Is it Bipolar, Bpd or ADHD


Connection between borderline personality and Attention Deficit disorders. There is a lot of similitary between BPD and ADHD but they remain two separate disorders. You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering
Meme page en Francais / Same page in french
Data, studies
What they say ?
Aapel view
Data, studies (statistics, prevalence, comorbidity, co-occurency)
* Biederman J, Newcorn J, Sprich S. - Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston
1991Am J Psychiatry. - Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders.
"The literature supports considerable comorbidity of attention deficit hyperactivity disorder with conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, learning disabilities, and other disorders, such as mental retardation, Tourette's syndrome, and borderline personality disorder"

* Fischer M, Barkley RA, Smallish L, Fletcher K. - Dept. of Neurology, Medical College of Wisconsin, Milwaukee, USA.
2OO2 J Abnorm Child Psychol. - Young adult follow-up of hyperactive children
At follow-up the yound adult group met criteria for ADHD (5%); major depressive disorder (26%); and histrionic (12%), antisocial (21%), passive-aggressive (18%), and borderline personality disorders (14%)
Results suggest that hyperactive children are at significant risk for at least 1 nondrug disorder in young adulthood, principally major depression and several personality disorders

* Fossati A, Novella L, Donati D, Donini M, Maffei C. - San Raffaele Vita-Salute University, Faculty of Psychology, Milano, Italy
2OO2 Compr Psychiatry. - History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder
The results of this study seem to support the hypothesis of an association between history of childhood ADHD symptoms and adult BPD diagnosis

ADHD and BPD, what they say
* "Very different disorders, with the similarities of distractibility and impulsiveness and sometimes lowered self-esteem -- but many differences in symptoms and etiology
The neurological excitability of bpd is related to emotional overreaction and difficulty controling / modulating anxiety and anger; the neurological aspect of add leads to distractibility and difficulty in focusing and concentrating--but it is not an emotional disorder or disorder of the self.
Stimulant medication is indicated with add, but not with bpd" (Daniel C Claiborn 2OO3)

* "Many people who have BPD also have other concerns, such as ... attention deficit disorder" (BPD Central 2OO1)

* "The differential diagnosis of ADHD in adults includes agitated depression, hypomania, dissociative disorders, borderline or antisocial personality disorder, alcohol and drug abuse or withdrawal" (Mina Dulcan, M.D ,…,“ATTENTION-DEFICIT/HYPERACTIVITY DISORDER”,American Academy of Child and Adolescent Psychiatry 1997)

* "All three of these diagnoses are distinct and very real entities. An individual can have one, both or all three diagnoses. Since they are all treated differently, the diagnoses must be made carefully and accurately. Bipolar is the least frequent, but the one that can be triggered by treating the other two.

Although MRI studies of the right prefrontal cortex may soon be available to diagnose AD(H)D, at this time there are no imaging or other studies that will confirm or rule out a diagnosis. The DSM is the diagnostic tool that establishes the official diagnoses, and in my opinion they are excellent and extraordinarily useful.
The primary symptom of bipolar is mania (or hypomania). Most individuals with depression do not have mania or hypomania. Cycling is not necessary for the diagnosis of bipolar, but it is common. Cycling is not exclusive to bipolar disorder. Most individuals with the BPD have mood swings, but they do not get mania or hypomania - their mood swings mostly vary within the realm of feeling bad.

The presence of mania or hypomania establishes the diagnosis of bipolar, which can begin as an infant. The BPD begins at puberty. AD(H)D appears to be a genetic phenomenon, not a disease, and does begin in early childhood - in fact, those with exclusively the inattention part of AD(H)D may be very "easy" babies.

The similarities are the irritability, the mood instability, and overreacting to stress. There are subtle differences however. Bipolars - especially children - respond badly to being told "no" whereas those with ADHD don’t like excessive stimulation, and borderlines cycle downward to dysphoria (anxiety, rage, depression and despair) under stress - particularly when experiencing fear or anger.

I suspect both the BPD and bipolar are a form of epilepsy (brain cells firing inappropriately and out of control). That’s why anti-epilepsy medications work so well. Bipolar may be epilepsy on top of a normal seasonal up and down pattern that our ancestors needed to survive the severe ice ages tens of thousands of years ago where hibernation in the winter and increased energy in the spring/summer were beneficial. The BPD is epilepsy in the "trapped, cornered, wounded animal" instinct. In the BPD, there are abnormalities in the brain’s "adrenergic and cholinergic systems" which respond to lithium and carbamazepine, abnormalities in the central dopaminergic systems causing psychotic symptoms that respond to low-dose neuroleptics, and abnormalities in the central nervous system serotonergic system underlying impulsive aggressive behaviors that respond to serotonergic agents such as Prozac.

Bipolar needs to be aggressively treated with antiepilepsy medications and antipsychotics prior to treating the other diagnoses, although in adults who also have the BPD I’ll usually treat with an SSRI first for a week prior to adding the antiepilepsy medication Tegretol because of the profound benefits waiting a week prior to initiating Tegretol can bring. Antipsychotics like Risperdal and Seroquel may be necessary early on"
((Leland M. Heller, MD, “Is it Bipolar, BPD or ADHD?” , ask the doctor)

Aapel view of ADHD and Borderline Personality Disorder
Here is our feeling.

Is ADHD and BPD two different disorders?
Yes, as you can read previously, each one has different characteritics.If they were the same disorder, it will be useless to have both in the DSM

Is it possible to have both ?
Yes, even if they are two different disorders, one person can have BPD and ADHD at the same time

ADHD Differential diagnosis
According to the DSM-IV, Attention-Deficit/Hyperactivity Disorder is not diagnosed if the symptoms are better accounted for by another mental disorder : Pervasive Developmental Disorder (autism, asperger,...), Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder (bipolarity, depression,...), Anxiety Disorder (gad,ptsd,...), Dissociative Disorders, or a Personality Disorder).
Or personality change due to a general medical condition, or a Substance-Related Disorder.

Does ADHD in children lead to adult BPD ?
It is true in numerous cases but not in all cases

Is BPD an adult disorder and ADHD a child disorder ?
On the hole, yes but not always. It is possible to diagnose BPD during childhoold (read studies) like it is possible to diagnose Adult ADHD

Does responding well to a stimulant drug proves a person has ADHD ?
Stimulants allow many people to focus and pay better attention, whether or not they have ADHD. The improvement is just more noticeable in people with ADHD (From NIMH ADHD page)

... (to be translated)
Conclusion ?
La coexistence des deux troubles, bien que non « obligatoire » semble évidente.

Les deux semblent donc pouvoir cohabiter ce qui n’est absolument pas incompatible quand l’on sait que se comporter "normalement", "fonctionner", pour une personne borderline est souvent épuisant.

Quant à distinguer les deux, cela ne semble pas poser de gros problèmes, les critères DSM  étant très différenciés notamment pas le coté "problème d'attention" qui semble le "coeur" du TDA.
La conclusion qui sera toujours la même dans ces pages est « Lorsque l’on pose un diagnostic de trouble d’attention, il est important de voir s’il n’y aurait pas "autre chose" derrière tout cela et notamment un trouble de la personnalité borderline (tout du moins en « gestation »)(...et inversement)

A propos des stimulants
A noter que les patients souffrant d'ADHD, TDAH peuvent être traités chimiquement par Methylphenidate Chlorhydrate (ritaline) ou dextroamphetamine (Dexedrine) qui ont un "effet stimulant de type amphétaminique, conséquence d'une augmentation de la libération de dopamine au niveau central" (biam), et ce en plus d'une prise en charge / thérapie adaptée

AAPEL - Back to BPD summary page

All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does

Last update  2012
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Author, , founder president of the Aapel