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ADHD Chatter PodcastADHD Chatter Podcast

Why ADHD Is Often Misdiagnosed As BPD

Dr Judith Mohring has over 25 years' experience of clinical and organisational practice having studied medicine at Cambridge. Today, she explains the difference between ADHD and BPD.

Alex Partridgehost
Sep 3, 202546mWatch on YouTube

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At a glance

WHAT IT’S REALLY ABOUT

Psychiatrist compares ADHD and BPD overlap, differences, and treatment approaches

  1. ADHD is framed as a two-branch profile of inattention/executive dysfunction and hyperactivity-impulsivity, while BPD is described as a DSM-5 cluster emphasizing impulsivity plus more severe emotional/relational instability.
  2. The conversation highlights substantial symptom overlap—especially impulsivity and emotional dysregulation—making misdiagnosis possible and sometimes leading to appropriate dual diagnoses when criteria for both are met.
  3. BPD is linked more strongly to trauma/attachment disruption and may include self-harm, intense abandonment fears, dissociation, and transient paranoia or psychotic-like experiences under stress.
  4. Stigma around BPD is addressed directly, including its historic use as a “diagnostic dumping ground” and the need for neuroinclusive assessment that considers ADHD/autism before labeling.
  5. Treatment is contrasted as medication-forward for ADHD versus therapy-forward for BPD (e.g., DBT), with discussion of adjunct medications for BPD and emerging consideration that some BPD presentations may benefit from stimulants.

IDEAS WORTH REMEMBERING

5 ideas

Impulsivity is the strongest bridge between ADHD and BPD.

Both conditions centrally feature difficulty inhibiting urges (spending, substances, sex, blurting, quitting jobs), which can make presentations look similar unless the full pattern and history are assessed.

Emotional dysregulation is common in ADHD, but is typically more severe and destabilizing in BPD.

The episode emphasizes that ADHD can be “massively emotional,” yet BPD more often includes extreme state shifts that may involve dissociation and rapid flips from “everything is fine” to “everything is not fine.”

Certain features are more diagnostically distinguishing for BPD than ADHD.

Recurrent self-harm, intense abandonment-related behaviors (e.g., begging/pleading to prevent leaving), and transient paranoia/psychotic-like experiences under stress are presented as more specific to BPD.

Trauma and attachment disruption are often central to BPD presentations.

The psychiatrist frames abandonment fears as understandable learned responses in context of significant early loss/unavailability (death, leaving, addiction, severe emotional unavailability), rather than trivializing it as minor parenting choices.

Misdiagnosis is plausible; “both/and” can be the correct answer.

Because ADHD and BPD can both meet criteria in the same individual, the recommendation is thorough assessment and transparent formulation rather than forcing a single label.

WORDS WORTH SAVING

5 quotes

Many people with ADHD cope really well, function really well. Many people with BPD cope well and function well, but BPD's probably more disabling, and there's a stronger emotional component to it. And that emotional component at times tips into kind of dissociation and where parts of the self don't really talk to each other, and that's where we get these really drastic mood swings, where everything will be fine and then suddenly everything's not fine.

— Dr Judith Mohring

When we add trauma into the mix with neurodiversity, so if you experienced early abandonment, so of course trust is gonna be hard to establish. Of course you're gonna worry about people leaving you. It's rational, right?

— Dr Judith Mohring

I'll often say to my kids, "Your emotions are important, but they're not in charge."

— Dr Judith Mohring

It's been used as a bit of a kind of diagnostic dumping ground in the past, um, a sense of, "I don't know what to do with this client. I don't know how to help them."

— Dr Judith Mohring

There's a phrase, "I love you, don't leave me" that comes from the BPD literature, um, meaning, "I really need you, and yet I can't bear the intimacy and it's too threatening, because I can't bear the fact that you can go away and leave me."

— Dr Judith Mohring

Read the available transcript
ADHD core traits (inattention vs hyperactivity/impulsivity)BPD DSM-5 criteria and hallmark featuresEmotional dysregulation, RSD, and “state shifts”Trauma, attachment, and fear of abandonmentDissociation, paranoia, and transient psychotic-like symptomsComorbidity and diagnostic complexityRelationships, social media triggers, and spiraling/catastrophizingBPD vs narcissism differentiationTreatment: DBT, group work, meds, and symptom management

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SPEAKERS

  • Alex Partridge

    host

    Host of the ADHD Chatter Podcast, interviewing experts about ADHD and related conditions.

High quality AI-generated summary created from speaker-labeled transcript.

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