
Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) are two distinct mental health conditions. ADHD is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity and impulsivity. Unlike ADHD, BPD is a personality disorder defined by a persistent pattern of instability in one’s self-image and interpersonal relationships. However, ADHD and BPD share many similar characteristics such as impulsivity, challenges with emotional regulation, self-esteem issues, among others. On top of this, ADHD and BPD often co-occur. Indeed, the prevalence of BPD among people with ADHD is 37% compared to 1-3% in the general population. Overlapping symptoms in ADHD and BPD pose challenges for diagnosis. As treatment approaches for ADHD and BPD vary significantly, receiving an accurate diagnosis is a crucial step towards managing symptoms and beginning to heal. In order to avoid misdiagnosis, it’s important that individuals and clinicians understand the ways ADHD and BPD are both similar to and distinct from one another.

How Are ADHD and BPD Different?
ADHD: A Neurodevelopmental Disorder
Attention Deficit Hyperactivity Disorder (ADHD) is classified as a neurodevelopmental disorder, which means it is a condition that typically manifests early in child development. Neurodevelopmental disorders are characterized by developmental deficits or differences in brain processes, leading to challenges in social, academic, or personal aspects of life. ADHD specifically is defined by a persistent pattern of inattention, hyperactivity, and impulsivity that significantly interferes with daily functioning in various settings and environments. Importantly, the diagnosis of ADHD requires that several symptoms be present before the age of 12.

Key Features of ADHD
One of the hallmark features of ADHD is inattention, which can manifest as difficulty following instructions, sustaining focus, and managing disorganization. Individuals with ADHD may also find that their effort quickly fades, which makes it challenging to complete a task from start to finish. Hyperactivity is another key characteristic, often exhibited through excessive motor activity such as fidgeting, tapping, or talkativeness. It can also manifest as mental hyperactivity where the individual thinks about several different things simultaneously, leading to feelings of restlessness and making it difficult to follow a single train of thought. Impulsivity in ADHD is reflected in hasty actions taken without much forethought, often driven by a desire for immediate rewards or an inability to delay gratification. For instance, someone with ADHD might make important decisions without considering the consequences. Or they may ignore responsibilities in favor of more pleasurable activities that offer instant gratification. Additionally, individuals with ADHD may struggle with emotional dysregulation, experiencing emotions very intensely and having difficulty managing their intense emotional responses. This can look like a high sensitivity to rejection, a “shorter fuse,” and a tendency towards anger and irritability.

BPD: A Personality Disorder
Borderline Personality Disorder (BPD) is categorized as a personality disorder. According to the DSM-5, personality disorders are enduring, inflexible patterns of inner experience and behavior that deviate from cultural expectations and lead to significant distress. In other words, personality disorders are features of one’s personality that cause disruptions in daily life. The onset of BPD can typically be traced back to adolescence or early adulthood. The disorder is often egosyntonic, meaning that individuals may not perceive their behaviors as problematic, even though these behaviors are often distressing to those around them.
Key Features of BPD
BPD is specifically characterized by instability in interpersonal relationships, self-image, and mood across various contexts, such as occupational, social, or academic. Individuals with BPD may exhibit frantic efforts to avoid real or imagined abandonment. This can lead to behaviors characterized by intense neediness and a deep fear of rejection or separation. As a result, they often become excessively dependent on others. People with BPD also tend to have a pattern of intense and unstable interpersonal relationships, characterized by sudden and dramatic shifts in their perception of others. They may oscillate between extreme idealization and intense devaluation of a person. For example, they might fall in love after the first or second date and want to spend all of their time with that person. However, within a week, they could quickly switch to feeling that the other person isn’t giving them enough attention or care. This black-and-white thinking leads to abrupt changes between positive and negative emotions, making it difficult for them to find a middle ground. Their shifting perceptions and moods often cause significant problems in their relationships.
Identity disturbance is another key feature in BPD, which manifests as an unstable self-image. This instability is usually accompanied by high levels of self-criticism and a chronic sense of emptiness. Because they lack a clear sense of self, people with BPD may attempt to mimic or mirror the behaviors and attitudes of those around them. Moreover, an unstable self-image makes it challenging for someone with BPD to recognize and address the maladaptive patterns in their behavior.
BPD also is marked by a pattern of impulsivity, which can emerge in various ways, such as impulsively spending money, substance abuse, binge eating, gambling, engaging in unsafe sex, self-harm, or suicide attempts. Lastly, individuals with BPD often experience emotional dysregulation, which is characterized by frequent mood changes and a low tolerance for distress. They tend to be extremely reactive to interpersonal stress and have difficulty regulating emotions such as anger and sadness. This can lead to explosive and inappropriate outbursts of anger or the use of self-destructive coping mechanisms such as self-mutilation.

ADHD and BPD: Overlapping Symptoms
Both ADHD and BPD are characterized by impulsivity and risk-taking behaviors. Impulsivity can lead to hasty decision-making and a preference for high-risk, high-reward activities. However, impulsivity in BPD tends to manifest as a direct response to stress. When someone with BPD experiences a stressful situation, they may impulsively engage in maladaptive coping strategies such as self-harm or drug and alcohol use. Conversely, impulsivity in ADHD typically presents as impatience around delaying gratification. For instance, someone with ADHD may interrupt others in conversation or impulsively abandon a mundane task for a novel, more interesting task.
Emotional dysregulation is another common feature of both disorders, marked by frequent and intense mood changes. Individuals experiencing emotional dysregulation often struggle to manage overwhelming emotions as they arise, resulting in emotional outbursts. Although ADHD and BPD are both marked by challenges with emotional regulation, the consequences of emotional dysregulation tend to be more severe in BPD. As mentioned above, individuals with BPD may engage in self-harm, suicidal ideation, or suicide attempts to cope with their overwhelming emotions. Such coping mechanisms are less common in individuals with ADHD.
Sensitivity to rejection is prominent in both ADHD and BPD and is closely tied to emotional dysregulation. This sensitivity involves intense emotional pain when experiencing rejection, criticism, or failure. Though unlike in ADHD, rejection sensitivity in BPD is often connected to an intense fear of abandonment in interpersonal relationships. Both also disorders involve all-or-nothing thinking, where individuals tend to see things in extremes. They often believe in absolutes and struggle to find a middle ground. This black-and-white thinking makes it challenging for them to recognize the nuances and shades of gray in different situations.
Finally, individuals with BPD and ADHD often struggle with low self-esteem, though the underlying causes may differ. In ADHD, low self-esteem is usually linked to receiving criticism from others for not meeting expectations or self-criticism for perceived failures. In contrast, low self-esteem in BPD is closely tied to persistent instability in one’s sense of self. People with BPD may experience frequent changes in how they view themselves, similar to how they oscillate between idealizing and devaluing others. This fluctuation in self-perception is tied to all-or-nothing thinking, making it difficult to maintain a stable and balanced self-image.

Treatment Approaches for BPD
The gold standard for treating BPD is Dialectical Behavior Therapy (DBT), a structured group program that teaches concrete skills for tolerating distress and managing overwhelming emotions. The term “dialectic” reflects the core principle of DBT: balancing acceptance of one’s current situation with a need to work towards change. The program consists of four key modules: distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness.
The distress tolerance module focuses on coping with painful events by building resilience and finding new ways to soften the effects of upsetting circumstances. Mindfulness teaches individuals to stay present in the moment, helping them focus on the here and now rather than dwelling on past painful experiences. The emotional regulation module aims to help individuals recognize and understand their emotions more clearly, allowing them to observe each emotion without becoming overwhelmed. Finally, interpersonal effectiveness provides tools to help individuals express their beliefs and needs, set boundaries, and negotiate solutions to conflicts with others. DBT skills training groups also offer a supportive community, providing participants with a sense of connection with others who understand what it’s like to live with BPD.

Treatment Approaches for ADHD
Cognitive Behavioral Therapy (CBT) is the first-line treatment approach for ADHD. The cognitive component of CBT helps individuals identify negative thought patterns and understand how these thoughts affect their emotions and behaviors. For instance, thought patterns like all-or-nothing thinking, overgeneralizing, or mind-reading – where one draws conclusions with limited information – can significantly impact emotional responses. CBT challenges the truth of these unhelpful thoughts and helps individuals develop strategies to change them, effectively retraining the brain. The goal is to empower individuals to become their own therapists by encouraging clients to reframe negative thoughts and practice positive self-talk.
In addition to providing cognitive tools, CBT teaches behavioral interventions proven to improve ADHD symptoms, such as mindfulness meditation, regular exercise, proper protein intake, adequate sleep, and the use of organizational tools. These interventions work together to enhance focus, reduce impulsivity, and improve overall emotional regulation. DBT can also be beneficial for ADHD, especially when emotional dysregulation is a prominent feature, as it equips individuals with practical skills to better manage their reactions to daily challenges.

In Conclusion
While ADHD and BPD are distinct disorders, they share overlapping symptoms that can complicate diagnosis and treatment. Recognizing the similarities, such as impulsivity, emotional dysregulation, sensitivity to rejection, and low self-esteem, is crucial for accurate diagnosis and effective intervention. Treatments like CBT for ADHD and DBT for BPD offer evidence-based methods to help individuals manage their symptoms and improve their quality of life. With accurate diagnosis and appropriate treatment, individuals with ADHD and BPD can learn to navigate their challenges more effectively, enhancing their emotional regulation, self-awareness, and interpersonal relationships.
Get Help at The ATTN Center
Our team knows that you may experience more than one mental health concern as a result of ADHD symptoms. This is why we are happy to also offer ADHD-focused therapy for anxiety, depression, and couples. We also provide services including neurofeedback, group therapy, and ADHD testing options. At the ATTN Center of NYC, we do everything in our power to treat ADHD without the use of medication, but we understand in some severe cases additional measures may be needed. As a result, we also maintain close relationships with many of NYC’s best psychiatrists. Feel free to visit our articles page for more helpful information today!