ABSTRACT
Attention deficit hyperactivity disorder (ADHD) is often a hidden constellation, based around certain neurobiological features, which underpins many mental health presentations including some personality disorders, particularly borderline personality disorder. The ADHD temperament is deficient in the capacity for affect regulation, so that high anxiety and anger are common. In these states, the person has impaired capacity for rational and coherent thought, speech, and behaviour. The legacy of repeated negative and unrewarding experiences with others will lead to an accumulation of injuries to self-esteem, culminating in a pervasive sense of being defective. This may be countered by defensive efforts to claim superiority over others or by extreme endeavours to achieve success in certain realms where talent is apparent. One young man reported considerable benefit from a single consultation regarding his ADHD. He had been aware that he had been described as having this condition from an early age, but his understanding of what it meant was limited.
