Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Centre for Epidemiology and Community Medicine & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Acta Psychiatr Scand. 2022 Oct;146(4):370-380. doi: 10.1111/acps.13476. Epub 2022 Jul 23.
Childhood attention-deficit /hyperactivity disorder (ADHD) is known to be associated with adult Borderline Personality Disorder (BPD). We investigated if any of the subdimensions of childhood ADHD, that is, impulsivity, inattention, or hyperactivity was more prominent in this association.
In a nation-wide cohort (N = 13,330), we utilized parent reported symptoms of childhood ADHD and clinically ascertained adult BPD diagnoses. The summed total scores of ADHD symptoms and its three subdimensions were used and standardized for effect size comparison. Associations were analyzed using Cox regression with sex and birth-year adjustments. Secondary outcomes were BPD-associated traits (i.e., self-harm and substance use) analyzed using logistic- and linear regression respectively.
ADHD symptom severity was positively associated with BPD with a hazard ratio (HR) of 1.47 (95% confidence interval [CI]: 1.22-1.79) per standard deviation increase in total ADHD symptoms. Impulsivity was the most prominent subdimension with the only statistically significant association when analyzed in a model mutually adjusted for all ADHD subdimensions-HR for inattention: 1.15 (95% CI: 0.85-1.55), hyperactivity: 0.94 (95% CI: 0.69-1.26), impulsivity: 1.46 (95% CI: 1.12-1.91). In secondary analyses, weak positive associations were seen between total ADHD symptom score and self-harm and substance use. In analyses by subdimensions of ADHD, associations were weak and most prominent for inattention in the model with self-harm.
Childhood ADHD symptoms were associated with subsequent development of BPD diagnosis and appeared to be driven primarily by impulsivity. Our findings are important for understanding the association between childhood symptoms of ADHD and subsequent BPD.
已知儿童注意缺陷多动障碍（ADHD）与成年边缘型人格障碍（BPD）有关。我们研究了 ADHD 的儿童亚维度，即冲动、注意力不集中或多动，是否在这种关联中更为突出。
在一项全国性队列研究（N=13330）中，我们利用父母报告的儿童 ADHD 症状和临床确定的成年 BPD 诊断。使用 ADHD 症状及其三个亚维度的总和总分进行标准化，以进行效应大小比较。使用 Cox 回归进行性别和出生年份调整后的关联分析。使用逻辑回归和线性回归分别分析 BPD 相关特征（即自我伤害和物质使用）。
ADHD 症状严重程度与 BPD 呈正相关，总 ADHD 症状每增加一个标准差，BPD 的风险比（HR）为 1.47（95%置信区间[CI]：1.22-1.79）。冲动是最突出的亚维度，当在相互调整所有 ADHD 亚维度的模型中进行分析时，唯一具有统计学意义的关联是注意力不集中：1.15（95%CI：0.85-1.55），多动：0.94（95%CI：0.69-1.26），冲动：1.46（95%CI：1.12-1.91）。在次要分析中，总 ADHD 症状评分与自我伤害和物质使用之间存在弱正相关。在 ADHD 亚维度的分析中，在包含自我伤害的模型中，注意力不集中的关联较弱且最为突出。
儿童 ADHD 症状与随后的 BPD 诊断有关，似乎主要由冲动驱动。我们的发现对于理解 ADHD 儿童症状与随后的 BPD 之间的关联很重要。
