Personality Disorders in Adhd Part 3: Personality Disorder,Social Adjustment,and Their Relation to dimensions of Adult Adhd

Abstract

Background

This study explored the relationship between the dimensions of adult attention-deficit/hyperactivity disorder (ADHD), personality disorder (PD), and adverse social adjustment.

Methods

In a controlled trial of osmotic release oral system methylphenidate, PD was assessed using the Wisconsin Personality Disorders Inventory IV (WISPI-IV), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and a final consensus diagnosis. Participants were categorized 2 ways: (1) ADHD alone, ADHD with emotional dysregulation (ADHD + ED), and ADHD plus emotional dysregulation plus oppositional symptoms (ADHD + ED + ODD); and (2) those with no PD (PD-negative), 1 (PD-positive), and 2 or more (PD-plus) PDs.

Results

None of the ADHD-alone patients had a PD compared with 33% of ADHD + ED patients and 68% of ADHD + ED + ODD patients. The level of ADHD-related emotional and oppositional symptoms correlated significantly with the severity of PD dimensions as assessed by WISPI-IV z scores and the number of items endorsed on the SCID-II screening questionnaire. Complex presentations (define by both ADHD and personality categories) were associated with high childhood ADHD ratings and problems in work, extended family, and economic functioning.

Conclusion

The ADHD symptoms of emotional dysregulation and oppositional symptoms were associated with increased Axis II disorders. Adverse outcomes were concentrated in patients with ADHD combined with emotional and oppositional symptoms, and in those with comorbid PDs.

Keywords

attention-deficit/hyperactivity disorder personality disorder emotional dysregulation oppositional

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References

Milberger

Biederman

Faraone

. Associations between ADHD and psychoactive substance use disorders. Findings from a longitudinal study of high-risk siblings of ADHD children. Am J Addict. 1997;6:318–329.

Biederman

Mick

Faraone

. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry. 2002;159:36–42.

Biederman

Faraone

Monuteaus

. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004;55:692–700.

Jensen

Hinshaw

Kraemer

. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40:147–158.

Reimherr

Williams

Strong

. A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007;68:93–101.

Myers

Burket

Otto

. Conduct disorder and personality disorders in hospitalized adolescents. J Clin Psychiatry. 1993;54:21–26.

Burket

Myers

. Axis I and personality comorbidity in adolescents with conduct disorder. Bull Am Acad Psychiatry Law. 1995;23:73–82.

Cukrowicz

Taylor

Schatschneider

. Personality differences in children and adolescents with attention-deficit/hyperactivity disorder, conduct disorder, and controls. J Child Psychol Psychiatry. 2006;47:151–159.

Johansson

Kerr

Andershed

Linking adult psychopathy with childhood hyperactivity-impulsivity-attention problems and conduct problems through retrospective self-reports. J Pers Disord. 2005;19:94–101.

10.

Secnik

Swensen

Lage

. Comorbidities and costs of adult patients diagnosed with attentiondeficit hyperactivity disorder. Pharmacoeconomics. 2005;23:93–102.

11.

Wilens

Kwon

Tanguay

. Characteristics of adults with attention deficit hyperactivity disorder plus substance use disorder: the role of psychiatric comorbidity. Am J Addict. 2005;14:319–327.

12.

Soderstrom

Nilsson

Sjodin

. The childhood-onset neuropsychiatric background to adulthood psychopathic traits and personality disorders. Compr Psychiatry. 2005;46:111–116.

13.

Helgeland

Kjelsberg

Torgersen

Continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood. Am J Psychiatry. 2005;162:1941–1947.

14.

Anckarsäter

, Stahlberg

, Larson

, . The impact of ADHD and autism spectrum disorders on temperament, character, and personality development. Am J Psychiatry. 2006;163:1239–1244.

15.

Jain

URK

. The personality constructs of adults with attention-deficit/hyperactivity disorder as measured by the temperament and character inventory. Dissertation Abstracts International: Section B: The Sciences and Engineering. 2003;64:1934.

16.

May

Bos

Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes. J Pers Assess. 2000;75:237–248.

17.

Nigg

Hinshaw

. Parent personality traits and psychopathology associated with antisocial behaviors in childhood attention-deficit hyperactivity disorder. J Child Psychol Psychiatry. 1998;39:145–159.

18.

Nigg

John

Blaskey

. Big five dimensions and ADHD symptoms: links between personality traits and clinical symptoms. J Pers Soc Psychol. 2002;83:451–469.

19.

Milman

. Minimal brain dysfunction in childhood: outcome in late adolescence and early adult years. J Clin Psychiatry. 1979;40:371–380.

20.

Rey

Morris-Yates

Singh

. Continuities between psychiatric disorders in adolescents and personality disorders in young adults. Am J Psychiatry. 1995;152:895–900.

21.

Güçlü

, Erkiran

Personality disorders in parents of children with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi. 2005;8:18–23.

22.

Burket

Sajid

Wasiak

. Personality comorbidity in adolescent females with ADHD. J Psychiatr Pract. 2005;11:131–136.

23.

Parker

JDA

Majeski

Collin

. ADHD symptoms and personality: relationships with the five-factor model. Pers Indiv Differ. 2004;36:977–987.

24.

Williams

Marchant

Reimherr

. The challenges in diagnosing ADHD in adults. CME LLC/Psychiatric Times; 2007.

25.

Murphy

Barkley

Bush

Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history. J Nerv Ment Dis. 2002:190:147–157.

26.

Biederman

Faraone

Spencer

. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry. 2006;67:524–540.

27.

Biederman

Monuteaux

Mick

. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med. 2006;36:167–179.

28.

Adler

Spencer

Levine

. Functional outcomes in the treatment of adults with ADHD. J Atten Disord. 2008;11:720–727.

29.

Kollins

McClernon

Fuemmeler

. Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Arch Gen Psychiatry. 2005;62:1142–1147.

30.

Barkley

Fischer

Smallish

. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45:192–202.

31.

Barkley

. Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2002, 63(suppl 12):10–15.

32.

Elkins

McGue

Iacono

. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64:1145–1152.

33.

Barkley

Murphy

Dupaul

. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. J Int Neuropsychol Soc. 2002;8:655–672.

34.

Hinnenthal

Perwien

Sterling

. A comparison of service use and costs among adults with ADHD and adults with other chronic diseases. Psychiatr Serv. 2005;56:1593–1599.

35.

Williams

Reimherr

Marchant

. Personality disorders in ADHD part 1: assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate (OROS MPH). Ann Clin Psychiatry. 2010;22:84–93.

36.

Fischer

Barkley

Smallish

. Young adult follow-up of hyperactive children: self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. J Abnorm Child Psychol. 2002;30:463–475.

37.

Barkley

Fischer

Smallish L. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry. 2004;45: 195–211.

38.

Whittinger

Langley

Fowler

. Clinical precursors of adolescent conduct disorder in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:179–187.

39.

Gordon

Antshel

Faraone

. Symptoms versus impairment: the case for respecting DSM-IV's Criterion D. J Atten Disord. 2006;9:465–475.

40.

Reimherr

Wender

Marchant

. The Wender-Reimherr adult attention deficit disorder scale as a research tool. Poster presented at the 2003 American College of Neuropsychopharmacology annual meeting; 2003; San Juan, Puerto Rico.

41.

Reimherr

Marchant

Strong

. Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry. 2005;58:125–131.

42.

Benjamin

. Interpersonal diagnosis and treatment of personality disorders. 2nd ed. New York, NY: Guilford; 1996.

43.

Smith

Klein

Benjamin

. Validation of the Wisconsin personality disorders inventory-IV with the SCID-II. J Pers Disord. 2003;17:173–187.

44.

Weissman

Bothwell

Assessment of social adjustment by patient self-report. Arch Gen Psychiatry. 1976;33:1111–1115.

45.

Robison

Reimherr

Gale

. Personality disorders in ADHD part 2: the effect of symptoms of personality disorder on response to treatment with OROS methylphenidate in adults with ADHD. Ann Clin Psychiatry. 2010;22:94–102.

46.

Adler

Barkley

Newcorn

JH.

ADHD and comorbid disorders in adults. J Clin Psychiatry. 2008; 69:1328–1335.