ADHD or Quiet Borderline Personality Disorder? [Overlap & Differences]

Summary

In this MedCircle discussion, Dr. Judy Ho addresses 'quiet borderline personality disorder' (qBPD), an emerging concept not yet in the DSM. qBPD is characterized by internalized mood swings and self-harming behaviors, making it challenging to diagnose. Dr. Ho also explores the overlap between qBPD and ADHD, noting that 25-40% of individuals with qBPD may exhibit ADHD traits. The conversation highlights the importance of transdiagnostic treatments and the potential for significant improvement with therapy, challenging the stigma and misconceptions surrounding BPD.

Takeaways

• 📚 Quiet Borderline Personality Disorder (BPD) is an emerging concept not recognized in the DSM, but is being discussed by clinicians and the public due to its wide spectrum of expression.
• 🔍 The term 'quiet BPD' refers to individuals with BPD who direct their mood swings and behaviors inward, making it harder to diagnose and treat as they may not outwardly exhibit typical BPD traits.
• 🤔 Overlapping symptoms between ADHD and BPD include difficulties with self-regulation, stable sense of self, and positive social interactions, making it challenging for laypeople to distinguish between the two.
• 🧠 Early research suggests a significant overlap between quiet BPD and ADHD, with 25-40% of individuals with quiet BPD also exhibiting ADHD traits.
• 👩‍⚕️ Treatment approaches like Dialectical Behavior Therapy (DBT) can be effective for both conditions due to their focus on emotion regulation and are part of a broader 'transdiagnostic' treatment approach.
• 💡 ADHD is less prevalent in adulthood, with roughly half of those diagnosed in childhood continuing to experience symptoms into adulthood.
• 🔑 Adults can develop BPD later in life, with symptoms possibly becoming more noticeable due to increased self-awareness or life stressors.
• 👨‍👩‍👧‍👦 Environmental and familial factors contribute to the development of both ADHD and BPD, with adverse childhood experiences and social isolation being potential triggers.
• 🚫 There is a stigma associated with BPD, which includes misconceptions about the treatability and stability of individuals with the disorder.
• 🛡 Creating a safety plan for BPD can be done without a professional, emphasizing the importance of self-awareness and preparation for crisis situations.
• 🌟 Despite the challenges and stigma, individuals with BPD can significantly improve their symptoms and quality of life through dedicated treatment and support.

Q & A

What is the term 'quiet borderline personality disorder' referring to, and why has it become a topic of discussion?

Quiet borderline personality disorder (BPD) is an emerging construct that is not yet in the DSM but is being discussed by clinicians and the public. It refers to a subtype of BPD where individuals direct their mood swings and behaviors inward instead of outward, making it harder to diagnose and treat due to its less obvious presentation.

How does quiet BPD manifest differently from the more commonly recognized forms of BPD?

Quiet BPD is characterized by individuals internalizing their intense emotions and anger, leading to self-harming and self-damaging behaviors that are not apparent until someone knows the person intimately over time. This contrasts with the more outward expressions of mood swings and behaviors seen in other forms of BPD.

What are some overlapping symptoms between ADHD and quiet BPD?

Both ADHD and quiet BPD can involve difficulties with self-regulation, a stable sense of self, and relating positively with others. Individuals with quiet BPD may also experience mood swings, lower self-esteem, and a fear of rejection or abandonment, which can be traits seen in ADHD as well.

Why might it be challenging to differentiate between ADHD and quiet BPD?

The challenge in differentiating ADHD from quiet BPD lies in the overlapping symptoms and the fact that individuals with quiet BPD may suppress their feelings and exhibit behaviors that are not immediately apparent, unlike the more outward expressions in ADHD.

What is the estimated percentage of overlap between quiet BPD and ADHD according to early research?

Early research suggests that there could be as much as a 25 to 40 percent overlap between quiet BPD and ADHD, indicating that a significant portion of individuals with quiet BPD may also have dimensions of ADHD.

What is the concept of transdiagnostic treatments, and how does it relate to ADHD and BPD?

Transdiagnostic treatments refer to evidence-based techniques that treat specific symptoms or groups of symptoms regardless of the diagnosis. This approach has been praised for its effectiveness in treating ADHD and BPD, as it focuses on the symptom and presentation level rather than the specific diagnosis.

How does ADHD present differently in adults compared to children?

In adults, ADHD may still involve restlessness but is expressed in more controlled ways due to societal expectations. For example, an adult with ADHD might tap nervously on a desk, indicating a form of restlessness that is less overt than a child running around a classroom.

Is it possible for an adult to develop quiet BPD later in life without showing symptoms in their teenage or early adult years?

While it is rare, it is possible for an adult to start noticing symptoms of quiet BPD later in life. This could be due to increased self-awareness, life stressors, or the realization of patterns in their relationships that were not recognized earlier.

What are some common misconceptions about ADHD in adults?

A common misconception is that ADHD is a condition that only affects children and that adults cannot develop it. However, ADHD can persist into adulthood, and while the hyperactive and impulsive features may change, the inattentive and restlessness aspects can continue.

How can the stigma around borderline personality disorder be addressed, and what is the outlook for individuals with BPD?

The stigma around BPD can be addressed by educating people that it is a treatable condition and that individuals with BPD can improve their functioning and relationships with appropriate treatment. The outlook is positive, as many people with BPD can experience significant symptom reduction and improved quality of life.

What is the significance of creating a safety plan for individuals with BPD, and can it be done without professional help?

A safety plan is significant as it helps individuals with BPD manage crises and feel safe during moments of emotional distress. It can be created without professional help by understanding what works for the individual during moments of crisis and collaborating to establish strategies that promote safety and stability.