What is ADD / ADHD?
“I don’t know who I am. I don’t fit in anywhere. I clash with everyone. It’s always ‘my’ fault, but I don’t even know why.”
Definition
Section titled “Definition”Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that begins in childhood, primarily characterized by strong distractibility and low persistence. The “H” stands for hyperactivity - a hard-to-control, overactive behavior that manifests in motor restlessness and increased urge to act.
ADD (without the H) refers to the variant without pronounced hyperactivity.
Prevalence and Gender Distribution
Section titled “Prevalence and Gender Distribution”- Approximately 4% of all children meet the diagnostic criteria
- Boys are diagnosed three times more frequently than girls (due to more conspicuous hyperactivity)
- ADD occurs more frequently in women
- ADHD occurs more frequently in men (presumably testosterone-related)
Causes
Section titled “Causes”The exact causes are not yet fully understood. Experts assume a primarily genetic disorder:
- Biochemical disruption of brain metabolism
- Striatofrontal dysfunction at the neurobiochemical level
- Psychosocial factors influence the course and expression
The spectrum of manifestation varies greatly - not all symptoms are equally pronounced in every affected individual.
History of the Diagnosis
Section titled “History of the Diagnosis”Struwwelpeter (1844)
Section titled “Struwwelpeter (1844)”The Frankfurt psychiatrist Dr. Heinrich Hoffmann (1809-1894) first described various disorder patterns in his famous children’s book:
- Fidgety Philip (Zappelphilipp) - ADHD
- Johnny Head-in-Air (Hans Guck in die Luft) - ADD
- Soup-Kaspar (Suppenkasper) - Anorexia
- Struwwelpeter - Dissocial behavior
Scientific Development
Section titled “Scientific Development”| Year | Milestone |
|---|---|
| 1902 | First professional description by G. F. Still |
| 1940s/50s | Term “Minimal Cerebral Dysfunction” (MCD) |
| 1972 | Description of “Hyperkinetic Syndrome” |
| 1980 | Inclusion as “Attention-Deficit Disorder” (ADD) in DSM-III |
| 1987 | Expansion to ADHD in DSM-III-R |
| 2002 | Official recognition in Germany (December 27, 2002) |
Distinction from Borderline Personality Disorder
Section titled “Distinction from Borderline Personality Disorder”The symptoms can overlap by up to 20%, which frequently leads to misdiagnosis.
Key Differences
Section titled “Key Differences”| Feature | ADD/ADHD | Borderline |
|---|---|---|
| EGO fragmentation | No | Yes |
| Splitting | No | Yes |
| Primitive defense mechanisms | No | Yes |
| Capacity to love | Yes | Limited |
| Rapid alternation idealization/devaluation | No | Yes |
| Free-floating anxiety | No | Yes |
| Inner emptiness | No | Yes |
| Deliberate self-harming behavior | No | Yes |
| Abandonment fears | Rarely | Yes |
Important Distinguishing Features
Section titled “Important Distinguishing Features”- Mood swings: In ADHD from day to day, in bipolar disorders weeks/months
- Impulsivity: In ADHD short-lived and thoughtless, in borderline more driven
- Anger: In ADHD episodic and brief, in borderline often persistent
- Relationships: ADHD sufferers less typically have the intense, short, conflict-ridden relationships
Comorbidity
Section titled “Comorbidity”ADHD very frequently occurs with comorbid disorders:
- Depression
- Anxiety disorders
- Substance abuse
- Personality disorders (as a consequence)
Current Care Situation
Section titled “Current Care Situation”The situation for adult ADHD sufferers in Germany is difficult:
- Only a few specialized clinics for adults
- Cost coverage for medications is often problematic
- Specialized therapy procedures are often not covered
- Pension insurance providers sometimes do not recognize ADHD in adults