Axis I and II comorbidity in adults with ADHD

J Abnorm Psychol. 2007 Aug;116(3):519-28. doi: 10.1037/0021-843X.116.3.519.


Ongoing debate over the validity of the attention-deficit/hyperactivity disorder (ADHD) construct in adulthood is fueled in part by uncertainty regarding implications of potentially extensive yet incompletely described comorbid Axis I and II psychopathology. Three hundred sixty-three adults ages 18 to 37 completed semistructured clinical interviews; informants were also interviewed, and best estimate diagnoses were obtained. Results were as follows: First, ADHD combined type (ADHD-C) had an excess of externalizing and internalizing Axis I disorders, suggesting a gradient-of-severity relationship between it and ADHD inattentive type (ADHD-I). Second, ADHD-C and ADHD-I did not differ in frequency of Axis II disorders. Third, however, ADHD overall was associated with increased rates of Axis II disorders, compared with rates in non-ADHD control participants, including both Cluster B (primarily borderline personality disorder) and Cluster C disorders. Fourth, ADHD incrementally accounted for clinician-rated global assessment of functioning scores above and beyond comorbid conditions or symptoms on either Axis I or Axis II. Results further inform nosology of ADHD in adults.

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Attention Deficit and Disruptive Behavior Disorders / diagnosis
  • Attention Deficit and Disruptive Behavior Disorders / epidemiology*
  • Comorbidity
  • Conduct Disorder / diagnosis
  • Conduct Disorder / epidemiology*
  • Female
  • Humans
  • Male
  • Personality Disorders / diagnosis
  • Personality Disorders / epidemiology*
  • Prevalence