ADHD and Personality Disorders

Transcription

1 ADHD and Personality Disorders J. Antoni Ramos-Quiroga Department of Psychiatry Hopsital Universitari Vall d Hebron Universitat Autònoma de Barcelona Geneva Centro de Investigación Biomédica En Red de Salud Mental

2 FINANCIAL DISCLOSURE COMPANY SPEAKER CONSULTANT GRANTS Janssen-Cilag X X X Lilly X X X Shire X X X Novartis X Laboratorios Rubió X X X Alicia Koplowitz Foundation Instituto Carlos III-EU X X X

3 OUTLINE Introduction Personality Disorders and ADHD Boderline Personality Disorder and ADHD Personality and ADHD Conclusions

4 OUTLINE Introduction Personality Disorders and ADHD Boderline Personality Disorder and ADHD Personality and ADHD Conclusions

5 ADHD and PERSONALITY ADHD From childhood Chronic disorder In 2 or more settings PERSONALITY Early development Relatively stable Consistent in different situations

6 OVERLAP OF SYMPTOMS Impulsivity. Difficulties in emotional regulation Interpersonal instability Dramatic expression of emotion Suggestibility BPD Hys. PD Difficulties in assuming responsibility Autonomy Difficulty in initiating activities Dep. PD Matthies et al. 2011

7 OUTLINE Introduction Personality Disorders and ADHD Boderline Personality Disorder and ADHD Personality and ADHD Conclusions

8 PD and ADHD subtypes Narcissistic personality disorder. Cluster B personality disorders. ADHD-Hy Cluster C personality disorders. ADHD-Inatte Jacob et al. 2007

9 PD in aadhd Philipsen et al. 2008: 25% of aadhd have personality disorders Avoidant PD (21%) Borderline PD (18.3%) Paranoid (8.3%)

10 PD in aadhd Rosler et al. 2009: Adult ADHD female prison inmates showed an increased prevalence of BPD and a higher prevalence of avoidant PD in comparison without ADHD: 54.5% vs. 28.9%

11 CHILDHOOD ADHD AND PD Fisher et al. 2008: Higher comorbidity of chilhood ADHD and personality disorders at mean age of years, in comparison with community control children: Antisocial (21%) Passive-aggressive (18%) Borderline personality disorders (14%) Histrionic (12%)

12 CHILDHOOD ADHD AND PD Lewinsohn et al. 1997: Reported that adults with history of ADHD behaviors during childhood were at higher risk of being diagnosed with: Antisocial, Histrionic, Narcissistic, Schizoid and Schizotypal personality disorders than comparisons in later life.

13 ADHD AND APD Biederman et al. 2010

14 ADHD AND APD Biederman et al. 2010

15 PD in aadhd (76.60%) ADHD GENDER 203 (67.44%) males 98 (32.56%) females 162 (53.8%) combined 92 (23.40%) non ADHD Ramos-Quiroga et al. In press SUBTYPE 115 (38.2%) inattentive 24 (8.0%) hyperactive

16 PD in aadhd 46.4% ADHD and 32.6% non ADHD showed PD (p=0.103). 25% 20% 25% P= 0.42 P= % 15% 15% 10% 10% 5% 5% 0% Schizotipal Paranoid Schizoid 0% Histrionic Narcisstic BDP CD Antisocial 25% 20% P= 0.10 ADHD 15% 10% Non ADHD 5% Avoidant amos-quiroga et al. In press 0% Dependent OC

17 PD in aadhd 54.7% of males and 31.7% of females have PD (p= 0.004) Paranoid 40% 35% 30% 25% P= Antisocial P= 0.05 CD P= 0,008 P= 0.06 P= 0.51 Males Females P= % 15% 10% 5% 0% Ramos-Quiroga et al. In press CLUSTER A CLUSTER B CLUSTER C

18 PD in aadhd 34.4% inattentive, 57.1% hyperactive-impulsive and 53.4% combined subtype showed any PD (p= 0,047) 60% 50% 40% P= Combined Inattentive 30% 20% Hyperactiveimpulsive 10% 0% PD Ramos-Quiroga et al. In press A B C

19 OUTLINE Introduction Personality Disorders and ADHD Boderline Personality Disorder and ADHD Personality and ADHD Conclusions

20 BPD and ADHD 1. APA. DSM-IV-TR. APA Miller et al. J Clin Psychiatr 2008;69: Distel et al. Am J Med Genet 2011;156: Kooij et al. J Att Dis 2012:16(5S):3S 19S.

21 BPD and ADHD

22 BPD and ADHD

23 BPD and ADHD

24 BPD and ADHD

25 BPD and ADHD

26 OUTLINE Introduction Personality Disorders and ADHD Boderline Personality Disorder and ADHD Personality and ADHD Conclusions

27 PERSONALITY IN ADULTS WITH ADHD PREVIOUS STUDIES REVIEW ADHD AND PERSONALITY Big Five (Jacob et al., 2007; Nigg et al., 2002; Parker, Majeski, y Collin, 2004; Ranseen, Campbell, y Baer, 1998; Retz et al., 2004, Miller et al., 2008) Neuroticism, Conscientiousness, Agreeableness Cloninger (Anckarsater et al., 2006; Downey, Pomerleau, & Pomerleau, 1996; Jacob et al., 2007) Openness to experience, Avoidance of damage Millon (May & Bos, 2000) Histrionism Eysenck & Gray (Braaten & Rosen, 1997, Nigg et al., 2004)? Extraversion, Neuroticism, Emotional reactions to negative

28 ZKPQ Zuckerman Kuhlman Personality Questionnaire (ZKPQ) Neuroticism-Anxiety (N-Anx) Activity (Act) Sociability (Sy) Impulsive Sensation-Seeking (ImpSS) Aggression-Hostility (Agg-Host) Infrequency scale (Infreq): validity measure for the individual test-taker.

29 ALTERNATIVE FIVE FACTOR MODEL Psychiatry Res Jun 30;198(1):130-4

30 PARTICIPANTS Variables Age Gender Ethnic Academic level ADHD subtype ADHD (N=217) M=33.69 years, SD=10.21 Range= years M: 139 (64.1%), W: 78 (35.9%) Caucasian High School 72.7% Combined 56.7% Inattentive 34.5% H-Impulsive 2.9 % Control (N=434) M=33.69 years, SD=10.20 Range= years M: 278 (64%), W: 156 (36%) Caucasian High School 51.4% NA NA NA

31 LOGISTIC REGRESSION ANALYSIS ZKPZ dimensions The resulting model was statisticaly significant: χ2 3=157.62, p= Sensitivity 65% Specificity 80% Total hit rate 75% OR 7.4

32 RESULTS aadhd showed higher scores vs community subjects: Neuroticism-Anxiety Impulsive-Sensation Seeking Aggression-Hostility But not on Activity.

33 LOGISTIC REGRESSION ANALYSIS ZKPQ dimensions and traits The resulting model was statisticaly significant: χ2 3=238, p= Sensitivity 71.9% Specificity 80.6% Total hit rate 79.1% OR 10.7

34 OUTLINE Introduction Personality Disorders and ADHD Boderline Personality Disorder and ADHD Personality and ADHD Conclusions

35 CONCLUSIONS ADHD share some features with personality disorders such as borderline personality disorder. One hypothesis for this relation could be that ADHD is a precursor to personality disorders. The prevalence of PD in adults with ADHD is high, in particular cluster B PD.

36 CONCLUSIONS ZKPQ: The most powerful predictors of aadhd classification taking account dimensions and traits: Neuroticism-Anxiety Impulsivity General activity Aggression-Hostility Work Activity

37 CONCLUSIONS Describing adult ADHD in terms of general personality structure can contribute to a better conceptualization of this disorder, to a better differential diagnosis and can also help to the development of more effective treatments.

38 ADHD and Personality Disorders J. Antoni Ramos-Quiroga Department of Psychiatry Hopsital Universitari Vall d Hebron Universitat Autònoma de Barcelona Geneva Centro de Investigación Biomédica En Red de Salud Mental