Double, double, toil and trouble?: Risks Associated with Elevated Symptoms of ADHD and Borderline Personality Disorder

Date of Award


Degree Type


Degree Name

Master of Science (MS)




Antshel, Kevin

Subject Categories

Clinical Psychology


Background: Attention-Deficit / Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) are frequently comorbid in young adult populations with up to 34% of young adults with BPD also having an ADHD diagnosis. Individuals with comorbid ADHD+BPD experience more severe impairments and have elevated risk for additional comorbidities (e.g., substance use disorders). Many studies have examined risks for the development of BPD in isolation yet far fewer have examined the role that ADHD may play in the development of BPD. The Biosocial Development Model of Borderline Personality suggests that emotion dysregulation and emotional invalidation contribute jointly to the development of BPD. Emotion dysregulation has been linked empirically to comorbid ADHD+BPD yet to date, no studies have examined how childhood emotional invalidation affects the risk for comorbid ADHD+BPD. Bullying victimization is associated with emotion dysregulation, but bullying victimization has not yet been examined in populations with comorbid ADHD+BPD. This project aims to fill bothADHD+BPD research voids. It was hypothesized that current emotion dysregulation and childhood emotional invalidation would moderate the association between childhood ADHD and current BPD symptoms. It was also hypothesized that bullying victimization would be the highest among individuals with comorbid ADHD+BPD than individuals with BPD, ADHD, and controls.

Methods: College student participants were recruited from an existing multisite ADHD research consortium. 2,078 participants (68% women, 60% White) completed a Qualtrics survey containing self-report measures of childhood and current ADHD symptoms, current BPD symptoms, current emotion dysregulation, perceived childhood emotional invalidation and childhood bullying/peer victimization. Hypotheses were tested utilizing linear and logistic regressions.

Results: Results indicated that current emotion dysregulation, childhood emotional invalidation, and childhood ADHD symptoms independently predicted current BPD symptoms. Childhood emotional invalidation and current emotion dysregulation did not moderate the association between childhood ADHD symptoms and current BPD symptoms. Childhood bullying victimization was the highest among the comorbid ADHD+BPD group, followed by the ADHD and BPD groups, and the lowest in the Control group.

Discussion: Study results support the Biosocial Developmental Model of Borderline Personality. However, the Biosocial Developmental Model of Borderline Personality does not explain the increased rates of BPD in individuals with ADHD; the presence or absence of emotion dysregulation and emotional invalidation did not impact the relationship between childhood ADHD and current BPD symptoms. Increased bullying victimization in the comorbid ADHD+BPD group provides initial support that bullying may play a role in the development of comorbid ADHD+BPD and should be further examined in future studies. This study highlights the importance of determining predictors of the comorbid state as well as considerations to prevent and treat comorbid ADHD+BPD.


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