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Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder

  • K. LAMPE (a1), K. KONRAD (a2), S. KROENER (a1), K. FAST (a3), H. J. KUNERT (a1) and S. C. HERPERTZ (a4)...

Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness.


The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups.


ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole.


Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.

Corresponding author
*Address for correspondence: Professor Dr Sabine C. Herpertz, Director of the Department of Psychiatry and Psychotherapy, Rostock University, Gehlsheimer Str. 20, D-18147 Rostock, Germany. (Email:
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R. A. Barkley (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin 121, 6594.

R. A. Barkley , M. Fischer , L. Smallish & K. Fletcher (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology 111, 279289.

M. Bohus , C. Schmahl & K. Lieb (2004). New developments in the neurobiology of borderline personality disorder. Current Psychiatry Reports 6, 4350.

E. Davids & M. Gastpar (2005). Attention deficit hyperactivity disorder and borderline personality disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 29, 865877.

J. H. Dowson , A. McLean , E. Bazanis , B. Toone , S. Young , T. W. Robbins & B. J. Sahakian (2004 a). Impaired spatial working memory in adults with attention-deficit/hyperactivity disorder: comparisons with performance in adults with borderline personality disorder and in control subjects. Acta Psychiatrica Scandinavica 110, 4554.

J. H. Dowson , A. McLean , E. Bazanis , B. Toone , S. Young , T. W. Robbins & B. Sahakian (2004 b). The specificity of clinical characteristics in adults with attention-deficit/hyperactivity disorder: a comparison with patients with borderline personality disorder. European Psychiatry 19, 7278.

M. Fischer , R. A. Barkley , L. Smallish & K. Fletcher (2002). Young adult follow-up of hyperactive children: self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. Journal of Abnormal Child Psychology 30, 463475.

T. W. Frazier , H. A. Damaree & E. A. Youngstrom (2004). Meta-analysis of intellectual and neuropsychology test performance in attention-deficit/hyperactivity disorder. Neuropsychology 18, 543555.

M. Gaub & C. L. Carlson (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child and Adolescence Psychiatry 36, 10361045.

S. Herpertz , A. Gretzer , E. M. Steinmeyer , V. Mühlbauer , A. Schürkens & H. Sass (1997). Affective instability and impulsivity in personality disorder. Results of an experimental study. Journal of Affective Disorders 44, 3137.

S. C. Herpertz , H. J. Kunert , U. B. Schwenger & H. Sass (1999). Affective responsiveness in borderline personality disorder: a psychophysiological approach. American Journal of Psychiatry 156, 15501556.

A. S. Hervey , J. N. Epstein & F. F. Curry (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology 18, 485503.

R. C. Kessler , L. Adler , R. Barkley , J. Biederman , C. K. Conners , O. Demler , S. V. Faraone , L. L. Greenhill , M. J. Howes , K. Secnik , T. Spencer , T. B. Ustun , E. E. Walters & A. M. Zaslavsky (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716723.

H. J. Kunert , H. W. Drücke , H. Sass & S. C. Herpertz (2003). Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings. Journal of Personality Disorders 17, 497509.

G. D. Logan & W. B. Cowan (1994). On the ability to inhibit thought and action: a theory of an act of control. Psychological Review 91, 295327.

A. W. Loranger , N. Sartorius , A. Andreoli , P. Berger , P. Buchheim , S. M. Channabasavanna , B. Coid , A. Dahl , F. F. Diekstra & B. Ferguson (1994). The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry 51, 215224.

J. T. Nigg (2001). Is ADHD a disinhibitory disorder? Psychological Bulletin 127, 571598.

J. T. Nigg (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biological Psychiatry 57, 14241435.

B. F. Pennington & S. Ozonoff (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry 37, 5187.

A. Philipsen (2006). Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. European Archives of Psychiatry and Clinical Neuroscience 256 (Suppl. 1), i42i46.

M. I. Posner & S. E. Petersen (1990). The attention systems of the human brain. Annual Review of Neuroscience 13, 2542.

M. I. Posner , M. K. Rothbart , N. Vizueta , K. N. Levy , D. E. Evans , K. M. Thomas & J. F. Clarkin (2002). Attentional mechanisms of borderline personality disorder. Proceedings of the National Academy of Sciences of the United States of America 99, 1636616370.

P. Sachdev (1999). Attention deficit hyperactivity disorder in adults. Psychological Medicine 29, 507514.

R. Schachar , V. L. Mota , G. D. Logan , R. Tannock & P. Klim (2000). Confirmation of an inhibitory control deficit in attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology 28, 227235.

C. Schoechlin & R. R. Engel (2005). Neuropsychological performance in adult attention-deficit hyperactivity disorder: meta-analysis of empirical data. Archives of Clinical Neuropsychology 20, 727744.

J. A. Sergeant (2005). Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biological Psychiatry 57, 12481255.

J. Sprock , T. J. Rader , J. P. Kendall & C. Y. Yoder (2000). Neuropsychological functioning in patients with borderline personality disorder. Journal of Clinical Psychology 56, 15871600.

J. F. Stins , J. C. Polderman , D. I. Boomsma & E. J. de Geus (2005). Response interference and working memory in 12-year-old children. Child Neuropsychology 11, 191201.

T. Swirsky-Sacchetti , G. Gorton , S. Samuel , R. Sobel , A. Genetta-Wadley & B. Burleigh (1993). Neuropsychological function in borderline personality disorder. Journal of Clinical Psychology 49, 385396.

R. Tannock (1998). Attention deficit hyperactivity disorder: advances in cognitive, neurobiological and genetic research. Journal of Child Psychology and Psychiatry 39, 6599.

E. G. Willcutt , B. F. Pennington , R. K. Olson , N. Chhabildas & J. Hulslander (2005). Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: in search of the common deficit. Developmental Neuropsychology 27, 3578.

T. R. Wodushek & C. S. Neumann (2003). Inhibitory capacity in adults with symptoms of attention deficit/hyperactivity disorder (ADHD). Archives of Clinical Neuropsychology 18, 317330.

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Psychological Medicine
  • ISSN: 0033-2917
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