Attention Deficit Hyperactivity Disorder in Childhood, Resilience, Compassion, Mentalization, and the Prevention of Borderline Personality Disorder in Adulthood: A Review

ABSTRACT

This paper explores the co-occurring features of Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) and ADHD as a risk factor for the emergence of BPD. It emphasizes the importance of clinical treatment to improve resiliency and addresses co-occurring areas of vulnerability in individuals with ADHD and those with BPD, as well as in individuals with both disorders. Although the specific developmental pathways and mediating factors remain uncertain, many investigations have identified ADHD and emotion dysregulation in childhood as risk factors for developing personality disorders, particularly BPD, in late adolescence and early adulthood. The frequent co-occurrence of ADHD with BPD in adulthood contributes to worse outcomes and continuing problems with impulsivity and regulating emotional arousal among individuals with both disorders. While the comorbidity of ADHD and BPD poses a risk, it is essential to also consider what factors may help moderate the risks and contribute to resiliency. This review highlights the gaps in the literature about resilience by reviewing existing literature that points to treatment approaches, such as compassion-focused and mentalization-focused psychotherapy, that may mediate ADHD-related risks. Long-term treatment outcome studies of emotion regulation therapies with children are needed to ascertain their effectiveness in reducing the psychological adversity associated with experiencing ADHD in childhood and reducing the emergence of BPD in adolescents and adults.

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No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

James B. McCarthy

James B. McCarthy, Ph.D., A.B.P.P., is Professor of Psychology and Director of Psychology Field Training at Pace University, New York City. Dr. McCarthy is a clinical psychologist, psychoanalyst, and researcher who has frequently contributed to the literature on adolescence, psychoanalytic psychotherapy, and severe mental illness. Dr. McCarthy is the former Director of Psychology at Sagamore Children’s Psychiatric Center in Dix Hills, NY, and the former Director of Psychology at New York City Children’s Center-Queens Campus in Bellerose, NY. His most recent book is Psychosis in Childhood and Adolescence.

Francine Conway

Francine Conway, Ph.D., is the Chancellor of Rutgers University, the former Provost of Rutgers University, and Distinguished Professor at the Graduate School of Applied and Professional Psychology at Rutgers University-New Brunswick, where she was formerly the Dean from 2016 to 2020. Dr. Conway is an internationally recognized scholar, researcher, and clinical psychologist who has made frequent contributions to the literature on the treatment of children with behavioral problems and children with Attention Deficit Hyperactivity Disorder. Her most recent book is Cultivating Compassion: A Psychodynamic Understanding of Attention Deficit Hyperactivity Disorder.

Jessica D. Kastin

Jessica D. Kastin, M.S.Ed., is a Psychology Intern at the Jewish Child Care Association in Pleasantville, NY, and a doctoral candidate in the Psy.D. Program in School-Clinical Child Psychology at Pace University, New York City.

Frank H. Seabrook

Frank H. Seabrook, M.S.Ed., is a Psychology Intern at the University of Miami Medical Center in Miami, FL, and a doctoral candidate in the Psy.D. Program in School-Clinical Child Psychology at Pace University, New York City.