The Link Between ADHD, BPD, and Trauma: Unveiling the Relationship

Q: “How should clinicians understand a patient’s experience with trauma and adverse events in relation to conditions that are often associated with trauma, like borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD)? How should clinicians take traumatic events into consideration when evaluating and treating these patients?”

With ADHD, we know that individuals have a higher risk for various kinds of trauma.1 We also know that the signs of trauma — like inattention and emotional dysregulation — can overlap with the signs of ADHD. Attention issues, for example, can be due to intrusive thoughts about a traumatic event. A stimulant medication can improve inattention in ADHD, but it won’t help inattention if it’s trauma-based and unrelated to ADHD. If anything, stimulant medication might worsen intrusive thoughts.

As for BPD, we know that most of these individuals (about 70%) have histories of trauma, and that trauma is thought to play a major role in BPD’s development.2 Understanding trauma’s ripple effects and processing its implications on a patient’s life is an important part of evaluating and treating BPD. A traumatic event, for example, may disrupt one’s identity development and sense of self — a sign of BPD.

At the same time, while it’s helpful to understand a patient’s BPD as a result of their traumatic experiences, clinicians should also consider that most individuals who experience trauma do not go on to develop BPD, PTSD, ADHD, or other serious mental health conditions. Even so, trauma can play out in myriad ways — from developing fears around abandonment to experiencing intense responses to sensory triggers related to the traumatic event. A nuanced approach to trauma that factors how a patient makes sense of the traumatic event is key.

Another important point: BPD and ADHD, like other mental health diagnoses, are unfortunately highly stigmatized. Whether a patient has BPD, ADHD, or both, and a history of trauma, clinicians should help patients look at their diagnoses as information that can help them understand what they’re experiencing and guide them to appropriate treatments.

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Borderline Personality Disorder & Its Connection to ADHD” [Video Replay & Podcast #446] with Roberto Olivardia, Ph.D., which was broadcast on March 15, 2023.

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