Does my HwuBPD have ADHD too?

[Family Court Strategies: When Your Partner Has BPD OR NPD Traits.]

I have a new therapist who has been very helpful so far. When I described some of the things about my husband that upset me the most — Pacing the floor, (verbally) attacking me when things are calm and quiet, repeating the same stories over and over, and doing extreme things, like driving to four different parks, all miles away from each other, in one day…She says he may have ADHD. Of course, I will never know, because he will never seek help, but it was interesting to hear. 

Lately, the anxiety he exhibits is irritating me more than the gaslighting and the name-calling. Of course, I know I’m not “stupid,” and he can’t fool me into thinking I’m “wrong” about everything.  But the pacing the repetition of the same stories, over and. over, , and his tendency to repeatedly say terrible things about people in the public who I respect, is maddening. 

I set boundaries by walking away, getting out and mingling with friends, and even verbalizing that I don’t appreciate and won’t tolerate whatever he’s saying (when I feel it’s safe to do so, but it only works for a short period of time. 

Still, it’s not easy, but —  I refuse to let him steal my joy.  If I am to spend my last days with him, I will appreciate and embrace every moment hat he is quiet and loving, and every moment that I am away from him. 

His anxiety, however, is disturbing to watch, and his repetition of crazy, negative stuff, is distressing. 

But I’m still here. 

Thanks for letting me vent.

JazzSinger

[JazzSinger]

I have a new therapist who has been very helpful so far. When I described some of the things about my husband that upset me the most — Pacing the floor, (verbally) attacking me when things are calm and quiet, repeating the same stories over and over, and doing extreme things, like driving to four different parks, all miles away from each other, in one day…She says he may have ADHD. Of course, I will never know, because he will never seek help, but it was interesting to hear. 

Lately, the anxiety he exhibits is irritating me more than the gaslighting and the name-calling. Of course, I know I’m not “stupid,” and he can’t fool me into thinking I’m “wrong” about everything.  But the pacing the repetition of the same stories, over and. over, , and his tendency to repeatedly say terrible things about people in the public who I respect, is maddening. 

I set boundaries by walking away, getting out and mingling with friends, and even verbalizing that I don’t appreciate and won’t tolerate whatever he’s saying (when I feel it’s safe to do so, but it only works for a short period of time. 

Still, it’s not easy, but —  I refuse to let him steal my joy.  If I am to spend my last days with him, I will appreciate and embrace every moment hat he is quiet and loving, and every moment that I am away from him. 

His anxiety, however, is disturbing to watch, and his repetition of crazy, negative stuff, is distressing. 

But I’m still here. 

Thanks for letting me vent.

JazzSinger

[Notwendy]

Personally, I don't think the label of ADHD - especially since it's speculation- as the therapist has not evaluated your husband- is going to be as helpful as looking at the behaviors that concern you.

There is a lot of overlap between mental health disorders. Anxiety can cause poor attention. And vice versa and so it's anyone's guess.

People can have controlling and repetitive behaviors as a way of managing anxiety.

You have mentioned before that you are seeing increases in some of your H's behaviors and that he is getting older. This is the kind of situation that would require a thorough medical evaluation. Understandable that it may be a challenge getting him to agree to this.

My BPD mother struggled with extreme anxiety. Trying to find the best way to manage this medically was a challenge as people also react differently to medicines as they get older. Without any medicine, the anxiety was really difficult for her. At higher doses, she'd get confused. So finding the right medicine and the right dose was some trial and error.

She would also say negative things and repeatedly. It's understandable that you would want to have some respite from this. But also, if there's an increase in behavior issues with your husband, getting him evaluated would be the best way to know what is going on with him. He may benefit from medicine for anxiety if he's willing to go that route. There is no medicine that specifically treats BPD, but there are medicines that can help with anxiety.

[HurtAndTired]

Hi Jazz,

There is a strong and well-researched connection between BPD and ADHD. I brought this up with my therapist as well. Although she, of course, won't diagnose my wife, she did say that many of my wife's behaviors (non-BPD behaviors like frequently leaving the toilet unflushed, etc.) are indicative of ADHD. Furthermore, there is a high rate of comorbidity between BPD and ADHD, with between 16% and 38% of people diagnosed with BPD also being diagnosed with ADHD. Both disorders involve having an overactive amygdala and an underactive prefrontal cortex. Both disorders are highly heritable with a significant genetic component. My SS26 has been diagnosed with ADHD, which also adds credence to the genetic connection. I am hyperaware of the genetic heritability aspect of both ADHD and BPD because I am very concerned about S3 (soon to be 4) developing either one or both of the disorders. I have plans to get him into play therapy ASAP to try to mitigate any risk he has inherited from Mom, or from my side of the family (I strongly suspect that my paternal grandmother was uBPD).

HurtAndTired

[Notwendy]

Hi Jazz,

I am very concerned about S3 (soon to be 4) developing either one or both of the disorders. I have plans to get him into play therapy ASAP to try to mitigate any risk he has inherited from Mom, or from my side of the family (I strongly suspect that my paternal grandmother was uBPD).

HurtAndTired

I think it's great to be on top of the prevention/mitigation aspect. With an elderly person, that window probably has closed, although if the person is willing to work with a therapist, perhaps that can help. In the event that they are not ( as was the case with my BPD mother) then the shift may need to be towards management and being vigilant for other possible conditions of aging such as dementia.

Although being on too much medication, or having an infection, would cause my mother to act as if she had dementia, this resolved once treated. This is why an elderly person needs to be evaluated for behavior changes because some causes are possibly treatable. There is no medication specifically for BPD but if the behavior is changing, there could be a treatable cause for that.

If there isn't another treatable cause- then the focus is on management. For their sake and for family members. There are emotional consequences connected to aging- loss of independence, physical discomfort, and these can add to anxiety. Although BPD had an effect on her emotions, the anxiety had a big effect on her quality of life so that was a goal of medical care.

It's possible for someone to have BPD and ADHD and anxiety but I think what direction to go with intervention depends on their age and situation. Which is the most difficult for them at the moment? It's also hard to know what is going on as normal aging also can come with anxiety, forgetfulness, and lower attention span and even without BPD, these can be a challenge for the elderly person and their family. I hope you can get your H to a medical provider to get some idea of what is going on and what can help.

[Notwendy]

To add -yes I agree for a child - do whatever possible to help them to mitigate both the possible genetic and environmental risk factors.

[JazzSinger]

She would also say negative things and repeatedly. It's understandable that you would want to have some respite from this. But also, if there's an increase in behavior issues with your husband, getting him evaluated would be the best way to know what is going on with him. He may benefit from medicine for anxiety if he's willing to go that route. There is no medicine that specifically treats BPD, but there are medicines that can help with anxiety.

Thanks, NotWendy. 

He seems to be repeating himself more and more, as he ages.  He still doesn’t seem to want any help, so I’ll just have to handle it differently.  I will need to excuse myself and walk away sometimes. 

It’s all about self-care now. 

Jazz

[Notwendy]

Thanks, NotWendy. 

He seems to be repeating himself more and more, as he ages.  He still doesn’t seem to want any help, so I’ll just have to handle it differently.  I will need to excuse myself and walk away sometimes. 

It’s all about self-care now. 

Jazz

Yes - agreed- keep your own sanity! And as long as he's legally competent- it's up to him to seek help and if he won't- then there's not much you can do about it.

If his behavior gets worse though, since the two of you live together- getting him evaluated is a form of self care- as his behaviors affect you. If he's not able to manage taking care of himself- then getting help for him also helps you.

As long as he refuses, you can't force him to seek help but if he begins to act very different, you can call 911.

[JazzSinger]

Hi Jazz,

There is a strong and well-researched connection between BPD and ADHD. I brought this up with my therapist as well. Although she, of course, won't diagnose my wife, she did say that many of my wife's behaviors (non-BPD behaviors like frequently leaving the toilet unflushed, etc.) are indicative of ADHD. Furthermore, there is a high rate of comorbidity between BPD and ADHD, with between 16% and 38% of people diagnosed with BPD also being diagnosed with ADHD. Both disorders involve having an overactive amygdala and an underactive prefrontal cortex. Both disorders are highly heritable with a significant genetic component. My SS26 has been diagnosed with ADHD, which also adds credence to the genetic connection. I am hyperaware of the genetic heritability aspect of both ADHD and BPD because I am very concerned about S3 (soon to be 4) developing either one or both of the disorders. I have plans to get him into play therapy ASAP to try to mitigate any risk he has inherited from Mom, or from my side of the family (I strongly suspect that my paternal grandmother was uBPD).

HurtAndTired

Thank you for sharing, HurtandTired.

This was quite helpful.

Jazz

[CC43]

Hi Jazz,

You're a real trooper, I know how rough you've had it lately, without peace in the home.

One thing I've noticed is that as people age--myself included--the filters gradually wear away.  It may be that historically, your husband was suppressing some thoughts and actions, in the name of being polite or respectful, with others and/or with you.  As he ages, he might not prioritize social graces anymore.  Alternatively, he could be losing his "social cognition" capabilities.  Does he have trouble hearing?  I bet that people who can't hear well can get easily frustrated because it's too hard to follow a conversation, let alone participate in one.  Is he losing his short-term memory?  That can be frustrating and scary, too.  I'm not saying he doesn't have ADHD, but my understanding was that the onset of ADHD was typically earlier in life, usually in childhood or young adulthood.  Having said that, your husband might have been able to manage his energy better when he had a regular schedule and purpose, such as employment.  The absence of that might be confusing and depressing, and he might be repeatedly acting out to give vent to his negative energy.  It's hard to be sure.  But I think you are on the right track--if he still has his mental faculties and he doesn't want to seek treatment in the name of feeling better, then there's not much you can do but prioritize your own well-being.  I think you already know how beneficial getting some distance and staying active with friendships can go a long way.

I also wonder if your husband is experiencing low-level pain all the time.  Feeling uncomfortable or in pain all the time could put him in a permanent bad mood.  I know that happens to me, too--but I'm pretty good about identifying the discomfort and doing something about it, like taking a break, taking some medicine and actively trying to avoid situations where I might be inclined to lash out.  The thing is though, my aches and pains are temporary, and I can get back to normal fairly quickly, usually with a night's rest.  But if aches and pains are permanent, I could see why he might be in a bad mood all the time, and his release is to lash out at you.  It makes you feel terrible, but maybe it makes him feel a little better, allowing him to focus on something else, a diversion from his pain.  Would that make any sense?

One other thing I've noticed is that thinking patterns can become ingrained.  I believe that with BPD, it's typical to ruminate about something negative, and repeating it ad nauseum.  They can't get past it, and by repeatedly thinking a negative thought, they wear a rut in their brain.  Retracing the mental pathway becomes a bizarre coping mechanism, perhaps because it's so familiar and predictable.  This is literally a learned coping mechanism.  At least that's what I saw in my BPD stepdaughter.  She'd repeat the same litany of negative events over and over, adding embellishments here and there, creating an ornate, colorful quilt of grievances and wrapping herself up in it.

[Notwendy]

Hi Jazz,

You're a real trooper, I know how rough you've had it lately, without peace in the home.

One thing I've noticed is that as people age--myself included--the filters gradually wear away. 

I also wonder if your husband is experiencing low-level pain all the time.  Feeling uncomfortable or in pain all the time could put him in a permanent bad mood. 

One other thing I've noticed is that thinking patterns can become ingrained.  I believe that with BPD, it's typical to ruminate about something negative, and repeating it ad nauseum. 

I am highlighting these as having aging parents and relatives is a recent experience, so I have an example of "normal" aging and aging+BPD.

They all "lost the filter" somewhat- but the difference is- when my usually sweet MIL snapped at me- this was out of character for her. The relationship was already formed on her usual personality. It didn't affect me as much because I knew she wasn't being her usual self.

When my BPD mother lost her filter- it wasn't much different from her dissociative episodes where she lost her filter too. And because our relationship was not formed on a foundation of consistency- it was hard to know what was "her" and what was aging.

Due to BPD, my mother already struggled with emotional pain. When she also had physical pain in addition, it amplified that. Since BPD behaviors are dysfunctional coping mechanisms, they increased. So while it wasn't possible to medically treat her BPD, treating her physical issues and her anxiety helped with both.

Understandable that you are fed up with the BPD behaviors and if your H won't seek help- then you can't focus. Taking care of yourself is important in this situation and even if he got care it would be important. It also is difficult to know what is his BPD behavior, what is aging, what is physical pain. Just remain aware that, if it does increase to more than usual- to get him evaluated  if possible.

[CC43]

Notwendy,

Once again you're very wise and stated things better than I could.  Indeed, I had a recent experience with my own dad, who was ageing and very ill, but since our relationship was a normal one, I could clearly see that his episodes of acting out were in response to pain, discomfort and fear, and so his behavior didn't hurt me as much emotionally, even if it did hurt me to see him hurting, if that makes any sense.  I guess it was clearer to me what the causes were for his acting out--pain, fear, losing control over life, losing purpose, too--and it was easier to both understand what was going on and to try to find help for him.  Even if he refused medications, because that would be an admission that his life was drawing to a close, his decision was at least understandable, and weirdly logical from his perspective.  In the end, caring for him was centered around trying to ease his discomfort, and even if we weren't always successful, we knew we tried our best.  His mean outbursts were mainly an indicator of his pain, and I never took it personally, because it was the pain (and mortality) talking, not him.  That's much easier to see in the context of a normal, loving relationship.

[CC43]

PS,

Just some notes on getting a medical evaluation.  Sometimes people will relish getting an evaluation, because of all the attention, and that was definitely the case for my dad.  But having said that, a confounding issue was that he usually wasn't honest with doctors about his issues, maybe to appear healthier and/or tougher than he really was?  My advice is, if you do try to get your husband checked out, try to have a chance to speak with staff yourself (in private, maybe over the phone) to ensure that they hear your concerns.  That might take a little manipulation, but I understand it's fairly typical when dealing with elderly patient who might not have all their faculties all the time.  You might say, he's not acting like his normal self, and he seems increasingly agitated, with episodes of nonsensical rambling lasting several hours each day, and you want to have him thoroughly checked out because you're concerned, and it's not getting better, it's been getting worse for the last couple of years.

Now I know that husbands can be extremely stubborn.  Maybe you just make him an appointment, possibly on the same day for yourself.  You say, it's time for our annual physical, we're going tomorrow at 10 am.  And you drive him, and bribe him with a special lunch out or something like that.

[Notwendy]

Notwendy,

Once again you're very wise and stated things better than I could.  Indeed, I had a recent experience with my own dad, who was ageing and very ill, but since our relationship was a normal one, I could clearly see that his episodes of acting out were in response to pain, discomfort and fear, and so his behavior didn't hurt me as much emotionally, even if it did hurt me to see him hurting, if that makes any sense.  I guess it was clearer to me what the causes were for his acting out--pain, fear, losing control over life, losing purpose, too--and it was easier to both understand what was going on and to try to find help for him.  Even if he refused medications, because that would be an admission that his life was drawing to a close, his decision was at least understandable, and weirdly logical from his perspective.  In the end, caring for him was centered around trying to ease his discomfort, and even if we weren't always successful, we knew we tried our best.  His mean outbursts were mainly an indicator of his pain, and I never took it personally, because it was the pain (and mortality) talking, not him.  That's much easier to see in the context of a normal, loving relationship.

Glad it helped. I also saw the same behaviors with my father when he was ill. What complicated the situation was the Karpman triangle dynamics and I didn't understand BPD or these dynamics well at the time.

BPD mother's behaviors were confusing because it was hard to know what was a reaction to aging, to pain, to the emotions of aging, or BPD behaviors. When she was in assisted living- it was a mixed blessing. It was reassuring to know her physical needs were being met. Her emotional needs were higher than her physical needs and it was a challenge to work with that.

In addition, medicine that used to help her anxiety didn't work in the same way.  At her usual dose, she'd become confused. It's common in elderly people to not manage medicine in the same way, so there was some trial and error with them.

Control, and lack of control were a factor, and I think this is an example of where BPD is different. My MIL, and father would be "snappy" probably due to that but they complied with people assisting them. BPD mother- whose had a higher need for control would act out with the staff and caregivers.

If we see BPD behaviors as maladaptive ways of coping- it makes sense that they'd increase with stressors and aging is one of them.

So for JazzSinger- there may not be a way to be proactive with your H if he won't agree to get medical assistance. Self care is important and this is what you are doing. Personally, I don't think looking at labels is as helpful as looking at his behaviors and if they change and also your ability to manage. The "label" on my mother's records was "anxiety" not BPD because this was the symptom that was most difficult for her and for people around her. Getting her on the medicine that worked best helped her feel better and because she felt better, her behaviors were less difficult. This is why - getting your H to medical help may also be self care for you.

Perhaps reaching out to adult social services will be informative- what options are there for help for you if he becomes too difficult for you to manage? This isn't lack of love for him. This is about meeting his medical and emotional needs- and by doing so- it's self care for you too.

[JazzSinger]

Yes - agreed- keep your own sanity! And as long as he's legally competent- it's up to him to seek help and if he won't- then there's not much you can do about it.

If his behavior gets worse though, since the two of you live together- getting him evaluated is a form of self care- as his behaviors affect you. If he's not able to manage taking care of himself- then getting help for him also helps you.

As long as he refuses, you can't force him to seek help but if he begins to act very different, you can call 911.

.

NotWendy, Thanks so much for the advice. If need be, I will call 911.

Jazz

[JazzSinger]

PS,

Just some notes on getting a medical evaluation.  Sometimes people will relish getting an evaluation, because of all the attention, and that was definitely the case for my dad.  But having said that, a confounding issue was that he usually wasn't honest with doctors about his issues, maybe to appear healthier and/or tougher than he really was?  My advice is, if you do try to get your husband checked out, try to have a chance to speak with staff yourself (in private, maybe over the phone) to ensure that they hear your concerns.  That might take a little manipulation, but I understand it's fairly typical when dealing with elderly patient who might not have all their faculties all the time.  You might say, he's not acting like his normal self, and he seems increasingly agitated, with episodes of nonsensical rambling lasting several hours each day, and you want to have him thoroughly checked out because you're concerned, and it's not getting better, it's been getting worse for the last couple of years.

Now I know that husbands can be extremely stubborn.  Maybe you just make him an appointment, possibly on the same day for yourself.  You say, it's time for our annual physical, we're going tomorrow at 10 am.  And you drive him, and bribe him with a special lunch out or something like that.

Thanks, CC43.

I’ve tried everything. I’ve talked to him.  I’ve conferred with his PCP. He won’t get help, and his doctor won’t help him get help, because he’s not asking for it.

He continues to tell me I am the one who has a problem, and I am the one who is difficult to get along with.  He puts everything back on me.

I will get through this.

Thanks again.

Jazz