, Kim BN, Kang E, Lee DS, Kim YK, Chung JK, Lee MC, Cho SC (2004) Regional cerebral blood flow in children with attention deficit hyperactivity disorder: comparison before and after methylphenidate treatment. Hum Brain Mapp 24:157–164CrossRefGoogle Scholar
  27. 27.
    Linehan MM (1993) Cognitive-behavioral treatment of borderline personality disorder. Guilford Press, New YorkGoogle Scholar
  28. 28.
    Philipsen A, Richter H, Schmahl C, Peters J, Rusch N, Bohus M, Lieb K (2004) Clonidine in acute aversive inner tension and self-injurious behavior in female patients with borderline personality disorder. J Clin Psychiatry 65:1414–1419PubMedGoogle Scholar
  29. 29.
    Retz W, Retz-Junginger P, Supprian T, Thome J, Rosler M (2004) Association of serotonin transporter promoter gene polymorphism with violence: relation with personality disorders, impulsivity, and childhood ADHD psychopathology. Behav Sci Law 22:415–425PubMedCrossRefGoogle Scholar
  30. 30.
    Rinne T van den, Brink W, Wouters L, Dyck R van (2002) SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry 159:2048–2054PubMedCrossRefGoogle Scholar
  31. 31.
    Safren SA, Otto MW, Sprich S, Winett CL, Wilens TE, Biederman J (2005) Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behav Res Ther 43:831–842PubMedCrossRefGoogle Scholar
  32. 32.
    Schmahl CG, Vermetten E, Elzinga BM, Bremner JD (2004) A positron emission tomography study of memories of childhood abuse in borderline personality disorder. Biol Psychiatry 55:759–765PubMedCrossRefGoogle Scholar
  33. 33.
    Schulz KP, Fan J, Tang CY,Newcorn JH, Buchsbaum MS, Cheung AM, Halperin JM (2004) Response inhibition in adolescents diagnosed with attention deficit hyperactivity disorder during childhood: an event-related FMRI study. Am J Psychiatry 161:1650–1657PubMedCrossRefGoogle Scholar
  34. 34.
    Schulz SC, Cornelius J, Schulz PM, Soloff PH (1988) The Amphetamine Challenge Test in patients with borderline disorder. Am J Psychiatry 145:809–814PubMedGoogle Scholar
  35. 35.
    Seidman LJ, Valera EM, Makris N (2005) Structural brain imaging of attention-deficit/hyperactivity disorder. Biol Psychiatry 57:1263–1372PubMedCrossRefGoogle Scholar
  36. 36.
    Soloff PH, Meltzer CC, Becker C, Greer PJ, Kelly TM, Constantine D (2003) Impulsivity and prefrontal hypometabolism in borderline personality disorder. Psychiatry Res 123:153–163PubMedGoogle Scholar
  37. 37.
    Soloff PH, Meltzer CC, Greer PJ, Constantine D, Kelly TMA (2000) Fenfluramine-activated FDG-PET study of borderline personality disorder. Biol Psychiatry 47:540–547PubMedCrossRefGoogle Scholar
  38. 38.
    Stevenson CS, Whitmont S, Bornholt L, Livesey D, Stevenson RJA (2002) Cognitive remediation programme for adults with attention deficit hyperactivity disorder. Aust N Z J Psychiatry 36:610–616PubMedCrossRefGoogle Scholar
  39. 39.
    Stiglmayr CE, Shapiro DA, Stieglitz RD, Limberger MF, Bohus M (2001) Experience of aversive tension and dissociation in female patients with borderline personality disorder—a controlled study. J Psychiatr Res 35:111–118PubMedCrossRefGoogle Scholar
  40. 40.
    Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M (2005) Aversive tension in patients with borderline personality disorder: a computer-based controlled field study. Acta Psychiatr Scand 111:372–379PubMedCrossRefGoogle Scholar
  41. 41.
    Tebartz van Elst L, Hesslinger B, Thiel T, Geiger E, Haegele K, Lemieux L, Lieb K, Bohus M, Hennig J, Ebert D (2003) Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry 54:163–171PubMedCrossRefGoogle Scholar
  42. 42.
    Vollm B, Richardson P, Stirling J, Elliott R, Dolan M, Chaudhry I, Del Ben C, McKie S, Anderson I, Deakin B (2004) Neurobiological substrates of antisocial and borderline personality disorder: preliminary results of a functional FMRI study. Crim Behav Ment Health 14:39–54PubMedCrossRefGoogle Scholar
  43. 43.
    Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. An overview. Ann N Y Acad Sci 931:1–16PubMedCrossRefGoogle Scholar
  44. 44.
    Wilens TE, Spencer TJ, Swanson JM, Connor DF, Cantwell D (1999) Combining methylphenidate and clonidine: a clinically sound medication option (Comment). J Am Acad Child Adolesc Psychiatry 38:614–619PubMedCrossRefGoogle Scholar
  45. 45.
    Wilens TE, Faraone SV, Biederman J (2004) Attention-deficit/hyperactivity disorder in adults. JAMA 292:619–623PubMedCrossRefGoogle Scholar
  46. 46.
    Zanarini MC, Gunderson JG, Marino MF, Schwartz EO, Frankenburg FR (1989) Childhood experiences of borderline patients. Compr Psychiatry 30:18–25PubMedCrossRefGoogle Scholar
  47. 47.
    Zanarini MC, Frankenburg FR, Parachini EAA (2004) Preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder. J Clin Psychiatry 65:903–907PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychotherapyUniversity of Freiburg Medical SchoolFreiburgGermany

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