“ADHD, bipolar disorder, borderline personality disorder. Okay, which is it?”

Do I have ADHD

Diabetes, hypothyroidism, hypertension, a UTI. If you have ’em, you have ’em – with numbers to support the diagnosis. The emotional and mental disorders? Were it that simple, right? Let’s bring the dilemma to the fore by chatting the symptoms, and their overlap, of ADHD, bipolar disorder, and borderline personality disorder…

When it comes to alleviating stress and tension, those with BPD typically turn to self-injurious behavior. ADHD patients are more likely to regulate their emotions via extreme sports, novelty seeking, sexual activity, and aggression.

What would any of us give to have our bipolar, OCD, depression, or generalized anxiety diagnosis based upon lab work or radiology. Of course, interventions remain dicey, but at least we’d have a lock on what we have. Now, I believe scientists are working on it; however, diagnosing the emotional and mental disorders remains overwhelmingly a signs and symptoms, age of onset, family history, etc. guessing-game (was that harsh?).

And that’s a dark veil over an already troubling set of circumstances.

In an effort to resolve some confusion in one particular neck of the woods, I’m going to summarize a fairly recent article from Psychiatric Times. “ADHD, Bipolar Disorder, or Borderline Personality Disorder” was written by Italian psychiatrist Ciro Marangoni, MD. I’ll slip you a link at the end.

“Significance for Practicing Psychiatrists”

At the beginning of Dr. Marangoni’s piece is a can’t-miss yellow box with the heading, SIGNIFICANCE FOR PRACTICING PSYCHIATRISTS. In the box, Marangoni emphasizes the high prevalence of ADHD, bipolar disorder (BD), and borderline personality disorder (BPD).

He goes on to say that comorbidity (coexistence) between the three is frequent, which impairs symptoms and treatment response. And for an accurate differential diagnosis (distinguishing a disorder from others that present with similar clinical features), he recommends the clinician rely upon, yep, signs and symptoms, age of onset, family history, etc. – as well as locomotor activity and sleep pattern.

Okay, let’s get our business handled by cherry-picking Dr. Marangoni’s discussion of ADHD, BD, and BPD…

Attention-Deficit/Hyperactivity Disorder

Generally speaking, a diagnosis of ADHD, which persists into adulthood in 50% of cases, is based upon life-interrupting levels of attention, hyperactivity, and impulsivity. But diagnosing ADHD becomes much more difficult when you toss-in lesser known symptoms such as irritability, emotional dysregulation, frequent mood changes, low frustration tolerance, poor self-esteem, and sleep problems.

And keep in mind, hyperactivity is characterized by phenomena such as restlessness, fidgeting, talkativeness, poor inhibition, and engaging in risky behaviors. These babies only complicate the diagnostic process.

Already, can you see the symptom overlaps with what you believe you’d find in BD and BPD?

Now, before we move on to BD and BPD, here’s an extremely informative and helpful table Dr. Marangoni included in his article. It’s definitely a keeper…

Do I have ADHD or bipolar disorder

Bipolar Disorder

Dr. Marangoni begins his discussion of BD by noting its episodic nature. He observes that some patients experience chronic, unremitting symptoms, while others may go weeks or months with reduced or no symptoms at all. Thing is, the diagnostic requirement of recurring episodes (mania and depression) often results in misdiagnosis of patients with a chronic, non-episodic presentation.

I’m thinking most of us are secure in our knowledge of symptoms of depression, but mania (including hypo) may be different. In serving his point, Marangoni includes euphoric and mixed (manic and depressed) mood states, talkativeness, decreased need for sleep, impulsivity, irritability, hyperactivity, and risky behaviors.

Are you still on board with symptom overlap? Now for BPD…

Borderline Personality Disorder

The good doctor begins his BPD chat by observing that DSM-5 criteria says a BPD diagnosis shouldn’t be made before age 18. However, it’s acceptable if symptoms are clear and persistent.

So what does BPD look like? How ’bout this from Marangoni? It’s a chronic and pervasive pattern of instability in interpersonal relationships, mood, and self-esteem – with significant impulsivity. And then there’s ramped-up risk for self-harm, suicide, feelings of abandonment, anger/rage, and come-and-go stress-induced psychotic symptoms.

Marangoni goes on to emphasize the features of BPD that overlap with ADHD. These include a chronic course, emotional instability, impulsivity, and risk-taking behaviors.

In fact, patients with BPD may experience their own special kind of inattention as part of dissociative states when they’re feeling emotionally stressed. This particularly presents in response to feelings of rejection, failure, and loneliness. By comparison, symptoms of inattention in ADHD are often seen in situations that lack external stimuli (eg: during boring, routine, or familiar tasks).

When it comes to alleviating stress and tension, those with BPD typically turn to self-injurious behavior. ADHD patients are more likely to regulate their emotions via extreme sports, novelty seeking, sexual activity, and aggression.

That’ll Do It

I long for the day when diagnosing emotional and mental health disorders becomes as routine and reliable as identifying diabetes, thyroid disease, hypertension – and, well, a UTI. Someday, right?

In the meantime we have to do the best we can with what we have, and trust that our clinicians stay informed and maintain a sharp eye. And we can help them do that by performing our due diligence and assertively sharing our findings with them.

If you’re dealing with ADHD, bipolar disorder, or borderline personality disorder – or wondering if you are, I hope this information is helpful.

Be sure to take a look at Dr. Marangoni’s article. No way could I include everything here, including his discussion of treatment.

And be sure to peruse hundreds and hundreds of Chipur titles. All sorts of helpful info is waiting for you.