We all know that the experience of living with ADHD is unique for every person. Though the majority of folks with ADHD struggle with the main symptoms like impulsivity, forgetfulness, inability to maintain focus for a long time, and constantly changing activities, other traits may vary greatly from person to person. This disparateness makes ADHD hard to diagnose.
However, the symptoms that are primarily associated with ADHD can also be misleading and indicate many other mental health conditions. Anxiety disorders, autism spectrum disorder, sleep, and bipolar disorders, and many more different conditions can manifest themselves in some people similar to ADHD (and confuse and annoy the poor doctors who are just trying to diagnose them and be left alone).
One of such conditions that sort of mimic some aspects of ADHD is borderline personality disorder. Though at first look, they are quite distinct, they overlap in some very curious ways. That's what we will dive into today, so buckle up; there's a looooooot we need to talk about.
[What is BPD?] What is borderline personality disorder?
Let's start by properly defining borderline personality disorder. Like ADHD, borderline personality disorder (further BPD) is a mental health condition. This disorder primarily impacts the ability of a person to manage emotions, causing problems in everyday life functioning.
Similarly to many other personality disorders, BPD usually begins during the teenage years. In general, women are more likely to be diagnosed with BPD, though it doesn't mean that men are not susceptible to it.
If you have parents or close relatives with BPD, you are more inclined to develop this condition as well (1). But people who don't are immune to it - everybody can develop BPD, especially when you've already grappled with such mental health conditions as anxiety, depression, or eating disorders. Past trauma, childhood maltreatment, and parental substance abuse also can contribute to the development of BPD.
Many people mix up BPD with bipolar disorder. I know, I know, they sound almost the same. Despite these two conditions having multiple similar symptoms, they are quite different.
Folks with BPD face mood and behavior changes when going through stress or because of interactions with other people, while the ones with bipolar disorder have more sustained changes in moods. Bipolar disorder also involves much more dramatic mood changes. In most cases, people with bipolar disorder will have distinct periods of mood shifts - highs (manias) and lows (depressions) with intervals of stable mood.
But let's not sidetrack from our main topic of interest and get into more detail about the symptoms of BPD.
[BPD Symptoms] What are the main symptoms of borderline personality disorder?
We have already discovered that because of their condition, folks with BPD struggle with managing their emotions. But what are the most common ways this struggle manifests?
An extremely common symptom that people with BPD experience is intense mood swings. You may say that having mood swings occasionally is one of the most normal human things overall. But with BPD, it's not a rare occurrence but a way of living.
The emotional rollercoaster that folks with BPD experience is not only frequent but also quite extreme - they may go from feeling joyful to utterly devastated in mere minutes. Like normal mood swings, the ones characteristic of BPD are usually caused by some external trigger - stress, traumatic events, or lack of sleep. Yet, scientists are still trying to figure out how stress and BDP relate (2).
BPD often comes with anger issues. Folks with this condition are prone to intense and inappropriate bursts of outrage and resentment. They can express their anger in many ways, from bitter, sarcastic remarks to even getting involved in physical fights.
That might seem strange, but despite having such intense emotions, people with BPD also may feel empty and numb for long periods.
If you have BPD, you may feel an intense fear of abandonment and go to great lengths to avoid being rejected by people. But you may instantaneously change your opinion about people - going from idealizing them to disregarding them without any serious reason.
Not only your opinion about others can suffer because of your BPD - but you may also feel drastic changes in your self-esteem.
Folks with BPD may also experience intense paranoia and lose contact with reality for hours.
They can often get involved in dangerous behaviors, like gambling, drug addiction, or reckless driving. Self-sabotage, binge eating, and compulsive buying are also not uncommon. BPD can make people suddenly quit their jobs or relationships, no matter how successful or happy they feel. Unfortunately, along with these tendencies also comes the predisposition to self-harm and suicidal thoughts.
[ADHD and BPD Similarities] Why borderline personality disorder and ADHD are similar?
Though ADHD and BPD may seem barely compatible, they overlap in some crucial symptoms. The amount of research that tries to make sense of this symptom overlap (quite a few studies on the topic!) complicates the lives of medical scientists and doctors.
The shared territory primarily lies in impulsivity, emotional dysregulation, and difficulties in interpersonal relationships. Yet the nature of these symptoms is quite different in those who have ADHD vs. BPD.
Impulsivity is a multifaceted concept broadly defined as a tendency to behave on a whim without thinking about the consequences of your actions. Impulsivity in ADHD is motor impulsivity, characterized by spontaneous physical responses.
In BPD, impulsivity is often a result of stress and is intrinsically linked to emotional dysregulation. That's why they manifest in different ways - people with ADHD are generally restless and often interrupt others. In contrast, people with BPD can harm themselves or suffer major emotional outbursts as a reaction to stress.
Along with impulsivity, folks with ADHD and BPD often share a related temperament trait of novelty seeking - a tendency to pursue new experiences with intense emotional sensations. This desire for thrilling and exciting activities comes with disorderliness, a struggle to maintain financial stability, and an overall carefree attitude toward life. This novelty-seeking can cause people with BPD to participate in risky activities that can harm them.
As for emotional dysregulation - the difficulty in regulating one's emotions - this symptom is much more severe in people with BPD. However, in ADHD and BPD, emotion dysregulation manifests itself similarly - by increased instability, intense negative emotions, and a slow return to the normal basic emotional state.
But compared to folks with ADHD, those with BPD are more likely to get aggressive and hostile; they also show a stronger propensity to express their anger when provoked and to direct anger on themselves. Folks with ADHD have better control over their emotions, and they are more likely to use adaptive cognitive strategies than folks with BPD (4).
Both folks with ADHD and BPD usually have problems with interpersonal relationships - the ability to form and maintain bonds with people around them. But there's also an important distinction in why people with ADHD and BPD struggle with connecting with people and building healthy relationships. In BPD, interpersonal problems are one of the most prominent symptoms inherent to the condition. BPD itself comes with the instability of the perception of other people, general sensitivity and emotional vulnerability, and the fear of abandonment.
On the other hand, in ADHD, the interpersonal problems are more of a result of the main symptoms of inattention, impulsivity, and hyperactivity.
So, though there's a considerable intersection in the symptoms between BPD and ADHD, if you explore it a bit deeper, you'll see that there are some aspects of these symptoms that are unique to each of these conditions.
[ADHD + BPD?] Can you have both ADHD and BPD?
Living with ADHD or BPD is not an easy thing on its own, but can you have both? I'm sorry to bring the bad news. BPD and ADHD may also be comorbid (that's a fancy word that means you can have them at the same time). And it's not such a rare occurrence. Several studies have found that childhood ADHD symptoms are significantly correlated with an increased likelihood of BPD diagnosis in adulthood (4).
Does it make it even more complicated for psychiatrists to give you a proper diagnosis? Absolutely.
We already talked about people being more likely to develop BPD if their relatives have it or some other mental illnesses. ADHD tends to run in families as well. So, when suspecting ADHD or BPD, psychiatrists will probably ask many questions about their patient's family medical history. The same goes with the history of trauma - as many people with BPD experienced trauma in their childhood or adolescence.
People who display symptoms of ADHD and BPD need to undergo a thorough psychological evaluation to be diagnosed with any or both of these conditions. They may use questionnaires to acquire information about symptoms and symptom history.
Psychiatrists will also work with your general medical practitioner and make you pass multiple medical tests to rule out any other conditions and illnesses that may provoke the symptoms you experience.
As you see, getting a diagnosis may be a lengthy process.
So, if you experience symptoms that are associated with ADHD or BPD, it's better not to waste time and contact your doctor. It's normal to feel frustrated or overwhelmed when being diagnosed with mental health conditions. Yet, the sooner you understand what is going on with you, the sooner your doctors can start your treatment and make your life a bit easier.
[BPD and ADHD Treatment] What about the treatment? Can these conditions be effectively treated if comorbid?
ADHD and BPD are treated quite differently, so if you have been diagnosed with both of these conditions, a combination of different treatments is needed to keep them at bay.
How is ADHD treated?
ADHD can be treated with different medications. Usually, folks with ADHD are prescribed some stimulant that helps their brains to concentrate better. In some cases, stimulants are not very effective or have unwanted side effects, then non-stimulants are prescribed. These medications can improve symptoms like concentration and impulse control. Often, ADHD comes with depression and anxiety, so the doctors may suggest you start taking antidepressants.
As for the other methods, cognitive-behavioral therapy is the most suggested option. Frankly speaking, the most effective treatment of ADHD is multimodal - when you combine medical treatment with therapy and skills training.
What about BPD?
BPD is mostly treated by psychotherapy. Dialectical behavior therapy is considered the most effective for BPD, as it generally stems from cognitive behavioral therapy but is specially adapted for people who feel emotions very intensely. We know that cognitive-behavioral therapy focuses on helping you change harmful and unhelpful patterns of thinking and behaving that you may be stuck in.
Dialectical behavior therapy is also focused on this, but it also helps you to accept who you are and get a sense of why you might do things like harming yourself or making rash decisions about your life. Dialectical behavior therapy may help folks with BPD. Still, it is more likely to work if they are committed to making consistent changes in their lives, do homework assignments, work in groups occasionally, and generally focus on the present and future instead of overanalyzing and regretting the past.
However, dialectical behavior therapy is not the only type of psychotherapy used for treating BPD. There's also a mentalization-based treatment that teaches folks with BPD to recognize their mental state better and to manage their emotions and impulses better.
Also notable is transference-focused psychotherapy, which uses your relationship with your therapist as a model that helps you to see how you interact with people and use these insights to build healthier and more stable relationships with others. These types of psychotherapy were also created primarily to treat BPD, so they may be quite effective.
We also need to catch another psychotherapeutic practice that is commonly used for treating BPD - schema-focused therapy. You may have heard about it, as it has become quite popular over the last few years. This therapy focuses on identifying and changing specific unhealthy and self-defeating behaviors and ways of thinking and uses a combination of cognitive, behavioral, and emotion-focused techniques (5).
So, you have plenty of available options here that may help. But is there something else besides therapy that can make your life with BPD a bit easier? Are there any medications created specifically for BPD? Unfortunately, there are no medications that treat BPD as a whole, but there are some that can regulate some symptoms. Like with ADHD, antidepressants can help regulate mood fluctuations or depressive tendencies (4).
Also, don't forget about the different support groups. This treatment method is often overlooked, but it can make a great difference. Especially considering that people with BPD struggle with interpersonal relationships.
Sharing your issues, getting constructive and helpful information, and receiving encouragement and understanding from people struggling with the same condition are already great starts that may lead you to build healthier relationships with others and better regulate your emotions.
This is where the Numo app becomes a vital tool in your journey. Numo offers unique 'squads' and 'tribes'—akin to online forums or hubs—where individuals with ADHD and BPD can connect. These groups provide a platform for sharing concerns, exchanging advice, and offering mutual support.
In these communities, you'll find people who understand both the struggles of ADHD and the complexities of BPD. By hanging around in our nurtured hubs, you can receive tailored advice and support from those who've navigated similar challenges, thereby aiding in building healthier relationships and improving emotional regulation.
By the way, if treated properly, can BPD become less bothersome?
Yes! BPD has some pretty cool rates of remission. One study that assessed a large group of patients with BPD for over ten years found that over 35% of patients with BPD went into remission after two years, and after ten years, 91% were in remission (6). The scientists who worked on this study noted that some patients went into remission not because they got better at regulating their emotions and developing better interpersonal skills but because they started to avoid interpersonal relationships. But still, remission was sustained for over eight years in 75% of patients, which is quite promising!
BPD and ADHD are conditions that can be very challenging in many aspects - from diagnostics to treatment (I'm not even talking about just trying to navigate the everyday hurdles of our existence). But if you have one of them or both, don't despair. You still can live a fulfilling life, build meaningful relationships, and feel good about yourself if you embrace these conditions and the challenges they come with.
Embracing BPD and ADHD doesn't mean surrendering to these challenges; it's rather about integrating them into the fabric of your life and personal growth - committing to self-awareness, seeking appropriate support, and using different therapeutic practices. This journey is not easy, but the destination is realizing that a happy and rewarding life is within your reach.
2 Frontiers in Psychology. How Do Stress Exposure and Stress Regulation Relate to Borderline Personality Disorder?
3 Borderline Personality Disorder and Emotion Dysregulation. Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited – a review-update on common grounds and subtle distinctions
5 PLoS ONE. Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions