Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults

Abstract

It is important to accurately diagnose ADHD, BD, and BPD to ensure correct targeting of treatments and improvements in patient outcomes. However, there is a shortage of data about treatment of adults with ADHD and comorbid BD or BPD.

Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis

“…(13) Furthermore, high levels of EL are also observed in ADHD patients who do not present with co-occurring mental health disorders, (7) indicating that the association of EL with ADHD cannot always be accounted for by the presence of comorbid disorders such as bipolar or borderline personality disorders. (14) Debate as to whether EL reflects a core domain of ADHD in adults is ongoing. (5,15,16) In particular it is unclear whether medications such as stimulants and atomoxetine, used in the treatment of ADHD, also lead to reductions in EL.…”

Clinical, neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review

“…The high degree of similarity between ADHD and BPD and the chronic trait-like course that is common to both disorders may represent a risk in misdiagnosing ADHD patients as if they suffered from BPD (and vice versa) (Asherson et al, 2014;Carlotta et al, 2013;Kernberg & Yeomans, 2013). It is therefore important to clarify whether the shared symptoms are pointing to the same underlying psychopathology or whether BPD and ADHD can be differentiated at the level of structural, clinical or neuropsychological processes.…”

“…On the other hand, the core ADHD symptoms of hyperactivity and attention deficits, often accompany BPD symptomatology despite the fact that they are not a prerequisite for its diagnosis, and thus the two disorders should not be differentiated on the basis of their presence (van Dijk et al, 2011). Moreover BPD has a more "internalizing" clinical profile, with symptoms such as odd thinking, unusual perceptual or stress related dissociative experiences, paranoid/quasi-psychotic ideation (Speranza et al, 2011) and frantic avoidance of real or imagined abandonment (Asherson et al, 2014), which are not found in the more "externalizing" ADHD symptomatology. Severe pathology of object relations and severe identity disturbances favor the diagnosis of BPD, whereas the capacity for deep interpersonal relations and the integrity of the personal identity lean towards ADHD (Kernberg & Yeomans, 2013).…”

“…Due to the persistent nature of the condition adults with ADHD are more likely than the general population to have long-term consequences in social, academic and occupational functioning and to be accompanied by other mental health symptoms such as anxiety, depression, emotional lability, and sleep disturbances (Asherson et al, 2014;Faraone et al, 2000). In some studies the estimates of the proportion of children with ADHD who continued to meet full DSM-IVconsistent ADHD criteria as adults varied from 30% to 66% Faraone, Biederman, & Mick, 2005).…”

“…The symptoms that are mostly shared by the two disorders are deficits in impulse control, in attention and in planning, hyperactivity, emotional dysregulation (including states of aversive inner tension, intense anger, or difficulty controlling anger), disturbed interpersonal relationships and quality of life, hostility, loneliness, low self esteem, self-destructive behavior, substance abuse and trauma associated symptoms (Asherson et al, 2014;Davids & Gastpar, 2005;Evenden, 1999;Hervey, Epstein, & Curry, 2004;La Barbera, Sideli, Mistretta, Sartorio, & Grillo, 2009;Philipsen, 2006;Philipsen et al, 2009), with female patients reportedly sharing more clinical features than males (Philipsen et al, 2009). Moreover in one study (Fossati et al, 2015) the relation between childhood ADHD symptoms and BPD symptoms was found to be moderated significantly by female gender.…”