Until the mid-1990’s, ADHD was predominantly diagnosed and treated as a childhood disorder. This lack of research data on cognitive and behavioral difficulties during adulthood has resulted in frequent misdiagnosis of adult ADHD with Generalized Anxiety Disorder, Major Depressive Disorder, Bipolar Disorder, and Borderline Personality Disorder. This blog post describes the main similarities and differences between Adult ADHD and these four psychological disorders. Keep reading to learn about misdiagnosis of: ADHD in Generalized Anxiety Disorder, ADHD in Major Depressive Disorder, ADHD in Bipolar Disorder, and ADHD in Borderline Personality Disorder.
Misdiagnosis of Adult ADHD in Major Depressive Disorder
Adult ADHD can certainly cause depressive symptoms, such as low motivation, feelings of hopelessness, and difficulty with daily task completion. While Major Depressive Disorder (MDD) can coexist in those with Adult ADHD, it can also be a result of Adult ADHD symptoms. Common similarities between Adult ADHD and MDD are restlessness, boredom, self-doubt, sadness, irritability, relationship conflicts, and social isolation. Furthermore, difficulty with concentration is one of the first symptoms of depression, which can result in a misdiagnosis of Adult ADHD in Major Depressive Disorder. Another factor leading to Adult ADHD being misdiagnosed as MDD is that depressive symptoms often result from the Adult ADHD individual’s social embarrassment, work or academic difficulties, failed relationships, and low self-worth.
There are some major differences between Adult ADHD and MDD. For instance, it is common for someone with Adult ADHD to hyperfocus on tasks which are enjoyable or interesting and then to grow bored after a certain period of time, while those with MDD tend to derive no enjoyment in anything. Another difference is that the symptoms of Adult ADHD tend to be enduring across time and situations, while those with MDD tend to experience distinct depressive episodes, which last at least two weeks or longer, and may come and go over time. A final difference is that people with Adult ADHD can experience motivation and pleasure when they spend their time on certain activities, while people with MDD often develop a complete lack of motivation in activities which were previously enjoyable or interesting to them.
Misdiagnosis of Adult ADHD in Generalized Anxiety Disorder
Many adults meet the criteria for having Generalized Anxiety Disorder (GAD), yet this diagnosis may be secondary to Adult ADHD. Some common similarities between Adult ADHD and GAD are disorganization, poor time management skills, procrastination, social insecurities, panic attacks, poor stress management skills, and being easily overwhelmed by even simple daily tasks. Two other major overlapping symptoms of these disorders are daily restlessness and fear about keeping one’s life under control. Furthermore, Adult ADHD can cause persistent anxiety about one’s ability to stay focused on parental, work, and/or academic responsibilities.
With GAD, a person has difficulty staying focused, due to persistent worries, irrational fears, and obsessive, unwanted thoughts. However, with Adult ADHD, anxious thoughts can be a distraction but can also be pleasant. Another difference is that those with Adult ADHD often like change, because they get bored easily, yet those with GAD tend to crave routine, because it offers certainty in their lives. Those with GAD desperately strive for structure, because it provides a much needed sense of control, but those with Adult ADHD actually become quite skilled at functioning within chaotic and unpredictable situations. A final key difference is that those with GAD tend to have poor focus, because their minds are dominated by intrusive, worrisome thoughts, while those with Adult ADHD have poor focus which results from a neurological learning disability.
Misdiagnosis of Adult ADHD in Bipolar Disorder
Adult ADHD has also been misdiagnosed as Bipolar Disorder. This misdiagnosis largely results from the psychomotor agitation, rapid speech patterns, racing thoughts, and unpredictable mood shifts, which can be observed in those with Adult ADHD. Also, both Adult ADHD and Bipolar Disorder are characterized by difficulty with achieving short-term and long-term goals. However, Adult ADHD symptoms are characterized by attention and behavioral disturbances, while Bipolar Disorder symptoms are characterized primarily by mood disturbances, which often lead to behavioral disturbances.
In contrast to those with Adult ADHD, those with Bipolar Disorder are more likely to exhibit anger outbursts, self-destructive behaviors, uncontrollable flight of ideas, severe instability in daily functioning, emotional extremes, and distinct periods of hopelessness and lethargy. Most importantly, Bipolar Disorder consists of specific episodes of depression and mania, due to an imbalance in the brain’s pleasure chemicals, which are primarily serotonin, dopamine, and norepinephrine, while Adult ADHD results from a deficiency in the brain’s attention and memory chemicals, which are primarily dopamine and acetylcholine.
Misdiagnosis of Adult ADHD as Borderline Personality Disorder
The two most common overlapping symptoms of Adult ADHD and Borderline Personality Disorder (BPD) are impulsivity and difficulty with emotional regulation. Other behavioral symptoms which overlap between Adult ADHD and BPD are unfiltered speech patterns, self-destructive and/or self-defeating behaviors, unstable relationships, difficulty with work or personal responsibilities, poor stress management skills, and a chaotic lifestyle. Emotional symptoms which may overlap between Adult ADHD and BPD are insecurity, unpredictable mood shifts, poor emotional regulation, inappropriate emotional boundaries toward friends and/or romantic partners, fear of rejection, and frequent self-doubt.
There are some differences, which are often overlooked when distinguishing between a diagnosis of Adult ADHD and BPD. For instance, BPD is a disorder that involves a longstanding pattern of mood instability, chronic feelings of emptiness, repetitive “testing” of others’ loyalty or love within romantic relationships, and a wavering sense of self which severely debilitates one’s daily life. However, the mental confusion and impulsivity of Adult ADHD differs from the more severe identity disturbances and dissociation of BPD. While BPD can develop at different time points and through different experiences, Adult ADHD is a condition which is typically present since childhood and involves symptoms relating to excessive attention challenges, excessive hyperactivity, and excessive impulsivity. Another difference is that someone with Adult ADHD tends to become more confused and impulsive when stressed, while someone with BPD tends to exhibit extreme emotions, particularly anger, when stressed. Furthermore, someone with Adult ADHD often has trouble with clarifying and moderating all emotions, but someone with BPD tends to exhibit a more dramatic pattern of losing one’s temper, having emotional meltdowns, and experiencing severe difficulty with discussing issues in a calm and productive manner. Adult ADHD individuals are prone to negative communication patterns in relationships, as a result of frequently “blurting out” unfiltered or unrelated thoughts. In contrast, BPD individuals often feel unloved and unwanted by romantic partners, friends, and family members, due to unresolved childhood traumatic events, emotional abuse, physical abuse, loss, family dysfunction, or neglect. While both ADHD and BPD can result from traumatic experiences, ADHD is a neurodevelopmental disorder, and BPD is a personality disorder which affects one’s mood states more than one’s attention span and memory.
Although the four disorders described in this blog post do often coexist with ADHD, each of them has been frequently diagnosed without first considering ADHD as the primary diagnosis. It is extremely important to educate yourself about different possible diagnoses which could apply to your unique set of symptoms prior to seeking a mental health evaluation. Furthermore, you may need to seek a second opinion for yourself or for your child if you suspect that a diagnosis may be incorrect or not the primary diagnosis. Remember that Adult ADHD is a relatively new diagnostic category and research area within the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM), thus it is worthwhile to do your own research about your emotional and cognitive difficulties, as well as your chaotic behavior patterns. The course of treatment and prescribed medication is quite different for each of these disorders, and a misdiagnosis of Bipolar Disorder is definitely the most concerning!
Curious about the Impact of Impulsivity in ADHD over a lifetime? Keep reading here.
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