Despite the stigma, whether real or perceived, thrust upon people battling a mental illness, the number of people struggling with a psychiatric disorder is more significant than many realize. In fact, according to the National Institute of Mental Health (NIMH), about one in five U.S. adults live with a mental illness — a number that equates to nearly 53 million Americans.
What’s also important to remember is that mental illness is a wide-ranging term that encompasses diagnoses of many types. To start, NIMH places these conditions in two distinct buckets: Any Mental Illness (AMI) and Serious Mental Illness (SMI). But beyond the severity of the condition are the characteristics and specific condition types that can sometimes be confusing. For example, many people unfamiliar with each disorder’s specifics believe there is a link or overlap between attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD). That’s why we want to take the time to analyze both ADHD and BPD, highlighting the similarities and differences.
What is ADHD?
Usually first diagnosed in childhood, ADHD is well-known as one of the most common neurodevelopmental disorders for younger people. Although doctors typically diagnose and address the disease early in life, ADHD will often last well into adulthood.
Someone with ADHD is likely to struggle with concentration, daydreaming, squirming, or fidgeting when awareness is required — like in a classroom setting. Because of these symptoms, the person may make mistakes and find it challenging to get along with others, take turns, or resist temptation. As the Centers for Disease Control and Prevention (CDC) writes on its website, ADHD presents itself in three distinct ways.
Predominately Inattentive Presentation is when the person finds it hard to organize or finish a task, focus on a task’s details, or follow instructions. In essence, this person becomes easily distracted, leading to forgetfulness.
Meanwhile, experts characterize Predominately Hyperactive-Impulsive Presentation as someone who fidgets and talks excessively. In addition, someone with this type of ADHD will find it taxing to sit still for long periods and may experience bouts of impulsivity.
Lastly, Combined Presentation is the term used to describe someone with ADHD who has equal amounts of both types of symptoms.
What is BPD?
The National Alliance on Mental Illness (NAMI) describes BPD as “a condition characterized by difficulties regulating emotion.” Further, NAMI writes, “This means that people who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.”
Because of that emotional instability, someone with BPD may present characteristics like impulsivity and poor self-image. Everyday stressors tend to affect someone with BPD on a magnified level, leading to overly emotional responses. Sometimes, these feelings can even result in self-harm, like cutting.
Interestingly, nearly 75% of those diagnosed with BPD are women. However, as NAMI points out, some experts believe men may be just as affected by BPD as women, but their doctor has misdiagnosed them with another type of mental illness.
No matter if the person is a man or woman, someone with BPD is likely to experience extreme mood swings. This person may also go to great lengths to avoid friends and family, remain an active participant in unstable relationships, have chronic feelings of emptiness, disconnect themselves from their thoughts or self-identity, and lash out at others with uncontrollable anger.
Causes of ADHD
With the causes of ADHD, researchers are unsure precisely why the condition occurs. However, studies show a connection between ADHD and genetics. We also know that children who live through trauma at an early age are more likely to be diagnosed with ADHD. As the CDC reports, scientists are also studying other potential risk factors, including:
- Brain injury
- Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
There’s a common misconception that behavioral actions like overeating sugar or watching too much television cause ADHD, but research has debunked those long-held and non-scientific theories. However, certain actions like risky behavior, fighting, stealing, or using an addictive substance may contribute to a worsening of symptoms.
Causes of BPD
Although the causes underlying BPD are somewhat unclear, scientists believe some risk factors increase the chance of one developing the condition. Genetics and brain abnormalities, including changes to areas of the brain that regulate emotions, are likely in play.
Someone with a close relative with BPD is at a higher risk for developing the condition. Researchers also suspect that environmental factors, like neglect or abuse, separation from a parent, or exposure to conflict or another trauma at a young age, increase a person’s chances of developing BPD.
Diagnosis and Treatment for ADHD
As with other mental health conditions, the diagnosis of ADHD follows the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5). Using DSM-5 as a guideline helps ensure that the condition is diagnosed across the country using the same standards.
While the symptoms for the different types of ADHD vary, how doctors diagnose the disorders are similar. For instance, six or more symptoms of inattention or hyperactivity-impulsivity, or both, in children up to age 16 must be present, those symptoms must have been present for at least six months, and the symptoms must be inappropriate for the child’s development level. Symptoms must have been present before age 12, appear in two or more settings, are a clear impediment toward proper functioning, and cannot be explained by another disorder.
In adults, or those 17 years or older, diagnosis requires the presence of five symptoms instead of six. Symptoms can also present differently in adults than in children, which is why it’s critically important to see a licensed mental health practitioner for a proper diagnosis.
Because ADHD is often first diagnosed in young children, treatment can be tricky. The American Academy of Pediatrics (AAP) recommends alternatives to medication for children younger than six years old, including parent training and behavior management. For kids older than six (and adults), the treatment plan may combine medication with behavioral therapy for a comprehensive approach. Stimulants are the most popular type of medication used to treat ADHD, though non-stimulants have been used in the past when stimulants are deemed ineffective.
At least half the children diagnosed with ADHD still technically meet the criteria for an ADHD diagnosis after reaching adulthood. Experts estimate that as much as 5% of adults have some form of ADHD, which can be socially and professionally crippling.
Diagnosis and Treatment for BPD
One of the most important things to remember about BPD is that a person’s personality continues to evolve throughout adolescence. Because of that, it’s unusual for someone under the age of 18 to be diagnosed with BPD unless their symptoms are significant and long-lasting.
As with ADHD, mental health professionals use DSM-5 to diagnose BPD, cross-checking symptoms with the manual’s diagnostic criteria. As part of that process, the practitioner will ask questions about personal and family medical history, the person’s ability to control impulses, and any work history or trauma that could have contributed to the condition.
People with BPD are likely to have co-occurring mental health conditions or substance abuse disorders. According to the Cleveland Clinic, the following ailments are among the most common to occur concurrently with BPD:
- Mood disorders (80% to 96% of people with BPD)
- Anxiety disorders (88%)
- Substance use disorder (64%)
- Eating disorders (53%)
- Attention-deficit/hyperactivity disorder (ADHD) (10% to 30%)
- Bipolar disorder (15%)
- Somatoform disorders (10%)
The most effective treatment method for BPD is psychotherapy, also known as talk therapy, which aims to guide the person in uncovering the root cause of their BPD and how they can overcome it. Medications have been mainly ineffectual in treating BPD, a factor that significantly increases the challenges in treating the condition.
The Similarities Between ADHD and BPD
Now that you understand the foundational elements of ADHD and BPD and how each condition can affect the person, let’s look at the ways the two conditions are similar. First, both disorders will often plague the person as a lifelong illness, and both conditions are significant drivers in quality of life and psychosocial functioning. But the most striking similarities between ADHD and BPD are found in the presentation of the conditions’ clinical symptoms.
The DSM-5 cites the key features of BPD as a “pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.” In describing ADHD, the manual says the disorder is characterized by “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
By evaluating the language used in the DSM-5, it’s easy to see how the overarching similarity between the two falls squarely within the realm of impulsivity. The tendency toward impulsive behavior means that both conditions are likely to cause the person to act unexpectedly or without fear of potential consequences.
Behaviors related to impulsivity can have a detrimental impact on one’s life, including straining relationships with those around them and influencing the opinions of others. For instance, someone with ADHD or BPD who battles impulsivity may find themselves blurting out inappropriate answers to questions, interrupting others, or wrestling with the thought of having to wait their turn in line. Importantly, researchers have identified correlations between the bouts of impulsivity found in ADHD and BPD sufferers and another behavior called emotion dysregulation.
Researchers believe emotion dysregulation includes the following four fundamental aspects — all of which are clear in the behaviors of those with both ADHD and BPD:
- A lack of awareness, understanding, and acceptance of emotions
- A lack of adaptive strategies for regulating emotions (the intensity or duration)
- An unwillingness to experience emotional distress while pursuing desired goals
- An inability to engage in goal-directed behaviors when experiencing distress
One other similarity uncovered by published research involved a study of 103 women, reviewing the subjects on a scale of the severity of their ADHD and BPD symptoms. Published in 2012, the study found that all groups — regardless of which condition the test group had — scored high on “high novelty seeking” as a personality trait. In this study, “high novelty seeking” is best described as thrill-seeking, or the pursuit of the types of experiences that propose a high risk or reward and elicit ample emotions.
Lastly, the two conditions share some contributory factors, including trauma, such as abuse and neglect, that occurred during early adolescence.
The Differences Between ADHD and BPD
Despite the many similarities between ADHD and BPD, some distinct differences warrant discussion. The first difference is in their classification within DSM-5 standards. According to the manual, ADHD is a neurodevelopmental disorder, while BPD is a personality disorder.
A deeper exploration of the symptoms reveals other differences between the two conditions. At its core, BPD is a condition predicated on spikes of emotion and intense feelings about oneself. On the contrary, ADHD centers on more than self-reflection, tapping into attention span and motor movements.
Oddly enough, studies find stark differences that mark even the similarities between the two. Remember the patterns of impulsivity described in the section on similarities? People struggling with ADHD often exhibit impulsivity through motor movements or physical spasticity. For example, children may act out and throw things out of boredom or an inability to pay attention and focus on the topic. However, cases of impulsivity related to BPD present as a stress response. Here, someone with BPD might exhibit impulsive behavior because they cannot recognize context cues or cannot effectively regulate their emotions when dealing with less-than-ideal outcomes.
We touched on a few of the other essential differences earlier, but those bear repeating here as well. While doctors most frequently diagnose ADHD during a person’s childhood, they can also diagnose the disorder in adults. Regardless of when a doctor first identified the condition, ADHD can remain a problem throughout adulthood. BPD is the opposite. Because our personalities change and develop as we age, children are rarely diagnosed with BPD. There are, of course, exceptions to the rule — but barring significant symptoms that are present for over one year, adults are far more likely to receive a diagnosis of BPD.
Another notable difference between ADHD and BPD is the use of medication to treat the respective conditions. In adults and children older than six years old, physicians frequently prescribe medication for ADHD (in coordination with forms of talk therapy), while there is no truly effective drug to treat BPD.
Can Someone Have Both ADHD and BPD?
The short answer here is yes, and it happens more often than you might think. That said, BPD occurs more frequently within the ADHD community than ADHD among the population of BPD sufferers. More specifically, “At least 14% of those diagnosed with ADHD in childhood later receive a diagnosis of BPD while between 18% and 34% of the adults with ADHD are estimated to have comorbid BPD.”
Other research supports that claim, including studies that showed someone with ADHD has 19.4% higher odds of obtaining a BPD diagnosis than someone without ADHD and that children diagnosed with ADHD between the ages of 7 and 11 were significantly more likely to receive a BPD diagnosis between the ages of 16 and 26. Because the two conditions have so many overlapping symptoms, there’s also the chance that one condition goes undiagnosed and untreated because of a singular focus on the other.
Rising Phoenix Wellness Services has Programs Specifically Designed for Mental Health Treatment
It’s crucial that health professionals assign the same importance and vigor to diagnosing and treating mental health as they do physical health. Rising Phoenix has mental health treatment programs aimed at helping clients overcome conditions like ADHD, BPD, and other mental health ailments.
With all clients, we perform a thorough intake assessment to evaluate the severity of the client’s condition, allowing that information to inform our unique approach to treatment. Depending on the person’s condition, we may or may not prescribe medication, but we’ll always work with the client on developing coping skills and training to help them live the best life possible.
Talk therapy, including dialectical behavior therapy (DBT) and cognitive behavior therapy (CBT), are essential aspects of our mental health programming. Treatment approaches may include individual, group, and family therapy. We recognize and respect the vital role family members can play in the long-term recovery of their loved ones and make a point to include them in the treatment process.
If you or a loved one have found the complexities of ADHD or BPD detrimental to daily living, Rising Phoenix can help. We encourage you to contact us by calling confidentially at 480-618-4791 or filling out our intake form. Our admissions advisor is available 24-7 to verify insurance and answer any questions you may have.