Attention deficit/hyperactivity disorder and borderline personality disorder: Differential diagnosis and comorbidity from childhood to adulthood [Disturbo da deficit dell'attenzione/iperattività e disturbo di personalità borderline: Diagnosi differenziale e comorbilità dall'età infantile all'età adulta]

Abstract

Aims Attention deficit/hyperactivity disorder is childhood-onset disorder that presents high rates of co-morbidity with personality disorders. Although the implications of having ADHD in childhood for the development of antisocial personality disorder have been long known, less information are available on its relationship with borderline personality disorder. Through a review of the literature, we explored the issue of co-morbidity between attention deficit/hyperactivity disorder and borderline disorder and analyze the role of possible modulating variables. Particular attention has been given to differential diagnosis between attention deficit/hyperactivity disorder in adulthood and borderline personality disorder from both clinical and neuropsychological perspectives. Method A systematic search was conducted on the databases of MedLine and PsyclNFO using combinations of the following keywords: attention deficit hyperactivity disorder, borderline personality disorder, aneuropsychology, and differential diagnosis. In particular, we selected studies on co-morbidity and differential diagnosis. As far as co-morbidity is concerned, we took epidemiological studies on samples of adults with attention deficit/hyperactivity disorder, prospective studies on samples of children with attention deficit/hyperactivity disorder, and retrospectives studies on samples of adults affected by borderline personality disorder into consideration. Due to the limited number of the studies, we also reported on non-controlled studies. With regard to differential diagnosis, we compared temperamental features and neuropsychologic alterations associated with the two disorders after examining the principal contributions of literature. For the purpose of understanding the relationship between childhood attention deficit/hyperactivity disorder and borderline personality disorder in adulthood, the most important contributions have been made by the antecedents of borderline disorder and its associated cognitive deficits. Specific studies related to the etiopathogenesis and treatments of the two disorders have not been included. Results Retrospective and prospective studies indicate that between 15% and 60% of children with attention deficit/hyperactivity disorder present borderline personality disorder in adulthood (Tables I, II). Although the two disorders have overlapping psychopathological aspects (impulsiveness, emotional lability, deficits in planning), in most studies they are considered as distinct nosographic entities. It was suggested that disorders of attention and impulsiveness may modulate the development of personality disorders, both expressing a vulnerable psychobiology that increases with exposure to environmental stressors. The few studies on this topic show a higher prevalence of a deficit in inhibitory control and strategic planning in children with early signs of borderline personality disorder (Table IV). Conclusions The study of co-morbidity between attention deficit/hyperactivity disorder and borderline personality disorder may deepen the cross-sectional aspects and dimensions of attention dysfunctions, may identify their connections with impulsive and affective instability which appear to be significant, not only in borderline personality disorder, but in many personality disorders. This, in turn, promotes the understanding of the relationship between cognitive processes and social behavior.