The use of dextroamphetamine/amphetamine to treat attention-deficit/hyperactivity disorder comorbid with borderline personality disorder: A case report

Background

30–60 % of patients with borderline personality disorder (BPD) also meet criteria for attention-deficit/hyperactivity disorder (ADHD). However, because symptoms of BPD tend to “overshadow” those of ADHD, clinicians frequently fail to diagnose, and therefore treat, comorbid BPD and ADHD (BPD+ADHD) appropriately. Psychostimulants such as dextroamphetamine/amphetamine (AMP) are considered the “gold standard” treatment for ADHD. Because BPD and ADHD share a number of clinical features – deficits in affect regulation, impulsivity, low self-esteem, interpersonal, educational, and occupational dysfunction – the current case report investigates the ability of AMP to mediate these variables in comorbid BPD+ADHD. The literature base on the treatment of BPD+ADHD is significantly limited, warranting the need for the current case report.

Case presentation

A 30-year-old cisgender female diagnosed with BPD and ADHD with history of multiple psychiatric inpatient hospitalizations, longstanding involvement in outpatient dialectical-behavior therapy, and marked functional impairment was treated with AMP. Significant improvements in functional outcome (gaining and maintaining employment, caring for self, maintaining financial stability) and decreases in functional impairment (no instances of psychiatric hospitalizations) occurred across a 1.5-year follow-up period after being treated with AMP.

Conclusions

We suggest that pharmacological treatment of comorbid BPD and ADHD with AMP may have been responsible for the overall improvement in functional outcome in this patient. We postulate that AMP allowed for increased ability to adopt and implement dialectical-behavior therapy skills that had previously been unable to be adopted and implemented prior to AMP administration. We hypothesize that increased ability to implement skills may have been attributable to improved overall cognitive and behavioral control induced by the administration of AMP.