BPD & ADHD: Is There a Link?

What Is Borderline Personality Disorder (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 misuse and self-harm.⁴

Common symptoms of BPD include:⁴

• A pattern of instability in life and relationships
• Fears of abandonment
• Frequent mood swings
• 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
• Trust issues
• Self-harm behavior or suicidal ideation

What Is Attention-Deficit/Hyperactivity Disorder (ADHD)?

ADHD is a neurodevelopmental disorder that affects someone’s ability to focus, remember things, and control impulses. 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

Common symptoms of ADHD include:⁴

• Trouble 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
• Fidgeting or trouble sitting still
• Difficulty staying quiet
• Often being ‘on the go’ or acting as if ‘driven by a motor
• Trouble waiting, taking turns, or interrupting others
• Challenges with emotional regulation
• Time management issues or time blindness

Similarities Between BPD & ADHD

While different disorders, BPD and ADHD both involve symptoms of impulsive behavior and emotional regulation issues.

ADHD & BPD Overlapping Symptoms 

Overlapping symptoms of ADHD and BPD include:

• Impulsiveness: Compulsive behavior without thinking about consequences.
• Emotional dysregulation: Severe mood swings, high highs and low lows.
• Executive dysfunction: The inability to do a task that you know you need to do (or even want to do).
• Relational challenges: Some of the symptoms involved in both conditions can make building and maintaining relationships difficult.
• Lack of self-directedness: Challenges with managing self and controlling behaviors.

Causes & Risk Factors

Similar possible causes between BPD and ADHD include:

• Experiencing trauma: Trauma changes the brain and can lead to symptoms that are seen in both BPD and ADHD.
• Genetic factors: A positive family history of BPD and/or ADHD are risk factors for developing either of these disorders in an individual.

Differences Between BPD & ADHD

Despite the fact that there are considerable similarities between ADHD and BPD, there are also some important differences between the two. ADHD is not a personality disorder like BPD and is characterized by inattentiveness and hyperactivity. BPD tends to cause more problems with emotional control and interpersonal relationships.^1,4 Additionally, people with BPD are more likely to engage in self-destructive behaviors.^2,3

Differences in the Nature of the Impulsivity

While impulsivity is a feature of both conditions, people with ADHD are impulsive in different ways and for different reasons than those with BPD. Those with ADHD often fail to fully think through things before acting, while a person with BPD may behave impulsively due to poor emotion regulation.^2,9

Abandonment Issues in Those With BPD

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

Age of Onset

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

Can You Have BPD & ADHD?

ADHD and BPD can overlap, but it is rare. It is more likely that a childhood diagnosis of ADHD can be linked to a higher chance of developing BPD later in life, however the two conditions are not usually misdiagnosed for one another as there are distinct differences between each disorder. However, a childhood history of ADHD can make adult BPD symptoms more severe.

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

Therapy options for co-occurring ADHD and BPD include:

• Dialectical behavioral therapy (DBT): DBT for BPD and ADHD 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.
• Mentalization-Based Therapy (MBT): This approach to therapy helps people learn about how their emotions and thoughts intersect and how these intersections impact their actions.
• Schema Therapy: This approach to therapy focuses on upgrading our automatic thoughts, and challenges us to change our perspective and normalize healthier behaviors.
• Transference-focused therapy: This approach to therapy leans into understanding the varying emotions that can stem from BPD, learning more about them, and finding a place for them.
• Cognitive Behavioral Therapy (CBT): This approach to therapy focuses on how thoughts become actions and how to redirect our thoughts.

Medications

In some cases, medications for BPD and ADHD may be incorporated into a comprehensive treatment plan. Medication is typically recommended in the treatment of adult ADHD, often in the form of stimulants that can help improve one’s focus and concentration. Examples of common stimulants used for ADHD include Adderall, Vyvanse, and Ritalin. Other times, a non-stimulant ADHD medication, like Strattera, may be recommended instead.

There aren’t any FDA-approved medications for BPD, but SSRIs or mood stabilizers may be advised in order to treat mood instability. Less commonly, antipsychotic medications may help reduce the symptoms of BPD.⁶ Medications for BPD are typically only recommended in combination with therapy, not as a stand-alone treatment.

Before you begin or end any medication, it is important that you talk to your psychiatrist or physician. Adderall can be risky for someone with these two conditions, as it can make BPD symptoms worse. Adderall is an amphetamine and can exacerbate symptoms; and long term use of them can lead to brain damage.

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:

• Practice mindfulness: Mindfulness for anxiety or mindfulness for BPD can help reduce stress, improve focus, and regulate moods. It can allow people to feel more stable and calm.
• Maintaining physical activity: Being physically active helps to improve mood and energy levels, reduce stress and anxiety, and boost mental clarity and focus.
• Engage in something creative: Journaling and finding a creative outlet can help people express their thoughts and feelings in ways that are healthy while also boosting self-awareness.
• Utilize organization tools: Staying organized with a schedule, maintaining a routine, and making a to-do list can help people limit the impact of BPD and ADHD on productivity, work, and daily tasks.
• Adopt 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.
• Practice stress management: Stress management can help to keep symptoms of BPD and ADHD under control and also reduces the risk of making impulsive decisions.
• Join a support group: 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 provide 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.