What is the Relationship Between BPD and ADHD?

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For young people living with untreated ADHD, navigating daily life can be a challenge. Coping with another co-occurring condition like borderline personality disorder can make it even harder. 

One in three adults with ADHD may also live with BPD. The two conditions share symptoms, genetic patterns, and environmental risk factors. Moreover, young people with ADHD are more likely to develop BPD than those who don’t.

While the relationship between ADHD and BPD is complex, understanding it is important. Misdiagnosis of the conditions is common and can prevent young people from receiving the treatment they require. For young people living with both conditions, understanding the way they interact or reinforce each other is key to providing the best kind of care.

This blog looks into the relationship between BPD and ADHD, exploring the reasons that they co-occur so often in young adults. It also outlines the types of treatment available for both conditions that can support young people to live rich and fulfilling lives, whatever their presenting issues may be.

What Is Borderline Personality Disorder?

Borderline personality disorder is a neurodevelopmental disorder that affects the way a person sees themselves and the world around them. Young people with BPD may have a shifting or unclear sense of self, unstable relationships with others, intense emotions, and patterns of impulsive behaviours. BPD is usually diagnosed during late adolescence or early adulthood.

BPD can look very different from one young person to the next. For example, some young people may display their anger and other intense emotions outwardly, while others may keep it inside.

What Is Attention Deficit Hyperactivity Disorder?

Attention deficit hyperactivity disorder is a condition characterised by difficulties concentrating, inattentiveness, and/or impulsivity. ADHD is common in young children and is most often diagnosed around the age of 6. While symptoms can reduce or change as a young person grows older, many teenagers, adolescents, and adults also live with ADHD.

Why Does BPD Often Co-Occur with ADHD?

Scientists aren’t sure exactly how and why BPD and ADHD develop. Both conditions are linked to both genetic and environmental risk factors (things experienced by a young person as they grow up). For many young people, the causal pathway to their condition may be complex and made up of multiple different factors.

Researchers have highlighted two possible explanations for the high co-occurrence of BPD and ADHD. The first is that young people with ADHD are more likely to develop BPD because of the way ADHD symptoms affect their childhood and teenage years. The second is that BPD and ADHD share several developmental pathways that make the development of both conditions more likely. In reality, both explanations probably play a role.

ADHD: a Risk Factor for BPD

There are several ways that ADHD symptoms could contribute to the development of borderline personality disorder. Young people with ADHD may find it hard to read social cues, sometimes leading to interpersonal difficulties that may cause long-term distress – a risk factor for BPD.

They may also be more likely to develop defensive and protective traits because of the way that adults and other children respond to their behaviours. For example, adults may criticise or punish what they interpret as misbehaviour by children with ADHD. This may lead to a distorted sense of self where a child views themselves as ‘bad’ against a world of ‘good’ people, beginning a process of black-and-white thinking that can characterise BPD.

Biology, Neurology, and Genetics

Certain aspects of a young person’s neurology and biology may make them more vulnerable to developing both BPD and ADHD. Scientists have found that several regions, systems, and processes of the brain that work differently in people with ADHD show similar changes in individuals with BPD. These neurological changes may be rooted in both genetic patterns and environmental factors that affect the way a young person’s brain develops. 

Experiences of Trauma

Young people who experience difficult events in their early childhood are more likely to develop BPD. Early life adversity may include childhood abuse, neglect, or growing up in a home with someone who has a serious mental health condition. BPD may also be linked to traumatic experiences later in life: around 1 in 3 people with BPD are diagnosed with post-traumatic stress disorder at some point in their life. 

Research has found that ADHD is a risk factor for post-traumatic stress disorder, even when other factors are controlled. People with ADHD often report emotional abuse and neglect, and, less frequently, physical and sexual abuse. One study found a strong association between women with BPD who received a retrospective diagnosis of childhood ADHD and childhood emotional abuse.

Despite all the available research, the exact relationship between trauma, BPD, and ADHD isn’t clear. One suggestion is that the behavioural symptoms of ADHD may lead to difficult parent-child relationships that are more involve traumatic interactions and experiences of abuse and neglect. These adverse events may make the development of BPD more likely. Alternatively, experiences of childhood trauma may exacerbate ADHD symptoms, increasing the risk of both BPD and more severe ADHD.

Living With Co-Occurring BPD and ADHD

Young people living with co-occurring BPD and ADHD often find that the symptoms of one condition make the other more difficult to cope with – and vice versa. Several studies suggest that people living with both conditions are more impulsive than those who have just one of the disorders. Adolescents with both BPD and ADHD are more likely to have disruptive disorders and cluster B personality disorders than those with only BPD.

Treating Co-Occurring BPD and ADHD

For young people living with co-occurring BPD and ADHD, treating the two conditions simultaneously is especially important. Co-morbid ADHD can complicate and intensify symptoms of BPD, making it more difficult for young people to respond to and benefit from treatment. Inattentiveness and hyperactivity can make it more difficult for teenagers and adolescents to learn and practise the skills necessary to manage symptoms of both disorders.

Addressing the complexities and interplay between the two conditions helps young people to engage in therapy and recover from both disorders as they discover and build fulfilling and productive lives.

Some types of treatment for co-morbid BPD and ADHD include:

  • Dialectical Behavioural Therapy (DBT) – Dialectical behavioural therapy (DBT) is a type of talk therapy that was initially developed specifically for people with BPD. DBT supports young people to accept themselves and their emotions while learning skills that promote positive change. There are now many different adaptations of DBT that effectively treat other mental health conditions, including ADHD.
  • Transference-Focused Psychotherapy (TFP) – Transference-focused psychotherapy (TFP) uses the emotions and behaviours that come up during therapy sessions to help young people with BPD cope with their experiences in daily life. During TFP sessions, the relationship between the therapist and the young person becomes itself a tool of treatment.
  • Cognitive Behavioural Therapy (CBT) – CBT is a skills-focused therapy that helps young people to identify problematic thoughts and behavioural patterns and turn them into more positive ones. CBT focuses on the present, supporting young people to develop valuable skills in real time that they can practice and reinforce between sessions. CBT is a common and effective treatment for ADHD, often in combination with stimulant medication.
  • Medications – Psychiatrists usually prescribe stimulant medications to treat ADHD, but may also prescribe other types of medication. While there are no FDA-approved treatments for BPD, some young people with the condition take anti-depressant medications (such as SSRIs) or mood stabilisers.
  • Other Approaches – Young people with BPD and ADHD may benefit from many other types of treatment, including creative therapies, experiential therapies, and life skills development. Individuals with BPD usually work with a support team involving social workers, family members, and other people who can form a crisis plan for situations where they are at risk of serious harm.

The Wave – Specialist Mental Health Treatment for Young People

The Wave Clinic offers specialist mental health treatment for young people, supporting them to transform their lives and build fulfilling futures. Our whole-person approach combines expert clinical care with social responsibility, education, and a gap year experience surrounded by the sublime natural beauty of Malaysia, offering young people the space to grow, develop, and heal from within.

Our centre is a haven of close care and professional support that ensures the safety and security of every young person we work with. Our team of expert staff have come from countries all over the world, bringing with them unequalled experience, knowledge, and reputation. 

The Wave Clinic is recognised as a Global Centre of Excellence for the treatment of borderline personality disorder by major insurance providers including BUPA, CIGNA and Allianz.

Our BPD treatment program is consistently considered the program of choice for psychiatrists and mental health professionals from London and New York who are working with young people with a complex presentation and history of unsuccessful or partially successful treatments.

Our transformative programs use relational psychotherapy to explore and overcome interpersonal difficulties, helping young people achieve meaningful and lasting change.

If you’re concerned about the mental health of your child or another young person, contact us today. We’re here to answer any questions you may have and talk you through the next steps.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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