It is understood that ADHD frequently co-occurs with a number of other neurodevelopmental and psychiatric conditions, and as such, a link between attention-deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) has been explored. 

Here, we are taking a closer look at the similarities and differences between these conditions, their clinical links, the likelihood of experiencing both, how symptom camouflaging affects both, the role trauma plays, and how women may experience this comorbidity differently. As always, we will also look at how to manage it in everyday life and where to turn if you need support. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about ADHD or BPD, we can help. 

What is ADHD and what are the symptoms? 

ADHD stands for attention-deficit hyperactivity disorder, which is a type of neurodivergence that can cause a difference in how the brain is hard-wired compared to neurotypical individuals. The main symptoms of ADHD in adults might include trouble focusing for a long time, impulsivity and inattentiveness. These symptoms tend to disrupt everyday activities like learning, studying, working, organising, remembering, following through on instructions, managing time, and more. 

In children, ADHD symptoms often look different. For example, they may exhibit hyperactive behaviours, struggle to play quietly, or have difficulty following simple instructions without becoming distracted. 

What is BPD and what are the symptoms? 

Borderline personality disorder (BPD) is a type of personality disorder that impacts the way a person thinks, feels, sees the world around them, and relates to others. Research suggests the prevalence of BPD is around 1.6% in the general population, and the condition is more likely to occur in women. 

Borderline personality disorder symptoms can include things like hypersensitivity to rejection, instability in relationships, a distorted sense of self-image, intense mood swings, rapid changes in interests or feelings for others, impulsivity or recklessness, avoidance of any sort of abandonment, self-harming behaviours, suicidal thoughts/behaviours, intense feelings of anger, and more. Not all symptoms will be present in everyone with BPD, as the severity and frequency often varies with each person. 

You may find more information on another type of BPD in our piece on What Is "Quiet BPD" And How Can You Spot It?

What are the differences and similarities between ADHD and BPD?

There are a number of similarities between ADHD and BPD which have led to research on the comorbidity of the two conditions. The known similarities at present include the symptoms of impulsivity, emotional dysregulation, low self-esteem, and difficulties with interpersonal relationships:

Impulsivity

Studies have found both ADHD and BPD share a key symptom of impulsivity, whereby an individual will act on a spontaneous impulse without putting thought into the potentially negative consequences. The psychopathological descriptions of impulsivity in both ADHD and BPD differ in the DSM criteria, as core impulsivity in BPD often refers to impulsive self-harm, while core impulsivity in ADHD refers to impatience, interrupting others and speaking over people. Despite the differences, impulsivity is a symptom of both conditions and could therefore lead to a misdiagnosis.

Emotional dysregulation

Emotional dysregulation is another symptom occurring in both ADHD and BPD, with studies finding it to be a core symptom of BPD. It is not as common in ADHD which is why it is not included in the official DSM diagnostic criteria for this condition, but it is a noted symptom nonetheless. Further studies have found individuals with both ADHD and BPD experienced the highest levels of emotional reactivity, including emotional sensitivity, intensity and persistence of emotions.

"BPD is a complex condition where sufferers will experience heightened emotional responses that take longer to decay back to baseline than the average person. These emotional responses may be triggered by interpersonal conflicts and other stress or life events. The typical problematic emotions are excessive or inappropriate anger, or excessive despair, distress and feelings of emptiness." - Dr Adrian Lord, Consultant Psychiatrist

Low self-esteem 

There are other less common but noteworthy symptom similarities, including low self-esteem. This is when someone has a lack of confidence in who they are and their abilities, which can impact a number of things in everyday life. This is an overlapping symptom of ADHD and BPD. 

"People with BPD may either think they are the best thing since sliced bread or the worst, there is no in between. They tend to perceive the world in black and white polar extremes without shades of grey in between and can rapidly shift between those polar states. They are exquisitely sensitive to real or imagined abandonment which can trigger the emotional crisis." - Dr Adrian Lord, Consultant Psychiatrist

Difficulties with interpersonal relationships 

Both those who live with ADHD and those with BPD can experience difficulties with their interpersonal relationships due to their other symptoms and the struggles they have in everyday life. These symptoms can lead to strain on families, clashes in friendships, and difficulties building and managing romantic relationships. 

In terms of differences in the symptoms and presentation of ADHD and BPD, the main differentiators are typically the variation in impulsivity symptoms as mentioned above, such as those with ADHD having more issues with patience and focusing. There is also thought to be a tendency for those with BPD to experience difficulties in their responses to stress, which can lead to self-harm activities or suicidal thoughts – this is not typical of ADHD. 

Is there a clinical link between BPD and ADHD?

Aside from symptom similarities, there is thought to be a significant clinical link between BPD and a history of ADHD in childhood, suggesting ADHD could be a developmental risk factor for BPD. Research estimates around 14% of those with an ADHD diagnosis in childhood will later be diagnosed with BPD, and around 18-34% of adults with ADHD may also have BPD. Other studies have suggested that 30-60% of people with BPD also had ADHD, so the true co-occurrence of these disorders varies per study, and remains unclear. 

Studies on genetics have investigated the shared genetic and environmental contributions to ADHD and BPD, with findings suggesting that around half of the association between ADHD and BPD could be explained by genetic factors, and half explainable by environmental factors that are unique to each individual. Further studies suggest those with diagnosed ADHD had 19.4 times higher odds of having BPD than those without ADHD. Further studies on the genetics of both conditions suggest that BPD and ADHD overlap on around 60% of the genetic variants involved. 

"People with BPD are often very impulsive across many areas of their lives. Although there might be some very superficial similarities these two conditions, they are quite distinct. However, they are not mutually exclusive and can co-exist in the same person. The combination of both can be particularly difficult and distressing because the impulsivity and other symptoms of ADHD amplify some of the difficulties in BPD." - Dr Adrian Lord, Consultant Psychiatrist

Does symptom camouflaging make BPD and ADHD worse?

You may have heard of ADHD masking, which is a coping mechanism that those with attention-deficit hyperactivity disorder use to manage how others view them. They may present in a manner that appears to others as if they do not have ADHD, and they do this by copying behaviours of neurotypical people and covering up symptoms.

This coping mechanism can be seen in other conditions too. For example, many studies suggest it is common for those with BPD and autism, particularly women, to camouflage their symptoms, but as yet there is little research on how this could manifest for those with ADHD and BPD. 

Those with co-occurring ADHD and BPD could experience difficulties self-regulating, impulsivity, emotional volatility, and more. Feeling the need to self-regulate to be perceived as neurotypical by other people can lead people with these comorbid conditions to feel ashamed and unsupported, which can lead to feelings of anxiety, depression and more.  

What role does childhood trauma play in BPD and ADHD?

It is understood that borderline personality disorder is most often related to childhood trauma, for example, physical or sexual abuse, or neglect. This has been found to be the case in up to 70% of people with BPD. 

Interestingly, studies suggest it may not only be those with BPD who have experienced childhood trauma or adverse events. Individuals with ADHD – particularly those with co-occurring ADHD and BPD – also have increased rates of childhood trauma and adverse events. This links to studies on genetics and environmental risks that play a part in the potential development of these conditions, and suggests children with ADHD could be more likely to develop BPD if they have been exposed to trauma at an early age.

Do ADHD and BPD manifest in the same way for both men and women? 

Many mental health conditions manifest differently for men and women, with some differing only slightly while others see drastic differences. 

In recent years it has become apparent that ADHD presents differently in girls than in boys, and in men than in women – girls tend to display less hyperactive and more inattentive symptoms. As ADHD was rarely diagnosed in women with inattention issues until recently, it has been common for women to be misdiagnosed with BPD. 

When it comes to borderline personality disorder, research shows that BPD is diagnosed in women three times more than in men, and is subject to significant gender inequality when it comes to the stigma associated with BPD compared to other disorders. The condition differs between the genders in many areas, including its developmental features, diagnosis and symptoms, psychiatric comorbidities, and the level of functional impairment experienced by those with the condition. 

For individuals with co-occurring ADHD and BPD, emotional dysregulation becomes a challenging symptom which puts women with both ADHD and BPD, as well as a history of  trauma, at the highest risk for negative outcomes. This confirms the need for support to manage the conditions long term. 

How to manage ADHD and BPD

Understanding the comorbidity of ADHD and BPD can help those who are living with both conditions. Treatments are available, but it is important to consider the best treatment options for both conditions together rather than treating both individually. 

This is because, while studies suggest that comorbid ADHD and BPD could benefit from medication to help with things like motor impulsiveness, depression severity, and ADHD severity, there is also concern that commonly prescribed ADHD medications (particularly stimulants) can have a negative impact on BPD symptoms. Working with a medical professional who specialises in both conditions can be an effective way to ensure your diagnoses and treatments are handled appropriately. 

You may find more information on medication options for ADHD in our article: Your Guide to ADHD Medication in the UK (for Adults & Children)

Research on impulsivity symptoms has suggested the importance of treatment strategies specific to both disorders to help with impulse control. This could be a mixture of both medication and psychotherapy, and could include:

• Dialectical Behavioural Therapy (DBT) – This can be helpful specifically for those with BPD, and uses mindfulness techniques to help an individual gain awareness of their emotions and learn to regulate them to reduce self-destructive behaviours.
• Cognitive Behavioural Therapy (CBT) – This is an option for those with co-occurring BPD and ADHD which can help people identify their beliefs and behaviours, and start to make conscious changes to help manage things like mood swings or self-harm urges. You can read more in our article: CBT For ADHD: How Well Does It Work?
• Certain medications – These may be prescribed to manage symptoms that can occur in both ADHD and BPD, such as mood swings and depression. 

"The first line of treatment for ADHD is stimulant medication which has a paradoxical, calming effect and enables the person to sustain concentration and focus for much longer. The treatment only relieves the symptoms and there is no curing effect on the underlying condition. Coaching and therapy can help people manage their ADHD better with or without medication. There is no medication licensed for BPD. The main treatment is skills based psychotherapy such as dialectical behavioural therapy, as well as treatment for the often complex traumas that these people have suffered in their childhood and which have adversely affected their personality's development." - Dr Adrian Lord, Consultant Psychiatrist

Where to find support with ADHD and BPD

Getting a diagnosis for ADHD or BPD can be a challenging process, and can take a long time in some cases, but it is worth it to avoid misdiagnosis. This ensures you are receiving the appropriate care for you, and the correct medication if required. 

If you recognise some of the aforementioned overlapping symptoms in yourself or a loved one, you may wish to start by speaking to your GP, or you can look for a professional who is a specialist in both ADHD and BPD so you can gain more insight on your symptoms and how to manage each of them.  

If you are already working with an ADHD specialist, don’t be afraid to speak to them about any potential comorbidities to get their advice on how to approach this. In many cases, if they cannot help with a comorbid diagnosis themselves, they may be able to point you in the direction of someone who can. 

You can also reach out for a private appointment to explore this, and you will find lots of useful information on how this works in our guides: Your Guide To Finding An ADHD Psychiatrist and What Is Involved In A Private ADHD Assessment?

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private adult ADHD assessment or AuDHD assessment, to help finding an ADHD specialist near you to support you on your journey.

If you have a question about mental health, such as what a dual diagnosis of ADHD and autism can mean, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.