Psychotherapy is the primary treatment for borderline personality disorder. No fully evidence-based pharmacotherapy exits for core borderline symptoms, although some medications (eg SSRIs, atypical antipsychotics) may be effective for individual symptom domains, such as impulsivity (shared by ADHD and BPD).
Treatment of ADHD should always be considered when treating comorbid personality disorders. If the core syndrome of ADHD improves then patients with comorbid personality disorders are likely to be less distressed, function better in their daily lives, and have more control over their behavior. Moreover, they are more likely to engage and benefit from psychological treatment programs.
Because ADHD, bipolar disorder, and borderline personality disorder share overlapping symptoms, these disorders can be difficult to differentiate and accurately diagnose. Therefore, it is important to take into account other information such as family history, developmental stages and delays, age and type of onset, course of illness, previous and current treatments, type of comorbidity.
ADHD comorbid with bipolar disorder or borderline personality disorder further complicates identification of these conditions and possibly causes patient functioning to be worse than in the presence of only one of these disorders. It is important to accurately diagnose and treat each disorder, comorbid or not, to achieve higher levels of patient functioning.
Dr Marangoni is Attending Psychiatrist, Department of Mental Health, Mater Salutis Hospital, Azienda ULSS 9, Legnago, Italy. Dr Marangoni reports no conflicts of interest concerning the subject matter of this article.
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