BPD vs ADHD: Whats the difference?

Borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD) are mental health conditions with overlapping symptoms. These two psychiatric disorders can also be present in the same individual, causing additional distress and negative impact on daily functioning. While these mental disorders may share similar presenting characteristics, there are also cardinal differences in their development and treatment.

What is BPD?

Borderline personality disorder, or BPD, is a mental health disorder that can cause excruciating emotional pain. Its core symptoms include emotional dysregulation, difficulty maintaining social relationships, impulsive behavior, and rapid fluctuations in mood.

Unfortunately, borderline personality disorder has historically been poorly understood and stigmatized. Professionals and loved ones of people with BPD must recognize that the symptoms of this disorder cause immense pain and suffering for the individual.

The development of borderline personality disorder is most often linked to traumatic experiences in childhood, although it can develop without a history of trauma. There is also a biological link to developing the disorder.

The symptoms of BPD begin before adulthood and cause marked distress in everyday life. However, it is a chronic condition that is manageable through treatment.

Borderline personality disorder symptoms include ^[2]:

• Instability of interpersonal relationships:
  • Attempts to avoid abandonment
  • Extreme idealization followed by a devaluation of loved ones
• Unstable self-image
• Impulsivity, particularly in self-damaging ways such as:
  • Recurrent suicidal behavior
  • Self-harm
• Rapid changes in mood and affect
  • Feelings of emptiness
  • Intense anger
• Dissociative symptoms

People with BPD may experience periods of relative stability with a worsening of symptoms during stressful times or periods of change.

People with this condition have an uncertain sense of their identity without the influence of external factors, which can cause intense sensitivity to change in relationships or other environmental factors, triggering heightened emotional reactivity and excessive seeking reassurance from other people.

Emotional reactivity may appear as anger that is difficult for them to control. Afterward, they may experience intense feelings of shame and guilt.

Impulsivity is more prevalent during stressful times or periods of change. For example, impulsivity in borderline personality disorder often takes the form of self-damaging behaviors like gambling, unsafe sex, suicide, or substance abuse.

Fear of abandonment is a core component of this disorder. In addition, many with BPD report low self-esteem or beliefs that they are “bad” or “evil”.

People with this disorder often have difficulty understanding context cues and may misperceive the intentions of others ^[1]. As a result, they may react to social situations in ways that appear over the top to others.

When alone, they may experience intense feelings of emptiness or a sense of not being real. Self-harm and suicidality can arise as unhealthy coping methods for managing these feelings of emptiness or apathy.

What is ADHD?

Attention-deficit/hyperactivity disorder, or ADHD, is a neurodevelopmental disorder with symptoms of inattention and/or hyperactivity-impulsivity that interfere with daily functioning across settings, including school, home and work ^[2].

Since it is a neurodevelopmental disorder, the symptoms must have been present before age 12 to meet the criteria for the disorder.

Attention-deficit/hyperactivity disorder symptoms include ^[2]:

• Difficulty sustaining attention or getting distractedeasily
• Disorganization, losing items
• Trouble breaking down larger tasks into smaller steps
• Fidgeting
• Impulsiveness
• Talking out of turn or having trouble waiting their turn
• Excessive talking or movement

There are two main subtypes of ADHD, inattentive and hyperactive-impulsive. It is possible to have a combination of the two subtypes.

Experts largely believe that ADHD symptoms are due to deficits in cognitive processes caused by how the brain develops.

Hyperactivity and impulsivity tend to be more prevalent during under or over-stimulation.

BPD vs ADHD: Symptoms

BPD and ADHD symptomology can present so similarly that research has shown screenings to determine a(n) ADHD or BPD diagnosis are ineffective due to the overlap of symptoms ^[4].

BPD and ADHD are also commonly diagnosed comorbidly, meaning someone can be diagnosed with both disorders.

Similarities

The most commonly overlapped symptoms between ADHD and BPD are:

• Impulsivity
• Emotional dysregulation

While not considered a specific diagnostic criterion for ADHD, emotional dysregulation is a predictive factor of whether ADHD symptoms will continue into adulthood ^[5].

People with BPD or ADHD have difficulty with executive functioning skills, such as:

• Planning
• Time management
• Multitasking
• Working memory
• Self-management

These challenges can impede social interactions, success in achieving goals, and tolerating distress.

Additionally, dissociative symptoms that can occur with borderline personality disorder may be mistaken for inattentiveness.

The functional impairment from these symptoms can present similarly, particularly in relationships with others. People with ADHD or BPD scored higher on loneliness scales in one previous study, indicating significant difficulty with interpersonal relationships for both disorders ^[4].

Researchers have found that adults with ADHD score higher on the borderline symptom list (BSL) than control participants but not high enough to meet the criteria for BPD ^[4].

Some have even theorized that ADHD may be an early indicator for BPD later in life.

Differences

External forces, like a friend being upset with them, tend to trigger impulsivity in those with BPD. For those with ADHD, however, impulsivity is considered as difficulty with inhibiting behavior due to cognitive functioning deficits ^[4].

The understanding of the association between childhood trauma and neurodevelopment is growing. Further research into the neurology of borderline personality disorder may show a link between cognitive processes like ADHD.

The main difference between BPD and ADHD is the self-destructive behaviors and affect dysregulation present with BPD but not ADHD. In addition, people with BPD experience rapid mood shifts that they feel unable to control.

Emotional dysregulation is often more severe for those with borderline personality disorder than attention-deficit/hyperactivity disorder.

BPD vs ADHD: Causes

There is no single cause for developing BPD or ADHD. However, genetics and environmental risk factors play a role in nearly all mental health disorders, including borderline personality disorder and attention-deficit/hyperactivity disorder.

ADHD and BPD have comparable biological vulnerabilities to their development ^[5]. Although BPD does have a genetic link, with ADHD it may be stronger. Furthermore, BPD may be more closely related to environmental factors such as childhood neglect or emotional abuse.

Adverse childhood experiences are associated with symptoms of ADHD and symptoms of BPD. Research findings have shown a correlation between adult ADHD and childhood physical abuse, while childhood emotional or sexual abuse correlated with BPD development or comorbid BPD and ADHD ^[3].

It is also possible that untreated ADHD in childhood increases the risk of experiencing abuse or neglect ^[5].

BPD vs ADHD: Treatment

Historically, the treatment approaches for BPD and ADHD were vastly different. ADHD was treated primarily by medication management with psychostimulants, while BPD was treated by psychotherapy.

Treatment options for these two disorders are becoming more closely aligned as research spotlights their similarities. A combination of psychotherapy and medication management is now considered the most effective approach for treating both conditions.

Medication management for those with borderline personality disorder aims to treat underlying mood disorders and help with mood stabilization.

There are also now non-stimulant medications available for managing ADHD symptoms.

Skills-building psychotherapy approaches are effective for treating both BPD and ADHD. These approaches include:

• Dialectal behavioral therapy (DBT)
• Cognitive behavioral therapy (CBT) 

DBT is the most widely researched therapeutic approach for borderline personality disorder. It is a form of CBT focusing on skills-building around attentional and cognitive processes relevant to impulse control and emotion regulation.

DBT uses individual therapy, psychoeducational groups, and check-in coaching sessions to learn and practice new distress tolerance skills. DBT effectively reduces anger, impulsivity, and suicidality symptoms for those with borderline personality disorder ^[4].

Adapted versions of DBT are currently being researched in treating ADHD symptoms effectively with promising results ^[4].

It is important to remember that even though the symptomology of these two disorders may present similarly, they have different triggers, biological mechanisms, and causes. Therefore, no one psychotherapy approach effectively works for every person.

Psychotherapy approaches proven useful in treating ADHD also include:

• Behavior management (primarily for kids)
• Neurofeedback

Other psychotherapy approaches to treating borderline personality disorder are ^[4]:

• Schema-focused therapies
• Psychodynamic therapy
• Mentalization-based treatment

Treatment for ADHD, BPD, or a combination of the two should be individualized based on the person’s symptoms.