Personality Disorders Common Among Adults With ADHD

Adults with ADHD had a high personality disorder burden.

Few adults with attention-deficit/hyperactivity disorder (ADHD) did not meet the criteria for a personality disorder (PD). The results of this study were published in the Journal of Attention Disorders.

Patients (N=181) with (n=147) and without (n=34) ADHD were recruited at the Sligo Mental Health Services in Ireland for this cross-sectional, pragmatic, observational study. Trends in PDs were evaluated using demographic characteristics, Conners’ Adult ADHD Diagnostic Interview for the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Millon Clinical Multiaxial Inventory-III (MCMI-III), and a psychiatric clinical evaluation.

The study population included individuals with a mean age of 32.94 years and 48.1% were women. Among the ADHD group, 59.9% were diagnosed with combined, 36.1% with inattentive, and 4.1% with hyperactive ADHD subtypes.

According to the MCMI-III, 71.8% did not have a severe personality pathology, 17.7% had 1, 8.3% had 2, and 2.2% had 3 severe personality pathologies, which included schizotypal, borderline, and/or paranoid pathologies. Stratified by ADHD diagnosis, no significant trends were observed.

A high rate of PDs was found, most notably dependent, depressive, avoidant, antisocial, negativistic and borderline.

For clinical personality patterns, 19.3% had no PDs, 31.5% had 1, 24.0% had 2, 16% had 3, and 12.1% had 4 or 5 PDs. Stratified by ADHD status, more of those with a narcissistic PD did not have ADHD (P =.017) whereas more with schizoid PD had ADHD (P =.018).

Among the ADHD group, the most common severe personality pathology was borderline (6.80%), followed by schizotypal (3.85%) and paranoid (2.95%) and for clinical PDs, the most common were dependent (3.59%), depressive (2.78%), and avoidant (2.35%) PDs and the least common were histrionic (0.06%), narcissistic (0.12%), and compulsive (0.12%) PDs.

Stratified by ADHD subtype, antisocial and negativistic PDs were more common in combined ADHD, a sadistic PD was more common in combined ADHD and less common in inattentive ADHD, and a dependent PD more common in inattentive ADHD and less common in combined ADHD (all P <.05).

Significant gender effects were observed for the prevalence of dependent (χ2, 5.272; P =.022), depressive (χ2, 5.161; P =.023), masochistic (χ2, 4.509; P =.034), and borderline (χ2, 4.019; P =.045) PDs which were all more common among women and an antisocial PD which was less common among women (χ2, 15.832; P <.001) compared with men.

This study may have been biased as all patients were referred for an ADHD evaluation.

These data indicated that adults with ADHD had a high PD burden. Study authors concluded, “A high rate of PDs was found, most notably dependent, depressive, avoidant, antisocial, negativistic and borderline. Why those personality disorders are more frequently found in ADHD patients remains the subject of debate and needs further investigations.”

This article originally appeared on Psychiatry Advisor


Adamis D, Kasianenko D, Usman M, et al. Prevalence of personality disorders in adults with attention deficit hyperactivity disorder (ADHD). J Atten Disord. 2023;10870547231161531. doi:10.1177/10870547231161531