Attention Magazine December 2025

When fourteen-year-old Lily began lashing out at her best friends and hiding razor blades under her bed, her parents assumed it was just teenage angst. But Lily had ADHD—and she was beginning to show signs of something more serious.

Adolescence is a pivotal time of development for girls with ADHD. While many girls with ADHD fly under the radar in childhood, their struggles often intensify as they reach adolescence. The challenges of navigating peer relationships, regulating strong emotions, and developing a sense of identity become more complex. For some, the emotional toll of ADHD can lay the groundwork for even deeper mental health concerns, including the emergence of traits associated with borderline personality disorder (BPD).

Overlapping features
ADHD and BPD share a number of overlapping features that can make them difficult to distinguish. Both conditions can involve impulsivity, emotional dysregulation, difficulties with executive functioning, and relationship problems. Teens with either condition may seem moody, reactive, or unpredictable to parents, teachers, or peers.

While ADHD is a neurodevelopmental disorder typically diagnosed in childhood and characterized by attentional and self-regulatory deficits, BPD is a personality disorder that tends to emerge later in adolescence or early adulthood. BPD is characterized by a pervasive pattern of instability in emotions, self-image, and relationships—often tied to deep fears of abandonment and rejection. ADHD-related emotional dysregulation, by contrast, tends to be more situational and linked to frustration or overstimulation.

ADHD as a precursor to BPD
Emerging research suggests that ADHD may be more than just a co-occurring condition with BPD—it may actually serve as an early risk factor for the development of BPD. Girls with ADHD are more likely to experience impulsivity, peer rejection, academic challenges, and heightened emotional sensitivity. When these vulnerabilities are compounded by environmental stressors such as trauma, unresponsive or overly critical caregiving, or chronic stress, the likelihood of developing more complex conditions like BPD increases.

This does not mean that every girl with ADHD will develop BPD. However, it does highlight the importance of early monitoring and support, especially when emotional instability, self-harming behaviors, or intense interpersonal struggles begin to emerge.

Red flags to watch for in teen girls with ADHD
Although BPD is usually diagnosed in adulthood, early warning signs often surface during adolescence. In girls with ADHD, watch for:

• experiencing intense emotional shifts that seem disproportionate to the situation
• forming unstable friendships and reacting strongly to perceived rejection
• engaging in self-harming behaviors or expressing hopelessness
• displaying persistent identity confusion or low self-worth

These behaviors alone do not confirm that a teen has BPD. However, when such patterns are intense and recurrent, and occur alongside ADHD, they may indicate increased vulnerability and warrant clinical attention. Early recognition allows for targeted support and preventative care, helping teens build resilience and thrive.

What parents and caregivers can do
Supporting a teen who shows signs of both ADHD and early BPD features can be challenging, but early intervention is key. Here are five essential steps:

Monitor behavior over time.

• Track concerning behaviors like self-harm, emotional outbursts, or impulsive decisions.
• Identify patterns, potential triggers, and how your teen recovers from emotional episodes.

Promote a stable, validating environment.

• Set consistent routines and clear, predictable boundaries.
• Use validating language to acknowledge your teen’s emotions without endorsing harmful behaviors.
• Foster open, nonjudgmental communication about emotional challenges.

Seek a comprehensive evaluation.

• Request a mental health evaluation from a clinician experienced in both neurodevelopmental and personality disorders.
• Understand that while a full BPD diagnosis may wait until adulthood, emerging symptoms may still be treated early and prevent the development of a full BPD diagnosis.

Prioritize safety and emotional support.

• Seek immediate help if your child shows signs of self-harm or suicidal thinking.
• Work with therapists, school counselors, or emergency services when needed.

Involve the right therapeutic support.

• Consider a multidisciplinary approach for the most effective support.
• Use cognitive behavioral therapy (CBT) or executive function coaching for ADHD-specific issues.
• Consider dialectical behavior therapy (DBT), the gold standard for treating BPD traits and emotional dysregulation.
• Know that while there is no medication treatment specifically for BPD, medications for ADHD, anxiety, or depression may help alleviate related symptoms.

Support for parents and caregivers
Parenting a teen with complex emotional needs can be overwhelming. Caregivers need support, too:

• Consider family therapy to improve communication.
• Remember that these challenges are not a result of poor parenting but often reflect a complex mix of neurobiological and environmental factors.

When to seek immediate help
Contact a mental health professional or go to the emergency room if your teen:

• threatens or engages in self-harm
• talks about or makes plans for suicide
• has emotional outbursts that endanger themselves or others

ADHD may heighten emotional sensitivity and increase vulnerability, but it also offers a critical window for early identification and intervention. With the right support system in place, teens at risk for BPD can learn to regulate emotions, build meaningful relationships, and grow into healthy, empowered adults.

Girls like Lily can thrive—not in spite of their diagnoses, but because their needs were seen and addressed. As a parent, being proactive is one of the most powerful things you can do to support your daughter.

Dara Babinski, PhD, is a licensed clinical psychologist and assistant professor of psychiatry at the Penn State University College of Medicine. Her research focuses on examining the course and treatment of ADHD in girls and women. Dr. Babinski is interested in identifying areas of impairment across the lifespan that are particularly relevant to girls and women with ADHD and developing interventions to target these difficulties.