Attention deficit disorder with hyperactivity (ADHD) and borderline personality disorder (BPD) have many overlapping symptoms and risk factors.1,2,3 Moreover, those with co-occurring ADHD and BPD are more likely to experience severe symptoms and impairment, and require specialized treatment to target both conditions.1,3
What Is ADHD?
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that causes difficulty focusing, remembering things, controlling impulses, and staying organized. People with ADHD also struggle with hyperactivity, which can cause them to feel restless, agitated, hyper, and unable to sit still for long periods of time.4 ADHD is often diagnosed in childhood and can persist into adulthood. It’s estimated that over 10% of children have ADHD, and 4.4% of adults are diagnosed with the disorder.5
Common symptoms of ADHD include:4
- Persistent trouble focusing and paying attention
- Making careless mistakes or overlooking details
- Not following instructions or following through on tasks
- Difficulty organizing tasks and activities
- Avoidance of tasks that require sustained attention
- Losing or forgetting things
- Easily distracted
- Fidgeting or trouble sitting still
- Difficulty staying quiet
- Often being ‘on the go’ or acting as if ‘driven by a motor’
- Talking excessively or interrupting people
- Trouble waiting or taking turns
What Is BPD?
Borderline personality disorder (BPD) is a mental health condition characterized by intense fears of abandonment, mood swings, impulsivity, and relationship instability. People with BPD often struggle to regulate their emotions, make healthy decisions, and think in rational ways when upset. This can sometimes lead to self-destructive behaviors, including engaging in drug and alcohol use and self-harm.4 BPD can be diagnosed in teens or adults, and is estimated to affect 1.6% of the population.6
Common symptoms of BPD include:4
- A pattern of instability in life and relationships
- Fears of abandonment & frantic efforts to avoid abandonment
- Trouble regulating emotions
- Impulsivity and reckless decision making
- Black and white thinking (all-or-nothing thinking)
- An unstable identity or sense of self
- Chronic feelings of emptiness
- Uncontrolled anger and outbursts
- Periodic dissociative symptoms
- Paranoid thoughts or delusions
Connections Between ADHD & BPD
The symptoms of ADHD and BPD overlap considerably. For instance, impulsivity, trouble regulating emotions, and relationship instability are commonly displayed in both conditions.2 A person with either condition is likely to struggle at work, in school, and in other situations that require sustained concentration. Unfortunately, these shared symptoms can make the diagnostic process more challenging.1,2
Similar risk factors such as childhood trauma, genetic predispositions, and temperament are also evident in ADHD and BPD.1,2,3 Being diagnosed with ADHD as a child or adolescent is considered a possible factor in the onset of BPD, as it increases the risk of developing this disorder in adulthood.7 In fact, research suggests that 14% of people diagnosed in childhood with ADHD go on to develop BPD, as opposed to less than 2% of the general population.3
Can You Have BPD and ADHD?
It’s not uncommon to be diagnosed with both ADHD and BPD. Studies show that between 18-34% of adults with ADHD also have a diagnosis of BPD.3 Those who have both conditions tend to experience more severe symptoms and impairments than others with just one diagnosis.1,8 For instance, a person with ADHD and BPD may struggle more with emotion regulation.2,8
Key Differences Between ADHD & BPD
Despite the fact that there are considerable similarities between ADHD and BPD, there are also some important differences between the two. ADHD is a neurocognitive/neurodevelopmental disorder, while BPD is classified as a personality disorder.4 Also, ADHD is characterized by inattentiveness and hyperactivity–BPD tends to cause more problems with emotional control and interpersonal relationships.1 Additionally, people with BPD are more likely to engage in self-destructive behaviors like self-harm, suicidality, substance use, and recklessness.2,3
While impulsivity is a feature of both conditions, people with ADHD are impulsive in different ways and for different reasons than those with BPD. Impulsivity in ADHD often stems from having a short attention span and failing to fully think through things before acting. Conversely, impulsivity in BPD is usually linked to poor emotion regulation.2,9 Someone with ADHD might blurt out, interrupt people, or show impatience in situations that require a lot of concentration, but a person with BPD may respond with emotional distress.9
Intense abandonment issues are a key symptom of BPD, which often triggers angry or emotional outbursts that lead to relationship challenges. A person with ADHD doesn’t necessarily struggle with these same fears, and therefore less likely to experience similar emotional turmoil.2 Lastly, the age of onset is different between both conditions, as ADHD is usually diagnosed in childhood. On the other hand, BPD is more readily diagnosed in adolescence or early adulthood.2,6
How Are Comorbid ADHD & BPD Treated?
With most co-occurring disorders, treatment requires a two pronged approach that can target the specific symptoms of each disorder–this is also the case with comorbid ADHD and BPD.1 People with both conditions often require a combination of medication and therapy to improve and manage their symptoms.
Treatment options for comorbid ADHD and BPD may include:
Therapy
Psychotherapy is considered a frontline treatment for most mental illnesses, and is often combined with medication for optimal results in treating both ADHD and BPD. One of the most effective therapies for BPD is Dialectical Behavioral Therapy (DBT).6,10 DBT teaches people how to regulate their emotions using mindfulness, communicate more effectively, and think in healthy ways when distressed. It can be offered in both individual or group therapy sessions.
Other evidence-based treatments for BPD include Mentalization-Based Therapy (MBT) and Schema Therapy, which focus on helping to change certain thoughts and beliefs that contribute to mood and behavior problems. Transference-focused therapy has also been shown to help some people with BPD overcome abandonment and attachment issues and develop healthier relationships with others.10
One of the only therapy methods that has been proven beneficial for those with ADHD is Cognitive Behavioral Therapy (CBT), which focuses on helping people change thought and behavior patterns that are worsening their symptoms.10
Medications
Medication is usually recommended in the treatment of adult ADHD, and usually involves a stimulant medication that can help improve one’s focus and concentration. Examples of common stimulants used for ADHD include Adderall, Vyvanse, and Ritalin. Stimulant ADHD medications do carry some potential for abuse and addiction and can also have some adverse side effects. For these reasons, some people are prescribed a non-stimulant ADHD medication, like Strattera.
There aren’t any FDA approved medications for BPD, but SSRIs or mood stabilizers may be recommended to treat mood instability in BPD. Less commonly, antipsychotic medications may help reduce the symptoms of BPD.6 Medications for BPD are typically only recommended in combination with therapy and aren’t used as a stand-alone treatment for BPD.
How to Cope With Comorbid ADHD & BPD
In addition to seeking help from a licensed therapist, there are also some things that people living with comorbid ADHD and BPD can do to manage their symptoms on their own. Adopting healthy habits and coping skills can help to reduce the impact of BPD and ADHD symptoms in a person’s daily life.
Here are some tips on how to cope with comorbid BPD and ADHD:
- Mindfulness and meditation: Mindfulness and meditation can help reduce stress, improve focus, and regulate moods. It can allow people to feel more stable and calm.
- Exercise and physical activity: Being physically active helps to improve mood and energy levels, reduce stress and anxiety, and boost mental clarity and focus.
- Journaling and creative outlets: Journaling and creative outlets can help people express their thoughts and feelings in ways that are healthy and can also boost self-awareness.
- Organization and time-management: Staying organized with a schedule, routine, and to-do list can help people limit the impact of BPD and ADHD on productivity, work, and daily tasks.
- Impulse control skills: Thinking before acting or speaking can help to reduce the negative impact of impulsivity on a person’s life, work, and relationships.
- Stress management: Managing stress levels can help to keep symptoms of BPD and ADHD under control and also reduces the risk of making impulsive decisions .
- Support groups: Finding a support group can help people with BPD and ADHD connect with others who can relate to the difficulties of managing mental illnesses, as well as providing a safe and supportive space to vent and share tips on how to cope.
Final Thoughts
Living with BPD and ADHD can make life more challenging–but there are several different treatment options that can help. Therapy (sometimes in combination with medication) can help people manage their symptoms and improve their overall quality of life. Finding a therapist who is skilled and experienced in treating both conditions is important, and will help to ensure that treatment addresses your symptoms effectively.
ADHD & BPD Infographics
