Schema Mechanisms Underlying Emotion Dysregulation and Impulsivity in Comorbid Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder.

This cross-sectional study investigated the association between early maladaptive schemas, schema modes, emotion dysregulation and impulsivity in individuals with comorbid attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). The study included 110 patients with ADHD-BPD comorbidity, 110 with only ADHD, 110 with only BPD, and 110 healthy controls, all assessed at Baharan Psychiatric Hospital in Iran. Diagnoses were established using the Structured Clinical Interview for DSM-5 Disorders (SCID-5-CV) and the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Participants completed the Young Early Maladaptive Schema Questionnaire, the Schema Mode Inventory-Short Form, the Difficulties in Emotion Regulation Scale-Brief Form, and the Barratt Impulsiveness Scale-11. Results indicated that the ADHD-BPD group exhibited significantly higher levels of emotion dysregulation, impulsivity, early maladaptive schemas, and schema modes compared to the other groups, except for the 'Happy Child' and 'Healthy Adult' schema modes, which were most prevalent in healthy controls. Regression analyses revealed that schema modes such as 'Angry Child' and 'Enraged Child', as well as early maladaptive schemas like 'Emotional Inhibition', 'Emotional Deprivation', 'Enmeshment', 'Subjugation', 'Self-Punitiveness' and 'Defectiveness/Shame', accounted for 85% of the variance in emotion dysregulation. Additionally, schema modes including 'Vulnerable Child', 'Demanding Parent' and 'Healthy Adult', along with early maladaptive schemas such as 'Pessimism', 'Emotional Inhibition', 'Failure' and 'Self-Sacrifice', explained 74% of the variance in impulsivity. These findings highlight robust associations between early maladaptive schemas/schema modes and core symptoms in ADHD-BPD comorbidity, suggesting that Schema Therapy may be particularly beneficial for this population. The study underscores the importance of distinguishing patients with ADHD-BPD from those with BPD alone, as comorbid individuals may encounter greater challenges in therapy, such as increased difficulties with adherence and homework completion. Future research should examine the effectiveness of Schema Therapy in addressing emotion dysregulation and impulsivity among these patients.