A look at “Schema Mechanisms Underlying Emotion Dysregulation and Impulsivity in Comorbid Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder” by Mohsen Khosravi (2025)
ADHD and borderline personality disorder (BPD) often turn up together, and they can look surprisingly alike. Both involve intense emotions, impulsive decisions and stormy relationships. So when someone has both, what’s going on underneath? This Iranian study looks through the lens of schema therapy, which explores the deep-rooted “life stories” and emotional states we develop, often in childhood, when our core needs aren’t met.
What they found
The study involved 440 people at a psychiatric hospital in Iran, split into four equal groups of 110: people with both ADHD and BPD, ADHD only, BPD only, and people with neither. Diagnoses were made through structured clinical interviews, and everyone completed questionnaires about schemas, emotional states (“schema modes”), emotional regulation and impulsivity.
The headlines:
- People with both ADHD and BPD had the highest levels of emotional difficulty, impulsivity and unhelpful schemas of any group.
- People without either diagnosis scored highest on the “Happy Child” and “Healthy Adult” modes, the playful, grounded parts of us that schema therapy aims to strengthen.
- Certain schemas and modes were strongly linked to emotional difficulties. These included the “Angry Child” and “Enraged Child”, and beliefs about emotional deprivation, shame, self-punishment and needing to suppress one’s feelings.
- Impulsivity was linked to feeling like a “Vulnerable Child”, having a harsh “Demanding Parent” inner voice, and beliefs about failure, pessimism and self-sacrifice.
The author suggests schema therapy could be a promising approach for this group.
A grain of glitter ✨
There’s something intuitively appealing here. Many people with these diagnoses carry painful early experiences, and schema therapy speaks to that. But the numbers deserve a raised eyebrow.
The study claims schemas and modes “explained” 85% of the variation in emotional difficulties. In psychology, that’s an extraordinarily high figure. It’s likely inflated partly because many variables were tested in a group of just 110 people, and partly because some schema modes, like “Enraged Child”, overlap heavily with what emotional dysregulation questionnaires measure. It’s a bit like finding that people who describe themselves as very angry also report struggling with anger.
It’s also a snapshot study, so we can’t tell which came first. The study was conducted by a single author in a single hospital. It doesn’t consider the role of trauma directly, even though trauma is strongly linked to both conditions. And it’s worth remembering that BPD remains a heavily stigmatised and contested diagnosis. Many people find frameworks like complex trauma a better fit for their experience.
Why this matters
If you live with ADHD, BPD or both, the emotional intensity can feel overwhelming, and others may have judged you harshly for it. This study suggests those big feelings may be tangled up with old stories about yourself: that you’re defective, that your needs don’t matter, that you’ll always fail. The hopeful part is that these stories can be gently explored and rewritten in therapy.
Every unicorn has a Vulnerable Foal inside. Good therapy helps the Healthy Adult unicorn take it by the hoof.