A Clinician’s Guide to Differentiating ADHD and Borderline Personality Disorder

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Borderline personality disorder (BPD) — characterized by unstable interpersonal relationships, self-image and identity issues, and impulsivity — shares many traits and features with attention deficit hyperactivity disorder (ADHD), a comorbidity that is largely under-appreciated despite its significant clinical implications.The ADHD-BPD overlap comes into focus when we look beyond the core symptoms of ADHD — inattention, hyperactivity, and/or impulsivity — and consider the full effect of ADHD and its related features, like dopamine deficiency and emotional dysregulation, on various domains of life.

Through this lens, we can recognize how ADHD presents in ways that may resemble the symptoms of BPD, and how misdiagnosis may occur.In addition to sharing symptoms, BPD and ADHD can co-occur and influence each other’s presentation.

Differentiating BPD from ADHD isn’t just a matter of avoiding misattribution of symptoms, but of recognizing the possible presence of both conditions for adequate treatment.To merit a BPD diagnosis, individuals must display at least five of the nine symptoms of BPD listed in each section below by early adulthood and in various contexts.1 Nearly all symptoms of BPD may seem to resemble symptoms of ADHD; understanding the ‘why’ of each symptom will help determine its relationship to ADHD and/or BPD.Fear of abandonment can cause people with BPD to misinterpret situations or events where no real rejection or lasting separation has taken place.