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Porfirio MC, Campanile R, Masi G, Purper-Ouakil D, Giovinazzo S, Ascenzi A, Troisi A, Mazzone L. Exploring the Link between ADHD and Obesity: A Focus on Temperament. Brain Sci 2022; 12:brainsci12121631. [PMID: 36552091 PMCID: PMC9775563 DOI: 10.3390/brainsci12121631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
Multiple studies support the relationship between ADHD and overweight/obesity in youth. Different mechanisms may be involved, such as temperamental and psychopathological factors. The aim of this study was to test the hypothesis that specific temperamental and psychopathological dimensions could mediate the relationship between ADHD and obesity. The sample included 100 children and adolescents (78 males and 22 females; age range 6 to 18 years; mean age 9.90 ± 2.5 years). The assessment procedure included Conners' Parent Rating Scale-Long (CPRS-R:L) as the inclusion criterion for ADHD diagnosis, the Child Behavior Checklist (CBCL), a dimensional measure for psychopathology, and the Junior Temperament and Character Inventory, which describes four temperamental dimensions: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P). While in the whole ADHD sample, the highest scores were found in NS and the lowest in P, ADHD with overweight/obesity, compared to ADHD with normal weight, showed higher HA and RD, lower NS, and higher CBCL Internalizing scores. These findings suggest that ADHD youth with overweight/obesity present specific temperamental and psychopathological features compared to those without overweight/obesity. If confirmed in larger samples, using a control group without ADHD, these temperamental and psychological features may be helpful for an earlier recognition of ADHD patients at higher risk for obesity, and may represent possible targets for temperament-based preventive interventions and tailored treatment programs. These features should be included in the routine assessment of children and adolescents with ADHD and/or are overweight/obese.
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Affiliation(s)
- Maria Cristina Porfirio
- Child Neurology and Psychiatry Unit, Tor Vergata Hospital, Fondazione PTV, Oxford Street 81, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-062-090-0249
| | - Roberta Campanile
- Child Neurology and Psychiatry Unit, Tor Vergata Hospital, Fondazione PTV, Oxford Street 81, 00133 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
| | - Gabriele Masi
- IRCCS Stella Maris Foundation, Department of Child and Adolescent Psychiatry and Psychopharmacology, 56128 Pisa, Italy
| | - Diane Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, School of Medicine, 34090 Montpellier, France
| | - Silvia Giovinazzo
- Child Neurology and Psychiatry Unit, Tor Vergata Hospital, Fondazione PTV, Oxford Street 81, 00133 Rome, Italy
| | - Alessandra Ascenzi
- Child Neurology and Psychiatry Unit, Tor Vergata Hospital, Fondazione PTV, Oxford Street 81, 00133 Rome, Italy
| | - Alfonso Troisi
- International Medical School, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Tor Vergata Hospital, Fondazione PTV, Oxford Street 81, 00133 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
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2
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Cavelti M, Corbisiero S, Bitto H, Moerstedt B, Newark P, Faschina S, Chanen A, Moggi F, Stieglitz RD. A Comparison of Self-Reported Emotional Regulation Skills in Adults With Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder. J Atten Disord 2019; 23:1396-1406. [PMID: 28367706 DOI: 10.1177/1087054717698814] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Emotion dysregulation has been described as a central feature of both borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD). The current study aims to compare emotion regulation among ADHD, BPD, and healthy controls (HC). Method: Eighty adults with ADHD, 55 with BPD, and 55 HC completed self-report assessments of ADHD and BPD symptoms, psychosocial functioning, and emotion regulation skills. Principal components analysis (PCA) was conducted on the emotion regulation items, followed by multivariate analyses of group differences in emotion regulation. Results: PCA yielded four components: "Being Aware of Emotions," "Making Sense of Emotions," "Modifying and Accepting Emotions," and "Confronting Emotions With Self-Encouragement." The last component best distinguished the two patient groups from the HC. No differences were found between adults with ADHD and BPD. Conclusion: Adults with ADHD and BPD report comparable difficulties in encouraging oneself to attend inner aversive experiences, without engaging in impulsive behavior.
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Affiliation(s)
- Marialuisa Cavelti
- 1 Translational Research Center, University Hopsital of Psychiatry and psychotherapy, University of Bern, Switzerland.,2 Orygen, The National Centre of Excellence in Youth Mental Health & Centre for Youth Mental Health, University of Melbourne, Australia
| | | | - Hannes Bitto
- 3 University of Basel Psychiatric Clinics, Switzerland
| | - Beatrice Moerstedt
- 3 University of Basel Psychiatric Clinics, Switzerland.,4 Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Switzerland
| | | | | | - Andrew Chanen
- 2 Orygen, The National Centre of Excellence in Youth Mental Health & Centre for Youth Mental Health, University of Melbourne, Australia
| | - Franz Moggi
- 1 Translational Research Center, University Hopsital of Psychiatry and psychotherapy, University of Bern, Switzerland
| | - Rolf-Dieter Stieglitz
- 3 University of Basel Psychiatric Clinics, Switzerland.,4 Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Switzerland
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3
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Evren C, Karabulut V, Alniak I, Evren B, Carkci OH, Yilmaz Cengel H, Ozkara Menekseoglu P, Cetin T, Bozkurt M, Umut G. Emotion dysregulation and internalizing symptoms affect relationships between ADHD symptoms and borderline personality features among male patients with substance use disorders. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1595271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahap Karabulut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Izgi Alniak
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
| | - Ozlem Helin Carkci
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Hanife Yilmaz Cengel
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Pelin Ozkara Menekseoglu
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Turan Cetin
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Muge Bozkurt
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
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4
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Weiner L, Perroud N, Weibel S. Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks. Neuropsychiatr Dis Treat 2019; 15:3115-3129. [PMID: 31806978 PMCID: PMC6850677 DOI: 10.2147/ndt.s192871] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are particularly common disorders, that are highly comorbid in adult populations. The symptomatic overlap between adult ADHD and BPD includes impulsivity, emotional dysregulation and interpersonal impairment, which makes the differential diagnosis difficult. Our review aims at focusing on recent data on the comorbid ADHD+BPD form, as well as the risk factors involved in the emergence of the two disorders. While adult ADHD and BPD share some genetic and temperamental risk factors, adult ADHD is characterized by more severe trait-impulsivity compared to non-comorbid BPD; BPD patients display more severe trait-emotion regulation symptoms compared to non-comorbid ADHD. Patients with the comorbid ADHD+BPD form have severe symptoms in both dimensions. Early-life exposure to adverse events is a shared risk factor for the development of ADHD and BPD, but type and timing of adversity seem to play a differential role in the development of BPD and ADHD symptoms. Age of onset used to be a discriminative diagnostic criterion between ADHD, an early-onset neurodevelopmental disorder, and BPD, a late-onset psychological disorder. However, this distinction has been recently called into question, increasing the need for more research aiming at delineating the disorders from a developmental and clinical standpoint. Clinicians should carefully consider the comorbidity, and consider ADHD and BPD dimensionally, in order to provide more effective patient management. This might improve early preventive interventions, and treatment for comorbid conditions in adulthood.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire De Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
| | - Nader Perroud
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
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5
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Ozdemiroglu F, Karakus K, Memis CO, Sevincok L, Mersin S. Temperament in Adulthood Attention Deficit-Hyperactivity Disorder without Bipolar Disorder. Psychiatry Investig 2018; 15:266-271. [PMID: 29475238 PMCID: PMC5900379 DOI: 10.30773/pi.2017.06.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 05/03/2017] [Accepted: 06/07/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We examined whether some temperamental traits would be associated with persistence of attention deficit-hyperacitivty disorder (ADHD) in adulthood independent from bipolar disorder (BD). METHODS Eighty-one ADHD patients without a comorbid diagnosis of BD were divided into two groups, those with childhood ADHD (n=46), and those with Adulthood ADHD (n=35). The severity of childhood and adulthood ADHD were assessed by using the Wender Utah Rating Scale (WURS-25) and Turgay's Adult ADD/ADHD Diagnosis and Evaluation Scale (DES). Subjects' temperamental characteristics were examined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A). RESULTS The mean scores of WURS-25 were higher in adult ADHD group than in childhood ADHD group (p<0.001). Adult ADHD group had significantly higher scores on cyclothymic (p=0.002), irritable (p<0.0001), and anxious (p=0.042) subscales of TEMPS-A. The scores of WURS-25 in adulthood ADHD group were positively correlated with cyclothymia scores (r=0.366, p=0.033). Total scores of Turgay's Adult ADD/ADHD DES were positively correlated with cyclothymic (r=0.354, p=0.040), hyperthymic (r=0.380, p=0.026), and irritable (r=0.380, p=0.026) subscale scores. Cychlothymic and irritable temperaments were significantly associated with the severity of adulthood symptoms of ADHD. CONCLUSION We might suggest that cyclothymic and irritable temperaments would predict the diagnosis of adulthood ADHD independent from BD.
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Affiliation(s)
| | - Kadir Karakus
- Department of Psychiatry, Adnan Menderes University, Aydın, Turkey
| | | | - Levent Sevincok
- Department of Psychiatry, Adnan Menderes University, Aydın, Turkey
| | - Sanem Mersin
- Karşıyaka State Hospital, Psychiatry Department, Izmir, Turkey
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6
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Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, Dayer A, Perroud N. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord 2018; 226:85-91. [PMID: 28964997 DOI: 10.1016/j.jad.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS Cross-sectional study on treatment-seeking patients. CONCLUSIONS We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
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Affiliation(s)
- Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France; Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Cole
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eva Rüfenacht
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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7
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Evren C, Alniak I, Karabulut V, Cetin T, Umut G, Agachanli R, Evren B. Relationship of probable ADHD with novelty seeking, severity of psychopathology and borderline personality disorder in a sample of patients with opioid use disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1395312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Izgi Alniak
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahap Karabulut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Turan Cetin
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Ruken Agachanli
- Department of Psychiatry, Ardahan State Hospital, Ardahan, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
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8
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Kulacaoglu F, Solmaz M, Belli H, Ardic FC, Akin E, Kose S. The relationship between impulsivity and attention-deficit/hyperactivity symptoms in female patients with borderline personality disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1342317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Filiz Kulacaoglu
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Mustafa Solmaz
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Hasan Belli
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ferhat Can Ardic
- Department of Psychiatry, Bagcilar Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School of Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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9
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Cho SW, Lee YJ, Lee SA, Hong M, Lee SM, Park JC, Bahn GH. Comparison of Adults with Attention-Deficit Hyperactivity Disorder Depending on the Age of Being Diagnosed in Childhood and Adulthood: Based on Retrospective Review in One University Hospital. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.3.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seong Woo Cho
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ae Lee
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea
| | - Sang Min Lee
- Department of Psychiatry, Konyang Univerisity College of Medicine, Konyang University Hospital, Daejeon, Korea
| | - Jin Cheol Park
- Department of Psychiatry, Silverheals Hospital, Namyangju, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
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10
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Odell A, Reynolds GL, Fisher DG, Huckabay LM, Pedersen WC, Xandre P, Miočević M. Attention Deficit Hyperactivity Disorder, Aggression, and Illicit Stimulant Use: Is This Self-Medication? J Nerv Ment Dis 2017; 205:372-379. [PMID: 28230564 PMCID: PMC5439354 DOI: 10.1097/nmd.0000000000000668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study compares adults with and without attention deficit hyperactivity disorder (ADHD) on measures of direct and displaced aggression and illicit drug use. Three hundred ninety-six adults were administered the Wender Utah Rating Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all scales of the AQ and DAQ, were younger at first use of amphetamines, and were more likely to have ever used crack and amphetamines. A Structural Equation Model found a significant interaction in that for those with medium and high levels of verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic regression models suggest that blacks self-medicate with crack and whites and Hispanics self-medicate with amphetamine when they have ADHD and verbal aggression.
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Affiliation(s)
- Annie Odell
- School of Nursing, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
| | - Grace L. Reynolds
- Center for Behavioral Research and Services, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
| | - Dennis G. Fisher
- Center for Behavioral Research and Services, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
- Department of Psychology, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
| | - Loucine M. Huckabay
- School of Nursing, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
| | - William C. Pedersen
- Department of Psychology, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
| | - Pamela Xandre
- School of Nursing, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, California 90840, USA
| | - Milica Miočević
- Department of Psychology, Arizona State University, 950 S. McAllister Ave, Tempe, AZ 85287, USA
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11
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Purper-Ouakil D, Porfirio MC, Le Strat Y, Falissard B, Gorwood P, Masi G. What do childhood attention deficit/hyperactivity symptoms in depressed adults tell us about the bipolar spectrum? Psychiatry Res 2017; 249:244-251. [PMID: 28126580 DOI: 10.1016/j.psychres.2016.12.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/15/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to establish if adult patients with major depressive disorder (MDD) and childhood Attention Deficit/Hyperactivity disorder (ADHD) symptoms would be more frequently within the bipolar spectrum than depressed patients without childhood ADHD. METHODS This study was carried out in outpatients recruited by psychiatrists in private practice, with 3963 participants being included in the final sample. Clinicians filled out questionnaires about current depressive symptoms in their patients, lifetime bipolar symptoms, global assessment of functioning and parental history of both major depression and bipolar disorder. Patients assessed current level of anxiety and depressive symptoms and antecedents of childhood ADHD symptoms. RESULTS Depressed adults with significant childhood ADHD symptoms had a specific pattern of their major depressive episode compared to depressed patients without such symptoms. Subjects with childhood ADHD symptoms were more likely to report lifetime symptoms of mania/hypomania and to have a parent with type I or II bipolar disorder. The developmental trajectories of familial risk for lifetime bipolar symptoms showed that parental bipolar disorder influenced lifetime bipolar symptoms both through a direct pathway and an indirect pathway involving childhood ADHD symptoms. Childhood ADHD and number of depressive symptoms both made direct contributions to lifetime bipolar symptoms.
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Affiliation(s)
- D Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, Montpellier, France.
| | - M C Porfirio
- Unit of Child Neurology and Psychiatry of "Tor Vergata", University of Rome, Italy
| | - Y Le Strat
- AP-HP Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, France; INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France
| | - B Falissard
- INSERM U1178, Maison de Solenn, Paris, France
| | - P Gorwood
- INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France; CMME Saint Anne Hospital, Hôpital Sainte-Anne (Paris-Descartes University), France
| | - G Masi
- Stella Maris Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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12
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Abstract
An existing relationship between attention-deficit/hyperactivity disorder (ADHD) and personality disorder (PD) has been well documented, yet research has been limited by possible selection and self-report biases as well as PD models of questionable validity. This study examined the relationship of ADHD with adult personality traits and disorders in a sample that included individuals prescreened for elevated childhood ADHD symptoms. Four hundred thirty-nine undergraduates completed retrospective reports of childhood ADHD symptoms as well as current ratings of ADHD symptoms, traditional PD categories, and the DSM-5 alternative PD trait model. To overcome potential biases in self-report, 161 parents of the participants provided ratings of childhood and current functioning. Results suggest that while self-report of ADHD was significantly correlated with several PDs, parent reports obtained somewhat more specific links with adult dependent, borderline, and paranoid PDs. Most importantly, the DSM-5 Section III dimensional trait model provided greater specificity, as the trait of distractibility consistently emerged as a unique predictor, and thus appeared more useful for understanding the developmental pathways of ADHD.
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Affiliation(s)
| | - Douglas B Samuel
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
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13
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Herpertz SC, Mancke F, Bertsch K. Aggressivität, emotionale Instabilität und Impulsivität bei der Borderline-Persönlichkeitsstörung. FORENSISCHE PSYCHIATRIE, PSYCHOLOGIE, KRIMINOLOGIE 2016. [DOI: 10.1007/s11757-016-0379-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Matthies S, Philipsen A. Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)--Review of Recent Findings. Curr Psychiatry Rep 2016; 18:33. [PMID: 26893231 DOI: 10.1007/s11920-016-0675-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.
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Affiliation(s)
- Swantje Matthies
- Department of Psychiatry & Psychotherapy, University Medical Centre Freiburg, Hauptstr. 5, D-79104, Freiburg, Germany.
| | - Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, D-26111, Oldenburg, Germany. .,Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Straße 7, D-26160, Bad Zwischenahn, Germany.
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15
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Scott LN, Stepp SD, Hallquist MN, Whalen DJ, Wright AGC, Pilkonis PA. Daily shame and hostile irritability in adolescent girls with borderline personality disorder symptoms. Personal Disord 2016; 6:53-63. [PMID: 25580673 DOI: 10.1037/per0000107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent theoretical and empirical work suggests that adults with borderline personality disorder (BPD) have difficulty regulating both shame and anger, and that these emotions may be functionally related in clinically relevant ways (e.g., Schoenleber & Berenbaum, 2012b). The covariation of shame with anger-related emotions has important clinical implications for interventions targeting shame and uncontrolled anger in BPD. However, no studies have examined shame, anger, and their covariation in adolescents who may be at risk for developing BPD. Therefore, this study focuses on associations between BPD symptoms and patterns of covariation between daily experiences of shame and anger-related affects (i.e., hostile irritability) in a community sample of adolescent girls using ecological momentary assessment. Multilevel models revealed that girls with greater BPD symptoms who reported greater mean levels of shame across the week also tended to report more hostile irritability, even after controlling for guilt. Additionally, examination of within-person variability showed that girls with greater BPD symptoms reported more hostile irritability on occasions when they also reported greater concurrent shame, but this was only the case in girls of average socioeconomic status (i.e., those not receiving public assistance). Unlike shame, guilt was not associated with hostile irritability in girls with greater BPD symptoms. Results suggest that shame may be a key clinical target in the treatment of anger-related difficulties among adolescent girls with BPD symptoms.
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Affiliation(s)
- Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | | | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
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16
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Affiliation(s)
| | - Shun Ting Loy
- Neurosurgery Service, Singapore General Hospital, Singapore.
| | - Arvind Gupta
- Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore
| | - Ivan Ng
- Neurosurgery Service, Singapore General Hospital, Singapore.
| | - James F Cullen
- Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore
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17
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Clinical, neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2015.06.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Might the temperament be a bias in clinical study on attention-deficit hyperactivity disorder (ADHD)?: Novelty Seeking dimension as a core feature of ADHD. Psychiatry Res 2015; 227:333-8. [PMID: 25895488 DOI: 10.1016/j.psychres.2015.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 02/11/2015] [Accepted: 02/21/2015] [Indexed: 11/24/2022]
Abstract
Some clinical studies on attention deficit hyperactivity disorder (ADHD) have been found to overlap those of studies on personality, particularly those on the Novelty Seeking trait (NS) as measured by the Junior Temperament and Character Inventory (JTCI). The aim of this study was to evaluate the potential role of NS in clinical research on ADHD. We enroled 146 ADHD children (125 boys; mean age=9.61, S.D.=2.50) and 223 age- and gender-matched control children (178 boys; mean age=9.41, S.D.=2.30). All the parents filled in the JTCI for the evaluation of personality according to Cloninger׳s model. An exploratory factor analysis differentiated the NS items that concern "Impulsivity" (NS1) from those that concern other features (NS2). Multivariate Analysis of Variance (MANOVAs) revealed significant differences between ADHD children and non-ADHD children in temperamental dimensions: the scores of ADHD children were higher than those of non-ADHD children in Total NS, NS1-Impulsivity and NS2. Our results show that the NS dimension of the JTCI in ADHD children is higher than in non-ADHD children, even when a correction is made for impulsivity items. This finding suggests that the NS trait plays a central role in ADHD diagnosis even when items referred to impulsivity are removed from the NS scale.
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19
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Dalbudak E, Evren C. The impact of childhood traumas, depressive and anxiety symptoms on the relationship between borderline personality features and symptoms of adult attention deficit hyperactivity disorder in Turkish university students. Nord J Psychiatry 2015; 69:42-7. [PMID: 24865122 DOI: 10.3109/08039488.2014.922612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies reported that there is a significant association between attention deficit hyperactivity disorder (ADHD) in childhood and borderline personality disorder (BPD) in adulthood. AIM The aim of this study is to investigate the relationship of borderline personality features (BPF) and ADHD symptoms while controlling the effect of childhood traumas, symptoms of depression and anxiety in adulthood on this relationship in Turkish university students. METHODS A total of 271 Turkish university students participated in this study. The students were assessed through the Turkish version of the Borderline Personality Inventory (BPI), the Adult ADHD Self-Report Scale (ASRS), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). RESULTS Correlation analyses have revealed that severity of BPF is related with adult ADHD symptoms, emotional, physical abuse and depression scores. Hierarchical regression analysis has indicated that depressive symptoms, emotional and physical abuse and the severity of ADHD symptoms are the predictors for severity of BPF. CONCLUSIONS Findings of the present study suggests that clinicians must carefully evaluate these variables and the relationship between them to understand BPF and ADHD symptoms in university students better. Together with depressive symptoms, emotional and physical abuse may play a mediator role on this relationship. Further studies are needed to evaluate causal relationship between these variables in both clinical and non-clinical populations.
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Affiliation(s)
- Ercan Dalbudak
- Ercan Dalbudak, Turgut Ozal University, Department of Psychiatry, Faculty of Medicine , Ankara , Turkey
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20
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Fossati A, Gratz KL, Borroni S, Maffei C, Somma A, Carlotta D. The relationship between childhood history of ADHD symptoms and DSM-IV borderline personality disorder features among personality disordered outpatients: the moderating role of gender and the mediating roles of emotion dysregulation and impulsivity. Compr Psychiatry 2015; 56:121-7. [PMID: 25446725 DOI: 10.1016/j.comppsych.2014.09.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022] Open
Abstract
A number of studies have reported data suggestive of a significant association between attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). However, the nature of this relation is not fully understood. This study aimed to evaluate if the relation between retrospectively assessed ADHD symptoms and adult BPD features is moderated by participants' gender and mediated by emotion dysregulation and impulsivity. Two hundred seventeen outpatients meeting DSM-IV criteria for at least one personality disorder (PD) consecutively admitted to the Clinical Psychology and Psychotherapy Unit of the Scientific Institute H San Raffaele of Milan, Italy, were administered Italian versions of the following instruments: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Wender Utah Rating Scale (WURS), Difficulties in Emotion Regulation Scale (DERS), and the Barratt Impulsiveness Scale-11 (BIS-11). Moderation analyses revealed a significant association between ADHD and BPD symptoms among only female (vs. male) outpatients. Furthermore, in the female subsample, mediation analyses revealed that both impulsivity and emotion dysregulation fully mediated the relationship between retrospectively assessed ADHD symptoms and current BPD features.
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Affiliation(s)
- Andrea Fossati
- Department of Human Studies, LUMSA University, Rome, Italy; Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Serena Borroni
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy; Faculty of Psychology, Vita-Salute San Raffaele University, Milano, Italy
| | - Cesare Maffei
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy; Faculty of Psychology, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonella Somma
- Department of Human Studies, LUMSA University, Rome, Italy; Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy
| | - Davide Carlotta
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milano, Italy.
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21
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Fossati A. Diagnosing Borderline Personality Disorder During Adolescence: A Review of the Published Literature. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Borderline personality disorder (BPD) is a debilitating disorder that occurs in approximately 1% to 3% of the general population. BPD is not only relatively prevalent; it is also associated with significant public health and security concerns. The clinical and social burden of adult BPD diagnosis has resulted in the desire for early diagnosis and the implementation of early intervention programs. A qualitative review of the scientific literature suggested that adolescence is a critical point for the early identification and therapeutic treatment of BPD. Although findings are far from conclusive, the inter-rater reliability and internal consistency of the Diagnostic and Statistical Manual of Mental Disorders symptom criteria for BPD during adolescence seem adequate. Recent studies based on a rigorous methodology of BPD assessment and large community samples reported prevalence rates for BPD diagnosis during adolescence that were less suspect than previous findings. A number of research studies addressed the construct validity of BPD in adolescents (i.e., whether a BPD diagnosis during adolescence actually measures what is intending to measure) and reported consistent relationships between BPD and associated areas of dysfunction and distress as evidence of the validity of the BPD diagnosis. Research evidence indicates that there is no single symptom that is predictive of later BPD diagnosis during adolescence; rather, a pattern of two to three selected BPD symptoms that are evident during adolescence seemed to be highly predictive of later BPD diagnosis, particularly when measures that were specifically designed to assess for BPD during adolescence were used as part of the assessment process.
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Affiliation(s)
- Andrea Fossati
- Department of Humanities, Libera Università Maria Ss. Assunta , Rome , Italy
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