Severity of Childhood Attention-Deficit Hyperactivity Disorder—A Risk Factor for Personality Disorders in Adult Life?

Abstract

Some evidence points to an increased rate of cluster B and C personality disorders (PDs) in adult ADHD patients. In order to assess axis II disorders comprehensively we used the diagnostic instrument of the WHO. In sixty adult out-patients with ADHD according to DSM-IV criteria PDs were assessed with the International PD Examination (IPDE) and severity of childhood ADHD with the Wender-Utah-Rating Scale (WURS). We found at least one PD in 25% of cases. Cluster C PDs were most common (36.6%) followed by Cluster B (23.3%) and A (8.3%). Avoidant (21.7%) and borderline (18.3%) were the most frequent single PD entities. ADHD patients with PD suffered from significantly more severe childhood ADHD compared to those without co-occurring PD. Applying the IPDE we confirmed a high number of PDs among adult ADHD patients. Our findings point to a higher vulnerability for the development of PDs in patients with severe childhood ADHD.

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

“…The risk for ADHD children in later developing BPD was found to be greater than would be expected by chance (odds ratio 5:56) . Several hypotheses have been suggested to explain the interrelationship of the two disorders: a) BPD and ADHD are different expressions of the same disorder rather than two distinct clinical entities; b) ADHD may be an early manifestation (precursor) of BPD; c) ADHD and BPD are distinct disorders sharing common genetic and environmental risk factors; d) the disorders reinforce one another resulting in a synergistic effect; and e) the presence of one disorder increases the risk of developing the other (ADHD presenting a risk factor for the development of BPD) (Carlotta et al, 2013;Davids & Gastpar, 2005;Koumoula, 2012;Matthies et al, 2011;Philipsen, 2006;Philipsen et al, 2008;Prada et al, 2014;Speranza et al, 2011;Storebø & Simonsen, 2014).…”

“…According to Fossati et al (2002), BPD symptoms can better be understood on the basis of the persistent consequences of the ADHD symptoms, which means that ADHD in childhood may be considered a risk factor that predisposes to BPD in adults Philipsen et al, 2008). It is already established that there is a higher vulnerability for the development of PDs in patients with severe childhood ADHD Matthies et al, 2011;Stepp et al, 2012) and Miller et al (2008) stressed the association with BPD; in their study patients with childhood ADHD had a high risk (odds ratio 13.2) of later developing BPD in adolescence. Furthermore ADHD symptoms' predictive attribute of borderline personality features was found to be significant, even after controlling the effects of some variables such as childhood, traumas, anxiety and depression symptoms, ADHD symptoms could still work as predictors of borderline personality features (Dalbudak & Evren, 2014).…”

“…Matthies et al (2011): Severity of childhood attention-deficit hyperactivity disorder -a risk factor for personality disorders in adult life?Distel et al (2011): Borderline personality traits and adult attention-deficit hyperactivity disorder symptoms: a genetic analysis of comorbidity Fischer et al (2002)…”

A Five‐Factor Model Framework for Understanding Childhood Personality Disorder Antecedents

“…Moreover, this Five‐Factor Model trait perspective on ADHD revealed that FFM traits have a mediating effect on genetic risk and ADHD symptomatology (Martel, Nikolas, Jernigan, Friderici, & Nigg, ), and that they may account for the phenotypic heterogeneity found within the ADHD symptomatology (Martel, Goth‐Owens, Martinez‐Torteya, & Nigg, ). Although various studies have indicated a link between early ADHD and later personality disorders, it has recently been accentuated that it is in particular the children with persisting ADHD symptoms who are at increased risk for a personality disorder outcome (Matthies et al., ; Miller et al., ). From their findings, Martel, Goth‐Ownes, et al.…”

Personality Disorder in Adult Attention-Deficit/Hyperactivity Disorder

“…A n expanding literature describes the association of attentiondeficit/hyperactivity disorder (ADHD) with a range of personality disorders (PDs), particularly clusters B Helgeland et al, 2005;Jacob et al, 2014;Stepp et al, 2012) and C (Burket et al, 2005;Cumyn et al, 2009;Matthies et al, 2011;Miller et al, 2007). Personality dimensions, as opposed to diagnostic categories, examined in adults with ADHD include neuroticism (Jacob et al, 2007;Knouse et al, 2013;Nigg and Hinshaw, 1998), harm avoidance (Jacob et al, 2007), aggression-hostility (Martínez Ortega et al, 2010), low conscientiousness, novelty seeking , and lack of cooperativeness .…”