Comparing Dimensional Models Assessing Personality Traits and Personality Pathology Among Adult ADHD and Borderline Personality Disorder

Abstract

Objective: This pilot study was a comparison of dimensional models assessing personality traits and personality pathology in a clinical sample of adults diagnosed with ADHD and adults diagnosed with borderline personality disorder (BPD), and a nonclinical control sample of healthy adults. Method: Personality traits were assessed using the NEO–Personality Inventory–Revised (NEO-PI-R) and dimensional personality pathology with the Dimensional Assessment of Personality Pathology–Basic Questionnaire (DAPP-BQ). Results: Adults with ADHD and BPD produced higher Emotional Dysregulation/Neuroticism and Dissocial Behavior scores than controls. For the Extraversion/Inhibitedness scale, adults with BPD produced significantly lower scores than adults with ADHD and controls. On the Conscientiousness/Compulsivity domains, Conscientiousness scores were lower for both disorders, whereas low Compulsivity values were specific to adult ADHD. Conclusion: Our results suggest that patients with adult ADHD and BPD have distinguishable profiles of personality traits and personality pathology.

Keywords

adult ADHD borderline personality disorder DAPP-BQ NEO-PI-R FFM dimensional assessment personality disorder personality traits personality pathology

Borderline personality disorder (BPD) emerges early in adulthood and is characterized by a pervasive pattern of instability known to affect interpersonal relationships, self-image, and impulsivity across a range of contexts (American Psychiatric Association [APA], 2000). Clinical indicators include emotion dysregulation, repeated self-harm, suicide ideation, and impulsive aggression (Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004). BPD is estimated to affect about 1% to 3% of the general population and about 10% to 20% of psychiatric outpatient and inpatient populations, respectively (Swartz, Blazer, George, & Winfield, 1990; Torgersen, Kringlen, & Cramer, 2001; Trull, Jahng, Tomko, Wood, & Sher, 2010; Widiger & Weissman, 1991).

The behavioral profile of BPD has been found to share a number of symptoms in common with adult ADHD, including impulsiveness, affective instability, and difficulty controlling anger (Wender, Wolf, & Wasserstein, 2001). Adults diagnosed with BPD have been found to produce higher scores on adult ADHD self-report measures in comparison with other personality disorders (PDs), and early childhood ADHD has been indicated as a precursor to adult BPD (Fossati, Novella, Donati, Donini, & Maffel, 2002; Miller et al., 2008). Comorbidity between the two conditions is well documented (Biederman et al., 2007; Ferrer et al., 2010; Fossati et al., 2002; Philipsen et al., 2008), and impulsivity has been identified as one of the most common traits within this behavioral overlap (Davids & Gastpar, 2005; Paris et al., 2004).

Although the behavioral profiles of adult ADHD and BPD share similarities, it is unclear whether these behaviors are motivated by similar underlying psychopathologies. For example, evidences exploring group differences between adult ADHD and BPD participants on impulsivity-related behavioral inhibition tasks have demonstrated significant variation between group performances relating to differences in emotion and inattention (G. A. Jacob et al., 2010; Lampe et al., 2007). One way to explore individual differences in underlying psychopathology is to examine the types of personality traits and personality pathology common within different groups. Exploring personality traits within clinical disorders helps enhance our understanding of the diatheses and structure of psychopathology (Watson, Clark, & Harkness, 1994).

Several studies provided evidence that adults diagnosed with ADHD tend to demonstrate lower levels of Conscientiousness and increased levels of Neuroticism compared with nonclinical controls (C. P. Jacob et al., 2007; Nigg et al., 2002; Parker, Majeski, & Collin, 2004; Ranseen, Campbell, & Baer, 1998), whereas measures of Extraversion and Agreeableness have reported mixed results (Braaten & Rosen, 1997; C. P. Jacob et al., 2007; John, Caspi, Robins, Moffitt, & Stouthamer-Loeber, 1994; Nigg et al., 2002; Parker et al., 2004; Ranseen et al., 1998). Interestingly, adults diagnosed with BPD have demonstrated a similar profile with elevated scores on measures of Neuroticism, lower scores on Agreeableness, and lower scores on Conscientiousness compared with nonclinical controls (see Saulsman & Page, 2004, for a review).

Although personality traits have been assessed separately in adult ADHD and BPD samples, to date, we are not aware of any published research that has directly compared personality trait and personality pathology profiles between adult ADHD and BPD groups. In particular for diagnostic purposes, it might be important to disclose personality profiles that distinguish adults with ADHD and BPD. The aim of this pilot study was thus to examine and compare individual differences in personality traits and personality pathology between adults diagnosed with ADHD, adults diagnosed with BPD, and a nonclinic control sample.

Method

Participants

Participants included 30 adults diagnosed with BPD (n = 13 male, n = 17 female), 30 adults diagnosed with ADHD (n = 13 male, n = 17 female), and 30 healthy adults with no known psychopathology. Clinical patients were recruited from the Department of Psychiatry, Charité - University Medicine Berlin. All BPD participants were inpatients admitted for specialized BPD treatment from a waiting list; all BPD patients had outpatient status before admission; none were transferred from another institution or were admitted for acute care. All ADHD participants were outpatients waiting to receive ADHD specialist treatment. All control group participants were recruited via advertising in local media outlets. A reimbursement of €25 was provided for all nonclinical participants on completion of the study.

Ethics approval was attained via the ethics committee of the Charité – University Medicine Berlin, Germany, and all participants provided fully informed written consent. Participant characteristics are provided in Table 1.

Table 1.

Sociodemographic Characteristics and Axis I/II Diagnoses of BPD Patients, ADHD Patients, and Nonclinical Individuals.

	BPD (N = 30)		ADHD (N = 30)		CG (N = 30)
	M	SD	M	SD	M	SD
Age	29.87	7.09	33.47	8.79	28.17	6.96
ADHD-CL score	11.32	5.73	20.48	7.69	4.83	4.51
Years of education	10.39	2.15	13.57	3.48	12.90	3.79
GSI of the SCL-90-R	1.73	0.79	1.16	0.61	0.416	0.25
	n	%	n	%	n	%
Female	17	56.7	17	56.7	17	56.7
Medication
Mood stabilizer	7	23.3	—	—	—	—
Neuroleptics	7	23.3	—	—	—	—
Antidepressants (including noradrenergic)	9	30.0	2	6.7	—	—
Antidepressants (not noradrenergic)	7	23.3	—	—	—	—
Axis II diagnoses
Any Cluster A PD	8	26.7	2	6.7	—	—
Any Cluster B PD	14	46.7	3	10.0	—	—
Any Cluster C PD	16	53.3	1	3.3	—	—
Axis I diagnoses
Any affective disorder	22	73.3	15	50.0	—	—
Any substance use disorder	13	43.3	7	23.3	—	—
Any anxiety disorder	15	50.0	7	23.3	—	—
Any eating disorder	6	20.0	—	—	—	—

Note. BPD = borderline personality disorder; CG = nonclinical controls; M = mean; SD = standard deviation; ADHD-CL = ADHD–Checklist; GSI = Global Severity Index; SCL-90-R = Symptom Checklist–90–Revised; PD = personality disorder.

Clinical Assessment

All Axes I and II diagnoses were guided by German versions of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (SCID I and II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997; First, Spitzer, Smith, Gibbon, & Williams, 1996) and were administered by trained psychologists. Each diagnosis of BPD was verified by the patients’ clinical lead case holder (senior psychiatrist) and the ward consultant.

Criteria for adult ADHD were guided by the diagnostic indicators outlined in the adult ADHD criterion range, German Society for Psychiatry, Psychotherapy, and Neurology (Ebert, Krause, & Roth-Sackenheim, 2003). This process includes a Semistructured Clinical Interview based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000) adult ADHD criteria and an adult ADHD–Checklist (ADHD-CL) for DSM-IV (APA, 1994; Hesslinger et al., 2002). The ADHD-CL was also used to assess the severity of adult ADHD symptoms. Childhood ADHD symptoms were rated retrospectively using the short version of the Wender Utah Rating Scale (WURS-k), which includes 25 items using a 5-point Likert-type scale (0 = not at all to 4 = severe). To strengthen the validity of the adult ADHD diagnosis, reported symptoms were assessed in relation to school records and a parental rating of childhood history.

Any participant with comorbid BPD and ADHD was excluded from the study to ensure the integrity of group comparisons, and all control participants with current or past psychiatric disorders, assessed using SCID I (First et al., 1996) and SCID II (First et al., 1997) screening questions and clinical evaluation, were also excluded.

Procedure

ADHD and BPD participants completed the questionnaires as a routine baseline assessment at the start of their treatment in the clinic. Patients did not receive any reward for taking part. All nonclinical participants were contacted by a member of the research team following their interest in response to local advertisement. Following fully informed signed consent, participants completed the measures outlined below.

Measures

NEO–Personality Inventory–Revised (NEO-PI-R)

The NEO-PI-R (Costa & McCrae, 1992) was administered to all three samples. It includes five personality domains—Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness—and is based on a 240-item self-report questionnaire answered on a 5-point Likert-type scale. It has demonstrated good convergent validity between community and psychiatric samples (Bagby et al., 1999), and has demonstrated strong internal consistency (.86-.92) and test–retest reliability (.79-.83) ranges (Costa & McCrae, 1992; Eggert, Levendosky, & Klump, 2007; Santor, Bagby, & Joffe, 1997). In our study, internal consistencies of all subscales ranged between α = .82 and α = .95.

Dimensional Assessment of Personality Pathology–Basic Questionnaire (DAPP-BQ)

The DAPP-BQ (Livesley, 1986, 1987) was administered to all three samples. It is a 290-item, self-report assessment of 18 lower order and 4 higher order dimensions of personality pathology. The 18 scales include 16 statements describing personal preferences and behaviors except for the Self-Harm and Suspiciousness scales that include 12 and 14 scales, respectively. Using a 5-point Likert-type scale ranging from 1 (very unlike me) to 5 (very like me), the 4 higher order factors include Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity. In addition, 8 items are also included to measure social desirability.

Coefficient α reliabilities have been found to range from .87 to .94 in a sample of 274 healthy participants with no known psychopathology and from .84 to .95 in a sample of 158 participants diagnosed with PD (Jang, McCrae, Angleitner, Riemann, & Livesley 1998; Schroeder, Wormsworth, & Livesley, 1992). In our study, internal consistencies of all subscales ranged between α = .80 and α = .96.

Symptom Checklist–90–Revised (SCL-90-R)

The SCL (Derogatis, 1977; German version: Franke, 1995) was used to assess general psychological impairments. Responses were made on 5-point Likert-type scales with endpoints labeled 0 = not at all and 4 = very much. The Global Severity Index (GSI) score of the SCL-90-R indicates psychological impairment in general.

Statistical Analyses

General psychopathology was assessed with the SCL-90-R, a 90-item self-report symptom inventory reflecting psychological symptom patterns of current, point-in-time symptoms. Each item of the questionnaire is rated on a 5-point scale of distress from 0 (none) to 4 (extreme). It consists of nine primary symptom dimensions: somatization, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. It further comprises a global indication of distress (GSI). Adequate stability estimates for the SCL-90-R have been reported across a range of populations. All statistical analyses were performed using SPSS (version 19.0). Correlational analysis explored the relationship between DAPP-BQ and NEO-PI-R higher order factors. A series of multivariate analysis of variance (MANOVA) were used to explore group differences among the following dependent variables: (a) NEO-PI-R scales, (b) DAPP-BQ lower order scales, and (c) DAPP-BQ higher order scales. Group condition was used as a between-participant independent variable, and pairwise Bonferroni-adjusted comparisons were used to explore any significant differences within the univariate statistics.

Results

A reliable effect of participant age was observed, F = 3.74, df = 2, p < .05, and pairwise comparisons indicated that on average adult ADHD participants were older than BPD participants and nonclinical participants—the latter two groups did not differ. All groups deviated on general psychological impairment (GSI), F = 36.99, df = 2, p < .000. Bonferroni post hoc tests indicated that BPD patients had higher scores on general psychological impairment than participants with ADHD (p < .001) and higher scores than nonclinical controls (p < .001). In comparison with nonclinical controls, patients with ADHD had higher scores on general psychological impairment (p < .001).

For the higher order and subscales of the NEO-PI-R, a reliable effect of group condition was observed (higher order scales: Wilks’s Lambda, F(10, 164) = 14.25, p < .001, η² = 0.465; subscales: Wilks’s Lambda, F(60, 114) = 3.97, p < .001, η² = 0.676). In addition, for both the DAPP-BQ higher order and lower order subscale measures, a reliable effect of group condition was also observed (Wilks’s Lambda, F(8, 166) = 15.14, p < .001, η² = 0.422, and F(36, 138) = 7.97, p < .001, η² = 0.675, respectively). Group means, standard deviations, and effect size measures are provided in Tables 2 to 5.

Table 2.

Means and Standard Deviations for NEO-PI-R Scales of BPD Patients, ADHD Patients, and Nonclinical Individuals.

										Post hoc tests (p, Bonferroni)
	1. BPD (N = 30)		2. ADHD (N = 30)		3. CG (N = 30)		MANCOVA			p	p	p
NEO-PI-R	M	SD	M	SD	M	SD	F	p	Partial η²	1 vs. 2	1 vs. 3	2 vs. 3
Neuroticism	2.87	0.45	2.41	0.45	1.82	0.38	43.78	<.001	0.50	<.001	<.001	<.001
Extraversion	1.68	0.43	2.13	0.43	2.33	0.32	21.71	<.001	0.34	<.001	<.001	.691
Openness to Experience	2.27	0.46	2.54	0.38	2.46	0.29	5.15	.008	0.11	.006	.265	.436
Agreeableness	2.26	0.39	2.27	0.33	2.42	0.26	2.64	.077	0.06	1.000	.145	.152
Conscientiousness	1.75	0.43	1.65	0.50	2.52	0.38	35.61	<.001	0.45	.779	<.001	<.001

Note. NEO-PI-R = measure of personality traits based on the five factor model; BPD = borderline personality disorder; CG = nonclinical controls; M = mean; SD = standard deviation.

Table 3.

Means and Standard Deviations for NEO-PI-R Lower Order Scales of BPD Patients, ADHD Patients, and Nonclinical Controls.

										Post hoc tests (p, Bonferroni)
	1. BPD (N = 30)		2. ADHD (N = 30)		3. CG (N = 30)		MANCOVA			p	p	p
NEO-PI-R	M	SD	M	SD	M	SD	F	p	Partial η²	1 vs. 2	1 vs. 3	2 vs. 3
Neuroticism
Anxiety	2.90	0.77	2.48	0.72	1.96	0.70	12.03	<.001	0.22	.076	<.001	.042
Angry hostility	2.77	0.59	2.38	0.52	1.63	0.50	33.40	<.001	0.44	.016	<.001	<.001
Depression	3.25	0.55	2.52	0.72	1.53	0.58	56.35	<.001	0.57	<.001	<.001	<.001
Self-consciousness	2.92	0.63	2.32	0.60	2.08	0.44	17.73	<.001	0.29	.001	<.001	.257
Impulsiveness	2.46	0.56	2.42	0.52	2.13	0.41	3.24	.044	0.07	1.000	.048	.219
Vulnerability	2.90	0.64	2.37	0.62	1.60	0.47	37.00	<.001	0.46	.002	<.001	<.001
Extraversion
Warmth	2.00	0.48	2.34	0.53	2.86	0.44	22.38	<.001	0.34	.012	<.001	.002
Gregariousness	1.57	0.65	1.90	0.72	2.39	0.62	11.26	<.001	0.21	.035	<.001	.132
Assertiveness	1.38	0.53	1.90	0.72	1.81	0.63	5.67	.005	0.12	.008	.029	1.000
Activity	1.88	0.66	2.40	0.58	2.19	0.47	5.67	.004	0.12	.003	.129	.541
Excitement seeking	1.89	0.75	2.12	0.61	1.99	0.50	2.48	.090	0.05	.113	1.000	.275
Positive emotions	1.37	0.83	2.08	0.81	2.71	0.46	26.39	<.001	0.38	<.001	<.001	.024
Openness to Experience
Fantasy	2.11	0.77	2.73	0.70	2.31	0.60	8.51	<.001	0.17	<.001	1.000	.011
Aesthetics	2.62	0.73	2.55	0.61	2.64	0.65	.00	.996	0.00	1.000	1.000	1.000
Feelings	2.48	0.68	2.59	0.55	2.69	0.41	1.02	.365	0.02	.914	.536	1.000
Actions	1.85	0.67	2.17	0.54	2.26	0.50	4.26	.017	0.09	.060	.031	1.000
Ideas	2.20	0.69	2.59	0.72	2.27	0.61	3.24	.044	0.07	.060	1.000	.138
Values	2.36	0.42	2.61	0.45	2.58	0.42	3.28	.042	0.07	.054	.182	1.000
Agreeableness
Trust	1.48	0.75	2.11	0.61	2.38	0.63	14.63	<.001	0.25	.003	<.001	.212
Straightforwardness	2.24	0.58	2.21	0.63	2.37	0.55	1.13	.327	0.03	1.000	.906	.441
Altruism	2.42	0.44	2.58	0.44	2.83	0.49	6.06	.003	0.12	.615	.003	.120
Compliance	1.87	0.77	1.83	0.52	2.11	0.47	1.78	.174	0.04	1.000	.381	.267
Modesty	2.88	0.52	2.18	0.56	2.21	0.50	17.12	<.001	0.29	<.001	<.001	1.000
Tender-mindedness	2.65	0.42	2.70	0.47	2.65	0.44	.27	.762	0.01	1.000	1.000	1.000
Conscientiousness
Competence	1.65	0.58	1.94	0.46	2.66	0.38	34.34	<.001	0.44	.079	<.001	<.001
Order	1.96	0.60	1.54	0.59	2.48	0.48	20.19	<.001	0.32	.014	.002	<.001
Dutifulness	2.10	0.60	2.02	0.72	2.88	0.43	22.45	<.001	0.34	.996	<.001	<.001
Achievement striving	1.90	0.61	1.88	0.64	2.39	0.47	7.98	.001	0.16	1.000	.003	.002
Self-discipline	1.40	0.69	1.07	0.67	2.53	0.53	46.13	<.001	0.52	.065	<.001	<.001
Deliberation	1.53	0.61	1.47	0.75	2.17	0.67	8.92	<.001	0.17	1.000	.002	.001

Note. NEO-PI-R = measure of personality traits based on the five factor model; BPD = borderline personality disorder; CG = nonclinical controls; M = mean; SD = standard deviation.

Table 4.

Means and Standard Deviations for DAPP-BQ Higher Order Scales of BPD Patients, ADHD Patients, and Nonclinical Individuals.

										Post hoc tests (p, Bonferroni)
	1. BPD (N = 30)		2. ADHD (N = 30)		3. CG (N = 30)		MANCOVA			p	p	p
DAPP-BQ	M	SD	M	SD	M	SD	F	p	Partial η²	1 vs. 2	1 vs. 3	2 vs. 3
Emotional Dysregulation	3.46	0.49	2.67	0.50	2.14	0.36	47.44	<.001	0.525	<.001	<.001	<.001
Dissocial Behavior	2.71	0.63	2.54	0.43	2.27	0.35	6.52	.002	0.132	1.000	.002	.037
Inhibitedness	3.14	0.63	2.49	0.42	1.98	0.32	57.10	<.001	0.570	<.001	<.001	<.001
Compulsivity	3.02	0.74	2.62	0.71	3.05	0.58	4.56	.013	0.096	.041	1.000	.022

Note. DAPP-BQ = Dimensional Assessment of Personality Pathology–Basic Questionnaire; BPD = borderline personality disorder; CG = nonclinical controls; M = mean; SD = standard deviation.

Table 5.

Means and Standard Deviations for DAPP-BQ Lower Order Scales of BPD Patients, ADHD Patients, and Nonclinical Individuals.

										Post hoc tests (p, Bonferroni)
	1. BPD (N = 30)		2. ADHD (N = 30)		3. CG (N = 30)		MANCOVA			p	p	p
DAPP-BQ	M	SD	M	SD	M	SD	F	p	Partial η²	1 vs. 2	1 vs. 3	2 vs. 3
Anxiousness	3.73	0.74	2.96	0.76	2.36	0.68	26.28	<.001	0.38	<.001	<.001	.010
Identity Problems	3.83	0.78	2.65	0.79	1.86	0.45	59.69	<.001	0.58	<.001	<.001	<.001
Social Avoidance	3.68	0.71	2.73	0.74	2.09	0.36	47.66	<.001	0.53	<.001	<.001	.001
Affective Lability	3.77	0.66	3.12	0.84	2.49	0.73	21.36	<.001	0.33	.004	<.001	.010
Cognitive Distortions	2.96	0.71	2.45	0.72	1.87	0.51	21.03	<.001	0.33	.015	<.001	.003
Passive Aggressiveness	3.32	0.61	3.48	0.71	2.30	0.42	37.23	<.001	0.46	.562	<.001	<.001
Submissiveness	3.18	0.55	2.61	0.60	2.32	0.44	20.09	<.001	0.32	<.001	<.001	.144
Insecure Attachment	3.67	0.66	2.63	0.72	2.44	0.71	26.88	<.001	0.39	<.001	<.001	.630
Self-Harm	3.81	0.98	1.64	0.62	1.22	0.48	109.09	<.001	0.72	<.001	<.001	.115
Suspiciousness	3.25	0.92	2.22	0.63	2.00	0.54	25.62	<.001	0.37	<.001	<.001	.729
Narcissism	2.85	0.80	2.89	0.66	2.56	0.64	2.14	.124	0.05	1.000	.301	.182
Stimulus Seeking	3.21	0.79	2.95	0.71	2.50	0.60	8.25	.001	0.16	.654	<.001	.029
Conduct Problems	2.44	0.88	2.10	0.59	1.87	0.42	6.15	.003	0.13	.290	.002	.257
Rejection	2.74	0.68	2.92	0.63	2.54	0.45	2.83	.065	0.06	.759	.597	.059
Callousness	2.45	0.70	2.18	0.54	2.14	0.47	2.57	.082	0.06	.341	.098	1.000
Restricted Expression	3.53	0.65	2.80	0.57	2.27	0.47	36.89	<.001	0.46	<.001	<.001	.002
Intimacy Problems	2.74	0.80	2.19	0.49	1.69	0.41	23.17	<.001	0.35	.001	<.001	.018

Note. DAPP-BQ = Dimensional Assessment of Personality Pathology–Basic Questionnaire; BPD = borderline personality disorder; CG = nonclinical controls; M = mean; SD = standard deviation.

Correlation coefficients between the DAPP-BQ and the NEO-PI-R scales in this study are provided in Table 6.

Table 6.

Correlations Between DAPP-BQ Higher Order and NEO-PI-R Scales.

	Neuroticism	Extraversion	Openness to Experience	Agreeableness	Conscientiousness
Emotional Dysregulation	.83**	−.16	−.16	−.54**	−.52**
Dissocial Behavior	.37**	.15	−.65**	−.36**	.13
Inhibitedness	.73**	−.39**	−.08	−.43**	−.74**
Compulsivity	.06	−.15	.01	.57**	−.27**

Note. DAPP-BQ = Dimensional Assessment of Personality Pathology–Basic Questionnaire; NEO-PI-R = NEO–Personality Inventory–Revised.

p < .001.

Discussion

To our knowledge, this pilot study was the first to directly compare personality traits and personality pathology of adult ADHD patients, BPD patients, and nonclinical individuals. We predicted that BPD patients and adult ADHD patients would have distinguishable personality structures and that both would differ from nonclinical controls.

On the NEO-PI-R, BPD patients were characterized by highest Neuroticism scores and lowest Extraversion and Openness to Experience scores in comparison with the other two groups. No specific trait or pattern of traits could be identified for adult ADHD on the higher order scales of the NEO-PI-R. Within the Compulsivity scales of the DAPP-BQ, low Compulsivity scores were characteristic for adult ADHD. BPD patients were characterized by high scores of Neuroticism and Inhibitedness compared with adult ADHD patients and nonclinical controls.

Neuroticism and Emotional Dysregulation

Both patient groups showed elevated Neuroticism scores compared with nonclinical controls, with BPD patients scoring substantially higher than adult ADHD patients. Our findings replicate previous studies that found Neuroticism scores to be elevated in BPD patients (Perry & Cooper, 1985; Pukrop, 2002; Trull, 1992) as well as in adult ADHD patients (C. P. Jacob et al., 2007; Ranseen et al., 1998; Retz et al., 2004).

This pattern was largely reflected on all Neuroticism subscales except Impulsiveness where both patient groups score similarly. This is in line with previous research consistently showing elevated Impulsivity self-report scores for both disorders (Davids & Gastpar, 2005; Paris et al., 2004).

On Emotional Dysregulation, a similar pattern was found, that is, significantly elevated scores in both patient groups but BPD scoring higher than adult ADHD, in line with previous research (Pukrop, 2002). This pattern was reflected on all subscales except on Passive Aggressiveness where ADHD and BPD scored similarly high. These results are not surprising as the Emotion Dysregulation scale has a close relationship to BPD and most of its DSM (APA, 2000) diagnostic criteria are captured by Emotion Dysregulation scales. However, while ADHD patients scored significantly lower than BPD patients, compared with nonclinical individuals, adult ADHD patients were also affected by enhanced emotional lability. This is in line with previous findings showing affect dysregulation in children with ADHD (Maedgen & Carlson, 2000) and supporting the view by Wender et al. (2001) that affect dysregulation is a diagnostic criteria for adult ADHD.

Extraversion and Inhibitedness

On the NEO-PI-R domain, low Extraversion scores were specific to BPD patients, in line with previous research (Pukrop, 2002). Most current conceptions view the core of Extraversion as positive emotionality and an energetic approach to the social and material world, including such traits as sociability, activity, and assertiveness (Clark & Watson, 1999; Lucas, Diener, Grob, Suh, & Shao, 2000). Low Extraversion scores in BPD are consistent with BPD’s diagnostic criteria of marked unstable social relationships, affective instability and inappropriate levels, and/or display of anger.

Adult ADHD patients scored comparable with nonclinical individuals on Extraversion. Previous research into the relationship between ADHD and Extraversion has produced mixed results (Braaten & Rosen, 1997; John et al., 1994; Nigg et al., 2002; Parker et al., 2004; Ranseen et al., 1998) and still needs to be clarified. In our study, Extraversion scores of adult ADHD patients were significantly lower only on the Warmth and Positive Emotions subscales, suggesting that only aspects relating to positive affect based on social activity were affected.

On the Social Avoidance scale of the DAPP-BQ, the BPD group scored significantly higher than the ADHD group, and both groups scored higher than nonclinical individuals, a pattern that was also found on the three subscales of the domain. Increased scores on Intimacy Problems and Low Affiliation are directly related to clinical descriptions of BPD, whereas increased scores of Restricted Expressions in BPD might reflect a reluctance to self-disclose rather than restricted emotional expression per se.

Openness to Experience

Scores on the Openness to Experience domain of the NEO-PI-R were comparable between all groups.

Agreeableness and Dissocial Behavior

No differences on NEO-PI-R domain Agreeableness were found between the groups. Lower scores were only found on subscales Altruism where BPD patients scored significantly lower than nonclinical individuals and Trust where BPD scored lower than both other groups.

The finding that low Agreeableness was only found on two subscales could be an effect of sample size, which underemphasizes the scales of lower order traits. It should be noted that our BPD sample also scored low on Extraversion. Previous research has proposed a relationship between low Extraversion scores and normal Agreeableness scores in BPD patients (Pukrop, 2002), suggesting that BPD patients with low Extraversion and normal Agreeableness scores represent less aggressive and more introverted subtypes of BPD.

On the corresponding DAPP-BQ Dissocial Behavior scale, no significant differences were found between the patient groups but both differed from nonclinical individuals, a finding in line with previous research (Pukrop, 2002). On lower order scales, both patient groups showed increased levels of Stimulus Seeking, which might be related to their behavioral overlap in impulsivity, as the scale captures aspects of impulsivity, sensation seeking, and reckless behavior (Livesley & Jackson, 2009).

Conscientiousness and Compulsivity

On the NEO-PI-R, both disorders displayed significantly lower scores on the Conscientiousness domain compared with nonclinical individuals, replicating findings of previous research (C. P. Jacob et al., 2007; Ranseen et al., 1998; Retz et al., 2004). On the DAPP-BQ Compulsivity domain, adult ADHD patients scored significantly lower than both other groups. Compulsivity is described as orderly, precise, and conscientious behavior, all of which are core impairments of adult ADHD.

Limitations

A clear limitation of this study was small sample size. Furthermore, a selection bias may have affected the results: All BPD patients were inpatients, recruited for a specialized inpatients program, whereas all adult ADHD patients were outpatients who came for diagnosis and referral to an outpatients program. Even though none of the BPD patients were recruited in acute “crisis,” one cannot rule out that the BPD patients in our study were more severely impaired than BPD patients in an outpatient setting and that higher scores in BPD patients compared with ADHD patients were related to severity of illness. Moreover, the range of our sample was restricted as we excluded patients who had diagnoses for adult ADHD and BPD. Furthermore, the effects of comorbid disorders and medication were not controlled for, and as such, one cannot rule out the possibility that the differences between the groups were influenced by the presence of other disorders or medication. Finally, most personality and psychopathology measures were assessed with self-rating instruments. It should further be mentioned that self-rated personality tests are rather limited in separating psychiatric disorders. Following the classical principles described by Robins and Guze (1970), to establish diagnostic validity, a broader range of evaluations is needed, including symptomatic profiles, corroboration of self-assessment by third-party reports, longitudinal data, treatment response, and biological markers.

Conclusion

In sum, our results suggest that BPD and adult ADHD have distinct and specific underlying patterns of personality traits and personality pathology. On the NEO-PI-R, BPD patients were characterized by highest Neuroticism scores and lowest Extraversion and Openness to Experience scores in comparison with the other two groups. On the DAPP-BQ, low Compulsivity scores were characteristic for adult ADHD, whereas high scores of Neuroticism and Inhibitedness were characteristic for BPD patients. Our findings suggest that BPD patients were more disturbed in the areas of negative affect and social interaction, whereas adult ADHD patients were more impaired in behavioral control.

Footnotes

Acknowledgements

The authors would like to thank Jonathan Seyghal for helpful comments on the manuscript.

Authors’ Note

Michael Colla and Stefan Roepke contributed equally to this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Johanna Koerting is a PhD student in developmental psychopathology at the Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology at the University of Southampton. Her research interests include ADHD and personality disorders, focusing in particular on identification of childhood risk factors and early intervention.

Philipp Klein is a physician and clinical researcher at the University of Luebeck. His research interests include chronic depression, ADHD and psychotherapy.

Kathrin Ritter is a Research Fellow and Lecturer at the Department of Psychology and Educational Sciences at the Free University Berlin. Her research interests include personality psychology and personality disorders with a particular interest in narcissism, self-esteem, and emotions. She is also a psychotherapist with a private practice in Berlin, and she supervises and teaches at several psychotherapy institutes in Germany.

Mark Knowles is a research fellow at the Developmental Brain Behaviour Laboratory, University of Southampton. His main interests focus on exploring factors that contribute to, and affect, developmental psychopathology.

Anke Banzhaf is a psychotherapist who has been working at the Charité University Medicine Berlin for the last 10 years. She is an expert in the treatment of borderline patients and patients with chronic and severe posttraumatic stress disorder. Her research focuses on personality disorders.

Laura Gentschow is a clinical psychologist and behavioral psychotherapist at the department of psychiatry at Charité University Medicine Berlin. Her research and clinical interests include the neurobiology, neuropsychology and psychotherapy of ADHD in adults.

Aline Vater is a clinical psychologist at the Free University of Berlin (Cluster Languages of Emotion). Her work focuses on self-esteem and emotion processing in patients with Narcissistic and Borderline Personality Disorder. She is also training to be a cognitive-behavior therapist.

Isabella Heuser is professor and head of department at the Department of Psychiatry and Psychotherapy at Charité - Universitätsmedizin Berlin.

Stefan Roepke is a senior physician at the Department of Psychiatry at Charité - Universitätsmedizin Berlin, and head of the personality disorders and PTSD unit. His research interests include emotion regulation, memory, social cognition and pharmacological and psychotherapeutic interventions in personality disorders, especially borderline personality disorder and PTSD.

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