Q. At what point is one able to determine the difference between impulsive and relationship problems resulting from a known diagnosis of ADHD and the patterns of BPD? Or can ADHD combined with a history of child abuse result in BPD, therefore both should be considered and possibly treated?
A. Yours is an excellent and insightful and important question. I believe untreated ADD is a major cause of the BPD. They then co-exist later on. BPD symptoms like being unable to get things done are really ADD symptoms.
The distinguishing features are:
1) In the BPD, impulsive behavior is self-destructive and designed to relieve dysphoria.
2) In ADD, impulsive behavior involves virtually everything. ADD victims have a hard time staying on task whether feeling good or dysphoric.
ADD and the BPD are separate diagnoses that frequently co-exist. I always look for both diagnoses when treating someone with either.