Skip to main content Accessibility help
×
Home

Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder

  • Alexandra Philipsen (a1), Matthias F. Limberger (a2), Klaus Lieb (a1), Bernd Feige (a1), Nikolaus Kleindienst (a3), Ulrich Ebner-Priemer (a3), Johanna Barth (a3), Christian Schmahl (a3) and Martin Bohus (a3)...

Abstract

Background

Clinical experience suggests that people with borderline personality disorder often meet criteria for attention-deficit hyperactivity disorder (ADHD). However, empirical data are sparse.

Aims

To establish the prevalence of childhood and adult ADHD in a group of women with borderline personality disorder and to investigate the psychopathology and childhood experiences of those with and without ADHD.

Method

We assessed women seeking treatment for borderline personality disorder (n=118) for childhood and adult ADHD, co-occurring Axis I and Axis II disorders, severity of borderline symptomatology and traumatic childhood experiences.

Results

Childhood (41.5%) and adult (16.1%) ADHD prevalence was high. Childhood ADHD was associated with emotional abuse in childhood and greater severity of adult borderline symptoms. Adult ADHD was associated with greater risk for co-occurring Axis I and II disorders.

Conclusions

Adults with severe borderline personality disorder frequently show a history of childhood ADHD symptomatology. Persisting ADHD correlates with frequency of co-occurring Axis I and II disorders. Severity of borderline symptomatology in adulthood is associated with emotional abuse in childhood. Further studies are needed to differentiate any potential causal relationship between ADHD and borderline personality disorder.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder
      Available formats
      ×

Copyright

Corresponding author

Professor Martin Bohus, Central Institute of Mental Health Mannheim, J5, D-68159 Mannheim, Germany. Email: martin.bohus@zimannheim.de

References

Hide All
1 Lieb, K, Zanarini, MC, Schmahl, C, Linehan, MM, Bohus, M. Borderline personality disorder. Lancet, 2004; 364: 453–61.
2 Bohus, M, Schmahl, C, Lieb, K. New developments in the neurobiology of borderline personality disorder. Curr Psychiatry Rep 2004; 6: 4350.
3 Skodol, AE, Gunderson, JG, McGlashan, TH, Dyck, IR, Stout, RL, Bender, DS, Grilo, CM, Shea, MT, Zanarini, MC, Morey, LC, Sanislow, CA, Oldham, JM. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry 2002; 159: 276–83.
4 Bohus, M, Haaf, B, Simms, T, Limberger, MF, Schmahl, C, Unckel, C, Lieb, K, Linehan, MM. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004; 42: 487–99.
5 Skodol, AE, Pagano, ME, Bender, DS, Shea, TM, Gunderson, JG, Yen, S, Stout, RL, Morey, LC, Sanislow, CA, Grilo, CM, Zanarini, MC, McGlashan, TH. Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychol Med 2005; 35: 443–51.
6 Black, DW, Blum, N, Pfohl, B, Hale, N. Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Personal Disord 2004; 18: 226–39.
7 Fossati, A, Novella, L, Donati, D, Donini, M, Maffei, C. History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study. Compr Psychiatry 2002; 43: 369–77.
8 Wender, PH, Wolf, LE, Wasserstein, J. Adults with ADHD. An overview. Ann N Y Acad Sci 2001; 931: 116.
9 Faraone, SV, Biederman, J, Spencer, T, Wilens, T, Seidman, LJ, Mick, E, Doyle, A. Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry 2000; 48: 920.
10 Biederman, J, Faraone, SV. Attention-deficit hyperactivity disorder. Lancet 2005; 366: 237–48.
11 Weiss, G, Hechtman, L, Milroy, T, Perlman, T. Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children. J Am Acad Child Adol Psychiatry 1985; 24: 211–20.
12 Barkley, RA. A critique of current diagnostic criteria for attention deficit hyperactivity disorder: clinical and research implications. J Dev Behav Pediatr 1990; 11: 343–52.
13 Mannuzza, S, Klein, RG, Addalli, KA. Young adult mental status of hyperactive boys and their brothers: a prospective follow-up study. J Am Acad Child Adol Psychiatry 1991; 30: 743–51.
14 Faraone, SV, Biederman, J, Mick, E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36: 159–65.
15 Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163: 716–23.
16 Linehan, MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press, 1993.
17 Bohus, M, Haaf, B, Stiglmayr, C, Pohl, U, Boehme, R, Linehan, M. Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder – a prospective study. Behav Res Ther 2000; 38: 875–87.
18 First, MB, Gibbon, M, Spitzer, RL, Williams, JB, Benjamin, L. Structured Clinical Interview for DSM–IV Axis I Disorders (SCID–I) – Clinical Version. American Psychiatric Press, 1997.
19 Loranger, AW, Sartorius, N, Andreoli, A, Berger, P, Buchheim, P, Channabasavanna, SM, Coid, B, Dahl, AA, Diekstra, RFW, Ferguson, B, Jakobsberg, L, Mombour, W, Pull, C, Ono, Y, Regier, DA. Deutschsprachige Fassung der International Personality Disorder Examination (IPDE) . [German Version of the International Personality Disorder Examination: IPDE World Health Organization, 1998.
20 Retz-Junginger, P, Retz, W, Blocher, D, Weijers, HG, Trott, GE, Wender, PH, Rossler, M. Wender Utah Rating Scale (WURS-k) Die deutsche Kurzform zur retrospektiven Erfassung des hyperkinetischen Syndroms bei Erwachsenen [Wender Utah Rating Scale. The short-version for the assessment of the attention-deficit hyperactivity disorder in adults]. Nervenarzt 2002; 73: 830–8.
21 Rosler, M, Retz, W, Retz-Junginger, P, Thome, J, Supprian, T, Nissen, T, Stieglitz, RD, Blocher, D, Hengesch, G, Trott, GE. Instrumente zur Diagnostik der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter [Tools for the diagnosis of attention-deficit/hyperactivity disorder in adults. Self-rating behaviour questionnaire and diagnostic checklist]. Nervenarzt 2004; 75: 888–95.
22 Bohus, M, Limberger, M, Frank, U, Chapman, AL, Kühler, T, Stieglitz, RD. Psychometric properties of the Borderline Symptom List (BSL). Psychopathol 2007; 40: 126–32.
23 Bernstein, DP, Fink, L, Handelsman, L, Foote, J, Lovejoy, M, Wenzel, K, Sapareto, E, Ruggiero, J. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994; 151: 1132–6.
24 Wilens, TE, Biederman, J, Spencer, TJ. Attention deficit/hyperactivity disorder across the lifespan. Ann Rev Med 2002; 53: 113–31.
25 Kessler, RC, Adler, LA, Barkley, R, Biederman, J, Conners, CK, Faraone, SV, Greenhill, LL, Jaeger, S, Secnik, K, Spencer, T, Ustün, TB, Zaslavsky, AM. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry 2005; 57: 1442–51.
26 Biederman, J, Faraone, SV, Monuteaux, MC. Differential effect of environmental adversity by gender: Rutter's index of adversity in a group of boys and girls with and without ADHD. Am J Psychiatry 2002; 159: 1556–62.
27 Wilens, TE. Mechanism of action of agents used in attention-deficit/hyperactivity disorder. J Clin Psychiatry 2006; 67 (suppl 8): 32–8.
28 Knopik, VS, Heath, AC, Jacob, T, Slutske, WS, Bucholz, KK, Madden, PA, Waldron, M, Martin, NG. Maternal alcohol use disorder and offspring ADHD: disentangling genetic and environmental effects using a children-of-twins design. Psychol Med 2006; 36: 1461–71.
29 Zweig-Frank, H, Paris, J, Guzder, J. Psychological risk factors for dissociation and self-mutilation in female patients with borderline personality disorder. Can J Psychiatry 1994; 39: 259–64.
30 Silk, KR, Lee, S, Hill, EM, Lohr, NE. Borderline personality disorder symptoms and severity of sexual abuse. Am J Psychiatry 1995; 152: 1059–64.
31 Zanarini, MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin North Am 2000; 23: 89101.
32 Zanarini, MC, Yong, L, Frankenburg, FR, Hennen, J, Reich, DB, Marino, MF, Vujanovic, AA. Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis 2002; 190: 381–7.
33 Rucklidge, JJ, Brown, DL, Crawford, S, Kaplan, BJ. Retrospective reports of childhood trauma in adults with ADHD. J Atten Disord 2006; 9: 631–41.
34 Watson, S, Chilton, R, Fairchild, H, Whewell, P. Association between childhood trauma and dissociation among patients with borderline personality disorder. Aust N Z J Psychiatry 2006; 40: 478–81.
35 Simeon, D, Nelson, D, Elias, R, Greenberg, J, Hollander, E. Relationship of personality to dissociation and childhood trauma in borderline personality disorder. CNS Spectr 2003; 8: 755–62.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder

  • Alexandra Philipsen (a1), Matthias F. Limberger (a2), Klaus Lieb (a1), Bernd Feige (a1), Nikolaus Kleindienst (a3), Ulrich Ebner-Priemer (a3), Johanna Barth (a3), Christian Schmahl (a3) and Martin Bohus (a3)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *