Women and girls being diagnosed with ADHD is topical. Once considered a ‘male’ disorder, major media outlets have swooped, with women and girls everywhere, revealing recent diagnoses – Em Rusciano at the ABC Press club, for one. What isn’t so widely known is how female ADHD and neurodiversity is often confused with borderline personality disorder (BPD). I’m wondering if this is why neurodiversity for a lot of women has only recently been diagnosed.
The internet is littered with swathes of articles about ADHD becoming confused with BPD.
“My ADHD was misdiagnosed as a personality disorder,” reads a Medium essay.]
“Missed Diagnosis,” is the title of another BuzzFeed article.
The Psychiatric Times questions,”ADHD, Bipolar Disorder or Borderline Personality Disorder?”
ADHD has been subject to gender bias, typically perceived in restless schoolboys. It’s not what psychiatry was looking for in women. Considered a more female disorder, women have predominantly been diagnosed with BPD.
I have ADHD. I was also diagnosed with BPD without any formal diagnosis or without health professionals following any diagnostic criteria. Later, I was told by a psychiatrist I might have elements of it but not BPD.
Confusion is a given with a lot of similarities between the two. Both disorders can make you feel like you run on an endless motor, cause distraction and lack of focus, as well as hyperfocus, mood swings, addiction, poor interpersonal relations, poor school and work performance and lack of organisation and time management.
Even therapies designed for one or the other can treat both. Popular pain management drug, Cymbalta, because of its chemical properties, is said to alleviate ADHD symptoms and also helps with chronic depression in BPD.
But they are two completely different things. One of the problems with BPD is how you are treated. Unfortunately, sometimes that’s internally by mental health services.
There’s still a lot of mystification surrounding BPD. I don’t even like the term. There are so many psychosocial factors that go into this disorder it can hardly be put down to just “personality.” It almost suggests it’s someone’s inherent flaw. Other American medical establishments have started to refer to BPD as “complex trauma.”
Perceptions of BPD are taken from popular media, modelled on the likes of Aileen Wournos. Her story was so contrived by the media and other establishments that I even question whether her case is archetypal.
But as people with BPD are believed to be dangerous like this, I question if mental health systems have their feelers out for it, sidelining other diagnoses.
I’ll never forget what one regional provider told me when I was worried about anger being worsened by antidepressants.
“Why are you worried about anger as a side effect of antidepressants?” she said. “You have anger anyway, don’t you?”
Definitions of BPD unto themselves are confusing and deceptively familiar. They can be so easily construed. Take the terms “ephemeral,” “markedly intense” and “idealisation,” in terms of relationships. Without a clear diagnostic context what does any of this mean? This could mean just about anything of a person’s mindset.
Talking of cursory diagnosis, BPD does have a clear diagnostic differential:
To paraphrase the words of clinical psychiatrist Dr Ramani on YouTube talk, Med Circle, to be diagnosed with BPD, patients must display five concurrent symptoms out of nine said characteristics of the disorder.
As Jillian Enright outlines in her Medium article according to Moukhtarian et al[CS|WWDA1] . in relation to:
“…the presence or severity of emotional dysregulation should not be used in clinical practice to distinguish between the two disorders.”
If any mental health service diagnoses someone, this criterion has to be met. If not, it’s not professional clarification and is poor mental health servicing.
As is the case with any disability, it’s complex, multi-factorial and presents with comorbidities or other illnesses. Why BPD is at the forefront of psychiatry, I don’t know? In any case, this convolutes treatment.
I’ve struggled with the right treatment for years, experiencing side effects and other complications. It’s still not right. I still don’t even know exactly what I have.
ADHD can even precipitate BPD. I wonder if that’s because ADHD sufferers are already vulnerable and sometimes subject to further disillusionment from such protracted experience.
On an extremely private, emotional level, I felt re-traumatised by the system and never seemed to get treatment closure. Not only have I struggled to get jobs, but all this added to my inability to fulfil a budding journalism career.
I don’t want this to happen to anyone else.
Kerry is a freelance writer from regional Australia. She writes about mental illness from an intersectional perspective. Her work has been published in Australia and America.