ADHD and borderline personality symptoms linked in Malaysian adolescents

A cross-sectional study of 126 adolescents from three urban government secondary schools in Selangor, Malaysia, found a moderate association between greater parent-rated attention-deficit/hyperactivity disorder (ADHD) symptom severity and greater adolescent-reported borderline personality symptom severity. The relationship remained statistically supported after adjustment for gender, age band and school membership, with an adjusted linear-regression coefficient of 0.0378 (95% confidence interval 0.0186–0.0570; p<.001). The findings concern questionnaire scores rather than diagnoses and do not establish that either set of symptoms caused the other.

Researchers distributed 900 study packs and analyzed 126 parent–adolescent datasets that met the participation requirements. Parents assessed ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale–Fourth Edition. Adolescents completed the Borderline Symptom List–23, the Parental Bonding Instrument, the Mentalization Scale–12 and a sociodemographic questionnaire. The primary analysis compared continuous symptom scores from the two informants rather than determining whether participants met diagnostic criteria for ADHD or borderline personality disorder.

Pearson correlation analysis quantified the main relationship. Greater ADHD symptom severity was moderately associated with greater borderline personality symptom severity, with r=.360 and p<.001. The association also remained statistically supported in the adjusted regression and in sensitivity analyses. Because the design was cross-sectional, it could not determine the temporal order of the symptoms, identify a developmental pathway or demonstrate a causal effect.

The investigators conducted exploratory analyses of parenting dimensions and mentalization as possible explanations for part of the association. These analyses used 10,000 bootstrap samples and heteroscedasticity-consistent standard errors. An indirect estimate involving paternal Care was statistically supported, whereas estimates involving paternal Overprotection and the individual maternal dimensions were not. Direct bootstrap contrasts did not demonstrate that the paternal estimates differed from the corresponding maternal estimates. The planned indirect estimate involving the total Mentalization Scale–12 score was not statistically supported; exploratory subdomain findings were reported in the main text. These results do not establish parenting or mentalization as a mechanism for the observed association.

ADHD and borderline personality symptoms can share features including impulsivity, emotional dysregulation and interpersonal difficulties, but overlapping questionnaire features do not by themselves demonstrate diagnostic comorbidity. The study was limited to a selected sample from three schools in one Malaysian state and relied on parent and adolescent questionnaires. The authors noted the need for longitudinal studies using more representative samples, culturally validated instruments, diagnostic interviews and multiple informants to examine whether the association persists over time, whether the symptom dimensions cluster diagnostically and whether parenting or mentalization has a causal role.

Subject of Research: Cross-sectional study of ADHD and borderline personality symptom associations in Malaysian adolescents

Article Title: Associations between ADHD symptoms, borderline personality symptoms, parenting dimensions, and mentalization among malaysian adolescents: a cross-sectional study

Article References: Tan, Y. X., Chow, S. K., Kaur, M., Azhar, F. L., & Ng, Y. H. (2026). Associations between ADHD symptoms, borderline personality symptoms, parenting dimensions, and mentalization among malaysian adolescents: a cross-sectional study. BMC Psychology. https://doi.org/10.1186/s40359-026-05730-9

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05730-9

Keywords: ADHD symptoms, Borderline personality symptoms, Adolescent mental health, Cross-sectional study, Malaysian adolescents, Parenting dimensions, Mentalization, Parent–adolescent reports, Psychological measures, Associations, between, ADHD