Identifying ADHD and BPD: Coexistence and misdiagnosis

Attention-deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are two mental health conditions that share some similar features. Sometimes, these similarities can make it difficult to tell the difference between them. For example, both conditions can cause problems with impulsivity. 

In addition, many people live with both ADHD and BPD at the same time. Known as having co-occurring conditions, this can make diagnosis and treatment more complex. 

Fortunately, our understanding of BPD and ADHD has evolved in recent decades. And today, experts have a clearer understanding of their similarities and differences. Thanks to continued improvements in diagnostic techniques and treatments, people living with BPD, ADHD, or both can access the care they need to help manage their mental health.

Similarities and differences in symptoms

BPD is a personality disorder that affects how people relate to others, view themselves, and manage their emotions. It often leads to impulsive actions and unstable relationships. 

ADHD, on the other hand, is a neurodevelopmental disorder that primarily affects focus and attention. It can make it challenging for people to stay organized and manage their impulses, impacting their daily functioning and development. 

So both conditions involve impulsivity, but they show up differently in each one. According to these insights, the most prevalent similarity between BPD and ADHD is impulsivity. 

For people living with either of these conditions, impulsivity can take many forms, including:

• Doing things without stopping to consider the consequences first
• Frequent conflict with others, especially when someone criticizes impulsive behaviors
• Frequent angry outbursts due to not being able to control one’s emotions
• Having trouble sticking to things when there’s not an immediate reward
• Frequent mood swings and emotional instability
• Impatience, like difficulty waiting one’s turn or frequently interrupting
• Intense emotional reactions to everyday stressors

As you can see, there is a decent amount of symptom overlap between BPD and ADHD. But there are some important differences between these conditions too.

ADHD symptoms that are not typically shared by people with BPD:

• Disorganization
• Hyperactivity
• Problems with executive functioning 
• Low inhibition

BPD symptoms that are not typically shared by people with ADHD:

• Feelings of emptiness
• Dissociation
• Non-suicidal self-injury (like cutting)
• Chronic suicidality*

Another key difference between BPD and ADHD is the age of onset. ADHD is most often diagnosed in childhood. However, BPD is usually diagnosed during late adolescence or young adulthood. Despite these diverging timelines, it’s still possible for BPD to be misdiagnosed as ADHD and vice versa. That’s why getting an evaluation from a qualified mental health professional is so important.

*The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or having a suicidal crisis, please call or text 988. If you’re experiencing a life-threatening emergency or need immediate help, please call 911.

Is there a link between ADHD and BPD?

Research shows that many people who have BPD would have met the clinical criteria for ADHD as children. This suggests that ADHD could be a precursor to BPD. So a child with ADHD might be at greater risk for developing BPD later in life. 

There’s also evidence to suggest that symptoms of both BPD and ADHD tend to be more severe if the person experienced trauma, especially childhood abuse. In addition, both conditions share a genetic component. This means that having a relative with BPD or ADHD might make you more likely to develop one or both of these conditions.

Treatment and co-treatment strategies

No matter the mental health conditions(s) you’re living with, getting an accurate diagnosis is a critical first step in ensuring that you get the right care for your needs. While this can get a bit more complicated when you have co-occurring conditions, treating BPD and ADHD at the same time is possible. 

An effective treatment plan for both BPD and ADHD might include an individualized combination of any of the following approaches:

• Dialectical behavioral therapy (DBT): DBT is considered the most effective form of talk therapy for BPD. But because it focuses on things like emotional regulation, distress tolerance, mindfulness, and interpersonal skills, it can also be helpful for ADHD.
• Cognitive-behavioral therapy (CBT): CBT can help you identify and interrupt unhelpful thought and behavior patterns and learn alternative ways to cope with stress. This form of care has been proven effective in supporting people living with BPD and ADHD.
• Transference-focused psychotherapy (TFP): TFP encourages you to explore how your BPD or ADHD symptoms influence the way you feel about your therapist. This insight can help you better navigate relationships and other challenges outside of therapy. 
• Couples therapy: Often, BPD and ADHD can impact your important relationships. Couples therapy can help you and your partner improve your communication, increase your empathy, and resolve conflicts more effectively. 
• Crisis planning: Since BPD can lead to safety concerns like suicidality, your treatment plan may include a crisis plan that you co-create with your therapist. Typically, crisis planning isn’t included in standard ADHD treatment. But it may be necessary if you have both BPD and ADHD.
• Medications: Several different types of medications are used to treat ADHD, and you can talk to your provider about which one might be right for you. There aren’t any approved medications for treating BPD on its own, but there are medications that can help manage individual symptoms. 

Find care with Rula

ADHD and BPD are two distinct mental health conditions. However, they have some things in common. Both are known to cause problems with impulsivity and emotional dysregulation. They also coexist frequently, making diagnosis and treatment more complex. 

Fortunately, experts have deepened their understanding of what BPD and ADHD have in common and what sets them apart in recent years. And today, people living with both conditions can access effective, individualized care that reflects their unique needs. 

When you need support for your mental health, Rula’s extensive network of therapists is just a few clicks away. With our therapist-matching program, you can find a provider who takes your insurance and schedule your first appointment for as soon as tomorrow. And thanks to our digital platform, you can see your therapist via a convenient online appointment at a time and place that works best for you.

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