Diagnostic Challenge 2 - Part II
Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.Personality Disorders and ADHD
Personality Disorders are a large category of disorders. A personality disorder impacts all aspects of a person's life including social, emotional, cognitive, and behavioral functioning. Each disorder within this category is unique. However, several personality disorders can be easily confused with adult ADHD particularly Borderline Personality Disorder (BPD), Narcissistic Personality Disorder, and Antisocial Personality Disorder. This represents a group of disorders that share some similar-looking symptoms with ADHD. These symptoms include: disorganization, social intrusiveness, impulsivity, and emotional dysregulation. As previously mentioned, individuals with ADHD are disorganized. They are often depressed and/or irritable. Their moods can shift frequently, and they act impulsively.
Despite these similarities, these three personality disorders are different from ADHD in several significant ways. First, a person with ADHD will exhibit momentary impulsivity, without much advance warning. In contrast, someone with a personality disorder, like BPD, will likely express impulsivity in a "driven" or pressured manner. This may be coupled with an irresistible urge to act impulsively. Regarding expressions of anger, those with ADHD exhibit anger in a brief and episodic manner. In contrast, those with personality disorders may have extended periods of brooding anger that often erupt with a retaliatory, impulsive act. A central distinguishing feature between ADHD and personality disorders are the symptoms that are not present in ADHD. These include self-mutilation; passionate but highly-conflicted relationships; unstable sense of self; suicidal preoccupations; intense feelings of abandonment; and, a gross sense of entitlement usually coupled with overt grandiosity. Although there are variations within each disorder, the lack of these troubling symptoms makes ADHD distinct from personality disorders.
Bipolar Disorder and ADHD
Bipolar disorder is characterized by widely unstable moods (labile mood). These moods typically swing from one extreme pole to another; i.e., from depressive mood to a euphoric or manic mood. Keep in mind that for some people, a depressed mood may be experienced as irritability and overall dissatisfaction. Stated differently, there are cultural and gender differences in the way people experience and express depression. Just because someone doesn't look or act "depressed" does not make them ineligible for a depression diagnosis.
Sometimes 'mood swings' rapidly switch back and forth; from a few hours to a few days. Other times moods may last for weeks or months. Moreover, the intensity of each mood state may vary. Sometimes depression may be more severe than mania, making it seem more obvious. Sometimes mania may be more severe than depression, making it seem more obvious.
Many ADHD individuals exhibit a combination of depression, mood swings, and irritability. These similarities between ADHD and bipolar disorder can cause diagnostic confusion between the two. One way to distinguish between them is by examining the length of time between mood swings. In bipolar disorder, moods typically last for weeks or months before shifting over to the other pole. In ADHD, moods last for a much shorter period: usually just a few hours or a few days. The depth of depression tends to be more severe in bipolar disorder than in ADHD, which tends to be less severe and fleeting.
When at the euphoric pole of Bipolar disorder (the manic phase), people demonstrate excessive energy, coupled with impulsive and even dangerous acts. This may look a lot like the hyperactivity-impulsivity symptoms in people with ADHD. Although ADHD adults' intense urge for activity can be easily confused with mania, it lacks the disruptive acting-out quality; i.e., the impulsive reckless behavior and omnipotence found in bipolar disorder. These additional symptoms can accompany bipolar disorder, but not ADHD. Medications commonly used for each disorder are very different. If medication for one disorder is taken by someone with the other disorder, their symptoms will dramatically worsen. This highlights the importance of an accurate diagnosis.
Depression, Anxiety and ADHD
ADHD evaluations should routinely include an assessment for anxiety disorders and mood disorders, particularly depression (a specific type of mood disorder). These disorders may turn out to be the true cause of ADHD-like symptoms; or, they may be separate, co-occurring disorders. The co-occurrence between mood disorders and ADHD is significant. Some studies suggest that the likelihood of a mood disorder in people with ADHD is more than double the likelihood of a mood disorder in the general population (Reinhold, 2015).
The determination as to whether an adult has ADHD alone, or in combination with a mood disorder, is critical in developing an effective treatment plan. Treatment protocols for either disorder or both disorders together, are very different. Depression can be distinguished from ADHD because it is often accompanied by anhedonia; i.e., the inability to experience pleasure. People with depression have depressive symptoms that are unrelenting. In contrast, depressive symptoms fade quickly in people with ADHD once their attention is redirected to something enjoyable. Meanwhile, folks with ADHD have more functional impairment than folks with mild to moderately severe depression. This greater impairment is due to the impulsivity, and organizational deficits that are root causes of ADHD.
Anxiety disorders in various forms often co-occur with ADHD. For example, people with ADHD may feel judged by others and develop a social anxiety disorder (SAD). Adults with ADHD have lived many years with symptoms that limit their ability to be successful. They may feel others are critical or judgmental about their behaviors or lack of success. They may begin to worry about other people's judgments and seek to avoid social interactions. In contrast, those with Social Anxiety often experience extreme worry for weeks or months in advance of an event. They become extremely self-conscious. Subsequently, they may be unable to follow a conversation and may blurt out comments that are irrelevant to the conversation. Likewise, they may have trouble focusing on what others are saying, because of their anxiety. This self-preoccupation and social awkwardness can resemble the ADHD symptoms of impulsivity, and difficulty with concentration. In addition, their challenges forming and maintaining social relationships also resemble ADHD. However, social anxiety disorder can be distinguished from ADHD because people with ADHD continue to engage in social activities. In general, for those with ADHD social activities are enjoyable and rewarding, despite their awkwardness and missteps. In contrast, people with social anxiety disorder find social events so painful and uncomfortable they would typically try to avoid them at all costs. However, as mentioned, a person may have both disorders.
Resources
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Articles
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Childhood ADHD Overview
- Introduction to Attention Deficit Hyperactivity Disorder (ADHD)
- Signs & Symptoms of ADHD
- ADHD Signs and Symptoms: Attention Difficulties
- ADHD Signs and Symptoms: Hyperactivity
- ADHD Signs and Symptoms: Impulsivity
- Are There Different Types of ADHD?
- The Social, Educational, Financial & Occupational Impact of ADHD
- What are the Legal Rights of Caregivers and Their Children with ADHD (USA)?
- A Positive Spin: Is There Anything Good about ADHD?
- Signs of ADHD in Children at Home
- Signs of ADHD in Children at School
- Signs of ADHD in Children in Peer Relationships
- How Do I know if My Child Needs an ADHD Evaluation?
- What Should I Do If I Think My Child Might Have ADHD?
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ADHD Discoveries and Controversies
- ADHD: New and Exciting Brain Research
- ADHD: New and Exciting Brain Research - Part II
- Neurotransmitter Changes with ADHD
- Executive Functions
- Neurodiversity: Is ADHD a True Mental Disorder?
- ADHD Statistics
- Cultural and Gender Differences in Prevalence Rates
- Should Children with ADHD Be Medicated?
- New and Promising Areas of Research
- Causes of ADHD in Children
- ADHD or Another Condition?
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Diagnosis of ADHD in Children
- Who Can Diagnose ADHD?
- How Does ADHD Multi-Source Assessment Work?
- Assessment Instruments: Behavioral Checklists
- Assessment Instruments: Intelligence Tests
- Assessment Instruments: Achievement Tests (or Academic Tests)
- Assessment Instruments: Tests of Attention
- Assessment Instruments: Memory and Other Common Tests
- Step 2: Clinical Interviews
- Step 3: Physical Exam and Medical History
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ADHD Treatment in Children
- Multimodal ADHD Treatment Approach
- ADHD Medications
- Treating ADHD with Stimulant Drugs
- Commonly Prescribed ADHD Stimulant Medications
- Treating ADHD with Non-Stimulant Drugs
- Risks of ADHD Medication
- Risks of ADHD Medications - Part II
- Benefits of ADHD Medication
- Side Effects of ADHD Medications
- Medication Decisions and Medication Management
- How Long Should ADHD Medication Treatment Last
- Psycho-Education about ADHD and Its Management
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- Individual and Cognitive Behavioral Psychotherapy for the Child with ADHD
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Family and Personal Supports
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- Learn about Resources and Be Proactive
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- Communicate and Collaborate with Schools
- Express Confidence in Your Child's Abilities
- Help Children Improve Social Skills and Peer Relationships
- Avoid Homework Battles and Monitor Medication
- I Think I have ADHD. What should I do?
- I Think I Have ADHD - Part II
- Famous People with ADHD
- Adult ADHD Overview
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Diagnosis of Adult ADHD
- How is Adult ADHD Diagnosed?
- Diagnostic Challenge 1: Looking into the Past
- Diagnostic Challenge 2: ADHD versus Similar Disorders
- Diagnostic Challenge 2 - Part II
- Diagnostic Challenge 3: ADHD Symptoms
- Diagnostic Challenge 3 - Part II
- Diagnostic Challenge 4: A Concealed Disorder
- Specialized Tests and Tools
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Adult ADHD Treatment
- ADHD Medication Treatment
- Stimulant and Non-Stimulant Drugs for Adult ADHD
- Medication Timing, Dosage, Monitoring, and Duration of Treatment
- Weighing the Risks and Benefits of Adult ADHD Medications
- Psychotherapy for ADHD
- Coaching/Supported Employment for Adult ADHD
- Social Skills Training for Adult ADHD
- Psycho-Education and Cognitive Behavioral Therapy (CBT)
- ADHD Resources and References
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Childhood ADHD Overview
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Questions and Answers
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- Reclaiming Our Children
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- Ritalin is Not the Answer Action Guide
- Ritalin Nation
- Running on Ritalin
- Should I Medicate My Child?
- Taking Charge of ADHD, Revised Edition
- The Explosive Child
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- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part I
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- ADHD in Preschoolers: What to Look For and How to Help
- FYI on ADHD Evaluations
- Teaching Grit, Perseverance and Frustration Tolerance to Students with ADHD
- Does my Child Have ADHD?
- How to Start Eating Well When You Have ADHD
- 5 Solutions for Common ADHD Social Struggles
- Is My High School Student Ready for College? (And Is My College Student Ready to Go Back?)
- Understanding and Applying the Science of Time Management
- ADHD Medication and College Students: Prevent Misuse, Abuse, and Diversion
- Improve Homework Time with Strategies That Work For ADHD
- Student Voices: What Really Matters to Young Adults With Learning and Attention Issues
- 5 Ways Nutrition can Impact ADHD Symptoms
- 3 Tips for Adjusting to a New Diagnosis of ADHD
- Creating the Best Learning Environment for Students with ADHD
- ADHD & Executive Functioning
- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part II
- Ask The Expert: Neurofeedback Treatment for ADHD
- ADHD and Suicide Risk Factors
- The Choice is in the Details: Medication Options for ADHD
- Understanding and Supporting Young Adults with ADHD
- Helping Your Young Adult Become Independent
- Creating Structure and Routines for Children with ADHD
- When You and Your Child Have ADHD - Communication Skills to Resolve Conflict
- Guidance for Uncertain Times: Navigating Relationship Challenges
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- Couples with ADHD: Creating Caring Connection amid the Chaos
- Disclosure and Workplace Accommodations for Individuals With ADHD
- A Summer At Camp
- Self-Advocacy Tips For Teens With ADHD
- ADHD and Curbing Impulsive Spending to Help Your Relationship
- ADHD: Signs, Symptoms, Research
- ADHD & Risk of Adult Drug Use
- Health and Life Expectancy in ADHD
- Focus on ADHD
- Pediatrics: ADHD and Food Allergies
- ADHD: It's a Family Affair
- Does Your Child Have ADHD?
- ADHD in Children
- Living with ADHD
- Rise in ADHD Cases in Children
- Why is Dating Difficult When You Have ADHD
- Video Games, Screens, and ADHD A Potent Mix
- Ask the Expert Helping Children with ADHD LD Conquer Chronic Stress
- Ask the Expert: Mindfulness, Stress, & Emotion
- Attention Deficit Hyperactivity Disorder
- Ask the Expert Educator Edition: ADHD & Executive Functioning
- Ask the Expert - Academic Evaluations - What Parents Need to Know
- ADHD and Sibling Relationships
- Medication Treatment for ADHD
- Using Time Out
- Treating Childhood ADHD
- ADHD-friendly Summer Family FUNdamentals
- Preparing Older Teens for the Road Ahead
- Tips for Teachers: Tailoring homework to make a difference
- Your Active Preschooler: Could it be ADHD?
- Tips for Teachers: Creating a positive dialogue with parents of students with ADHD
- Helping Parents & Kids Understand the Social & Emotional Aspects of ADHD
- Social and Emotional Concerns of Children with ADHD: Strategies to Help
- Holiday Gifts for Children with ADHD
- Behavior Management and Combined Treatment for Children with ADHD
- Setting Realistic School Expectations for Students with ADHD
- On Their Own: Helping College Students with ADHD
- Children's Communication Challenges: Is it Attention, Language or Both?
- Out-of-School: Parenting During the Summer
- ADHD in the Workplace: Finding Success
- Emotions and Motivation in ADHD
- The Role of Medication in Managing Children's ADHD Symptoms
- Top Tips for Combating Stigma and Addressing Myths about ADHD
- Facts and Myths about ADHD
- What To Do If Your Child Has ADHD?
- How Common is ADHD?
- Children, Meds, and Heart Safety: A Tale of ADHD and Public Health
- ADHD & Your Child’s Transition to College
- Your Teen with ADHD: Challenges and Strategies for Success
- Ask the Expert - No more homework battles
- A Frontline to ADHD
- Understanding Girls with ADHD
- What is ADHD?
- What To Do When Your Child With ADHD is Bullied
- Stop the Chaos! Tips for Creating a Peaceful Household When Mom has ADHD
- Is It ADHD?
- Ask the Expert - What else can I do? Complementary approaches to ADHD treatment
- All in a row: Getting your kids with ADHD organized
- Your Student With ADHD Was Admitted to College, Now what?
- Evidence-based treatment for ADHD in young children
- Home life when Mom or Dad has ADHD: Succeeding with your family
- How does technology affect ADHD?
- Diagnosing ADHD
- Helping Your Child Successfully Handle Change
- Recognizing challenging behaviors in young children: Could it be ADHD?
- Classroom Managment Supports for ADHD Behaviors in Preschool Settings
- Getting through to your teenager with ADHD
- What Everyone Should Know about ADHD
- Make Learning Exciting: Apps for Executive Functioning
- Teenagers, ADHD, and Substance Abuse
- Past Procrastination -- Get Your Kids Organized, Focused and Motivated
- Ask the Expert: Late, Lost, and Unprepared: How to Help Your Child with Executive Functioning
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