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Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder

Published online by Cambridge University Press:  17 May 2007

K. LAMPE ,
K. KONRAD ,
S. KROENER ,
K. FAST ,
H. J. KUNERT  and
S. C. HERPERTZ
K. LAMPE
Affiliation:
Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital
K. KONRAD
Affiliation:
Department of Child and Adolescence Psychiatry and Psychotherapy, RWTH Aachen, University Hospital
S. KROENER
Affiliation:
Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital
K. FAST
Affiliation:
Department of Psychiatry and Psychotherapy, Munich University (LMU)
H. J. KUNERT
Affiliation:
Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital
S. C. HERPERTZ*
Affiliation:
Department of Psychiatry and Psychotherapy, Rostock University, Germany
*
*Address for correspondence: Professor Dr Sabine C. Herpertz, Director of the Department of Psychiatry and Psychotherapy, Rostock University, Gehlsheimer Str. 20, D-18147 Rostock, Germany. (Email: [email protected])
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Abstract

Background

Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness.

Method

The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups.

Results

ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole.

Conclusions

Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 12 , December 2007 , pp. 1717 - 1729
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin 121, 65–94.Google Scholar
Barkley, R. A., Fischer, M., Smallish, L. & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology 111, 279–289.Google Scholar
Barratt, C. S. (1985). Impulsiveness subtraits, arousal and information processing. In Motivation, Emotion and Personality (ed. Spence, J. T. and Izard, C. E.), pp. 137–146. Elsevier: Amsterdam.Google Scholar
Bäumler, G. (1985). Colour-Word Interference Test on Stroop [in German]. Hogrefe: Göttingen.Google Scholar
Bazanis, E., Rogers, R. D., Dowson, J. H., Taylor, P., Meux, C., Staley, C., Nevinson-Andrews, D., Taylor, C., Robbins, T. W. & Sahakian, B. J. (2002). Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychological Medicine 32, 1395–1405.Google Scholar
Bohus, M., Schmahl, C. & Lieb, K. (2004). New developments in the neurobiology of borderline personality disorder. Current Psychiatry Reports 6, 43–50.Google Scholar
Boonstra, A. M., Oosterlaan, J., Sergeant, J. A. & Buitelaar, J. K. (2005). Executive functioning in adult ADHD: a meta-analytic review. Psychological Medicine 35, 1097–1108.Google Scholar
Conners, C. K., Erhardt, D. & Sparrow, E. P. (2002). Conners' Adult ADHD Rating Scales (CAARS). Multi-Health Systems Inc.: Toronto.Google Scholar
Davids, E. & Gastpar, M. (2005). Attention deficit hyperactivity disorder and borderline personality disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 29, 865–877.Google Scholar
Domes, G., Winter, B., Schnell, K., Vohs, K., Fast, K. & Herpertz, S. C. (2006). Inhibitory functioning in borderline personality disorder and the influence of emotions. Psychological Medicine 36, 1163–1172.Google Scholar
Dowson, J. H., McLean, A., Bazanis, E., Toone, B., Young, S., Robbins, T. W. & Sahakian, B. J. (2004 a). Impaired spatial working memory in adults with attention-deficit/hyperactivity disorder: comparisons with performance in adults with borderline personality disorder and in control subjects. Acta Psychiatrica Scandinavica 110, 45–54.Google Scholar
Dowson, J. H., McLean, A., Bazanis, E., Toone, B., Young, S., Robbins, T. W. & Sahakian, B. (2004 b). The specificity of clinical characteristics in adults with attention-deficit/hyperactivity disorder: a comparison with patients with borderline personality disorder. European Psychiatry 19, 72–78.Google Scholar
Faraone, S. V., Biederman, J. & Mick, E. (2005). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 35, 1121–1132.Google Scholar
Fischer, M., Barkley, R. A., Smallish, L. & Fletcher, K. (2002). Young adult follow-up of hyperactive children: self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. Journal of Abnormal Child Psychology 30, 463–475.Google Scholar
Frazier, T. W., Damaree, H. A. & Youngstrom, E. A. (2004). Meta-analysis of intellectual and neuropsychology test performance in attention-deficit/hyperactivity disorder. Neuropsychology 18, 543–555.Google Scholar
Gaub, M. & Carlson, C. L. (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child and Adolescence Psychiatry 36, 1036–1045.Google Scholar
Herpertz, S., Gretzer, A., Steinmeyer, E. M., Mühlbauer, V., Schürkens, A. & Sass, H. (1997). Affective instability and impulsivity in personality disorder. Results of an experimental study. Journal of Affective Disorders 44, 31–37.Google Scholar
Herpertz, S. C., Kunert, H. J., Schwenger, U. B. & Sass, H. (1999). Affective responsiveness in borderline personality disorder: a psychophysiological approach. American Journal of Psychiatry 156, 1550–1556.CrossRefGoogle Scholar
Hervey, A. S., Epstein, J. N. & Curry, F. F. (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology 18, 485–503.Google Scholar
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E. & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716–723.Google Scholar
Konrad, K., Gauggel, S., Manz, A. & Schöll, M. (2000 a). Inhibitory control in children with traumatic brain injury (TBI) and children with attention deficit/hyperactivity disorder (ADHD). Brain Injury 14, 859–875.Google Scholar
Konrad, K., Gauggel, S., Manz, A. & Scholl, M. (2000 b). Lack of inhibition: a motivational deficit in children with attention deficit/hyperactivity disorder and children with traumatic brain injury. Neuropsychology 6, 286–296.Google Scholar
Kunert, H. J., Drücke, H. W., Sass, H. & Herpertz, S. C. (2003). Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings. Journal of Personality Disorders 17, 497–509.Google Scholar
Lijffijt, M., Kenemans, J. L., Verbaten, M. N. & Van Engeland, H. (2005). A meta-analytic review of stopping performance in ADHD: deficient inhibitory motor control? Journal of Abnormal Psychology 196, 216–222.Google Scholar
Logan, G. D. (1994). A users' guide to the stop signal paradigm. In Inhibitory Processes in Attention, Memory and Language (ed. Dagenbach, D. and Carr, T. H.), pp. 189–239. Academic Press: San Diego.Google Scholar
Logan, G. D. & Cowan, W. B. (1994). On the ability to inhibit thought and action: a theory of an act of control. Psychological Review 91, 295–327.Google Scholar
Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., Coid, B., Dahl, A., Diekstra, F. F. & Ferguson, B. (1994). The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry 51, 215–224.Google Scholar
Margraf, J., Schneider, S., Ehlers, A., DiNardo, P. & Barlow, D. (1994). DIPS – Diagnostic Interview of Psychological Disorders (2nd edn). Springer: Berlin.Google Scholar
Nigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin 2, 220–246.Google Scholar
Nigg, J. T. (2001). Is ADHD a disinhibitory disorder? Psychological Bulletin 127, 571–598.Google Scholar
Nigg, J. T. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biological Psychiatry 57, 1424–1435.Google Scholar
Pennington, B. F. & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry 37, 51–87.Google Scholar
Philipsen, A. (2006). Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. European Archives of Psychiatry and Clinical Neuroscience 256 (Suppl. 1), i42–i46.Google Scholar
Posner, M. I. & Petersen, S. E. (1990). The attention systems of the human brain. Annual Review of Neuroscience 13, 25–42.Google Scholar
Posner, M. I., Rothbart, M. K., Vizueta, N., Levy, K. N., Evans, D. E., Thomas, K. M. & Clarkin, J. F. (2002). Attentional mechanisms of borderline personality disorder. Proceedings of the National Academy of Sciences of the United States of America 99, 16366–16370.Google Scholar
Rey, J. M., Morris-Yates, A., Singh, M., Andrews, G. & Stewart, G. W. (1995). Continuities between psychiatric disorders in adolescents and personality disorders in young adults. American Journal of Psychiatry 152, 895–900.Google Scholar
Sachdev, P. (1999). Attention deficit hyperactivity disorder in adults. Psychological Medicine 29, 507–514.Google Scholar
Schachar, R., Mota, V. L., Logan, G. D., Tannock, R. & Klim, P. (2000). Confirmation of an inhibitory control deficit in attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology 28, 227–235.Google Scholar
Schoechlin, C. & Engel, R. R. (2005). Neuropsychological performance in adult attention-deficit hyperactivity disorder: meta-analysis of empirical data. Archives of Clinical Neuropsychology 20, 727–744.Google Scholar
Sergeant, J. A. (2005). Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biological Psychiatry 57, 1248–1255.Google Scholar
Spielberger, C. D. (1988). Manuel for the State-Trait Anger Expression Inventory (STAXI). Psychological Assessment Resources: Odessa, FL.Google Scholar
Sprock, J., Rader, T. J., Kendall, J. P. & Yoder, C. Y. (2000). Neuropsychological functioning in patients with borderline personality disorder. Journal of Clinical Psychology 56, 1587–1600.Google Scholar
Stins, J. F., Polderman, J. C., Boomsma, D. I. & de Geus, E. J. (2005). Response interference and working memory in 12-year-old children. Child Neuropsychology 11, 191–201.Google Scholar
Swirsky-Sacchetti, T., Gorton, G., Samuel, S., Sobel, R., Genetta-Wadley, A. & Burleigh, B. (1993). Neuropsychological function in borderline personality disorder. Journal of Clinical Psychology 49, 385–396.Google Scholar
Tannock, R. (1998). Attention deficit hyperactivity disorder: advances in cognitive, neurobiological and genetic research. Journal of Child Psychology and Psychiatry 39, 65–99.Google Scholar
Van Reekum, R., Links, P. S., Finlayson, M. A., Boyle, M., Boiago, I., Ostrander, L. A. & Moustacalis, E. (1996). Repeat neurobehavioral study of borderline personality disorder. Journal of Psychiatry and Neuroscience 21, 13–20.Google Scholar
Ward, M. F., Wender, P. H. & Reimherr, F. W. (1993). The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry 150, 885–890.Google Scholar
Wechsler, D. (1987). Wechsler Memory Scale – Revised. The Psychological Corporation: San Antonio, TX.Google Scholar
Wender, P. H. (1995). Attention Deficit/Hyperactivity Disorders in Adults. Oxford University Press: New York.Google Scholar
Willcutt, E. G., Pennington, B. F., Olson, R. K., Chhabildas, N. & Hulslander, J. (2005). Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: in search of the common deficit. Developmental Neuropsychology 27, 35–78.Google Scholar
Wodushek, T. R. & Neumann, C. S. (2003). Inhibitory capacity in adults with symptoms of attention deficit/hyperactivity disorder (ADHD). Archives of Clinical Neuropsychology 18, 317–330.Google Scholar
Zimmermann, P. & Fimm, B. (1993). Test Battery for Attentional Performance, Version 1.02 [in German]. Psytest: Würselen.Google Scholar