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Borderline Personality Disorder and Addiction

Borderline personality disorder (BPD) and addiction often co-occur and have similar signs and symptoms. A dual diagnosis treatment program can help those struggling with BPD and addiction.

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental illness characterized by a distorted self-image, impulsiveness, extreme emotions and intense, unstable relationships.

Individuals with BPD often suffer from other psychological disorders, such as anxiety, depression and eating disorders.

People with borderline personality disorder have high rates of suicidal behaviors and substance abuse.

Researchers believe several factors contribute to a person’s development of borderline personality disorder, including:

  • Genetics – BPD often runs in families, leading scientists to believe genetics play a role in the disorder. Certain inherited temperaments or personality traits, such as aggression, may increase BPD risk when combined with environmental factors.
  • Neurotransmitters – Altered functioning of neurotransmitters in the brain—specifically serotonin, dopamine and noradrenaline—may make a person more likely to develop BPD. These neurotransmitters are responsible for the regulation of certain emotions and urges.
  • Neurobiology – Studies have found that certain regions of the brain are often smaller or more active in those with BPD. The three areas in particular are the amygdala, the hippocampus and the orbitofrontal cortex.
  • Environmental factors – There are several environmental factors that seem to be common among those with BPD. These factors include childhood trauma and growing up in an unstable family situation or around people with mental disorders or substance use problems.

Borderline Personality Disorder and Addiction

Addiction and BPD often occur concurrently. Two-thirds of individuals suffering from BPD have abused a substance at some point in their lives.

Many BPD sufferers use drugs to mask their symptoms or to feel better about themselves, making substance abuse common among those with this disorder. For some, it can be a form of self-medication that brings feelings of calm.

The symptoms and signs of BPD and addiction are very similar.

Both conditions are characterized by extreme mood swings, self-destructive behaviors, deceitful actions, and unstable relationships and careers. These similarities make it difficult to diagnose both conditions separately. Often, a single condition is diagnosed first and the other is discovered later.

Treating co-occurring addiction and BPD is also quite challenging. Given that those with BPD are already prone to emotional instability, adding drugs or alcohol to the mix can make their behaviors and choices even more erratic. One of the biggest struggles in treating these co-occurring disorders is getting the patient to complete the treatment program.

“Addicts with BPD have been described as both treatment demanding and treatment resistant. Research shows more positive outcomes the longer an addict with BPD stays in treatment, yet keeping them in treatment is no easy task. In a study of patients in a detox program, those with BPD were significantly more likely to have an unplanned discharge than those without BPD.”

Dr. David Sack, Psych Central, 2012

While diagnosing and treating these disorders can be difficult, there is an increasing number of facilities that offer dual diagnosis programs for BPD and addiction.

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BPD Symptoms and Effects

Symptoms of BPD are often confused with symptoms of substance abuse, which can make BPD difficult to recognize. However, therapists have made great strides over the past 20 years in understanding and diagnosing BPD and addiction.

Common borderline personality disorder symptoms include:

  • Intense emotional swings
  • Extreme episodes of depression or anxiety
  • Suicidal tendencies
  • Impulsive behavior
  • Extreme changes in perceptions of others
  • Paranoia
  • Episodes of extreme anger or aggression
  • Lack of or unstable sense of self
  • Intense fear of being alone
  • Eating disorders, such as anorexia or bulimia
  • Feelings of emptiness
  • Manipulative behavior
Some people with BPD may also lapse into brief psychotic episodes when under stress.

The effects of BPD leave individuals with an extremely low feeling of self-worth. Their impulsive behavior and bouts of anger can often push others away, leaving them isolated. This isolation can lead to extreme anxiety or depression, as many people with BPD have a fear of being alone or abandoned. People suffering from BPD are often unsure of their sense of self and are constantly trying to change who they are in an effort to build relationships.

Addiction and Borderline Personality Disorder Treatment

Addiction and BPD can be treated simultaneously in rehabs that offer dual diagnosis programs. These programs provide both psychotherapy and substance abuse treatment services.

Various modes of therapy, such as cognitive behavioral therapy, are used in rehab to help patients identify the thought patterns that cause their impulsive behavior. Cognitive behavioral therapy also helps patients to better manage their emotions so they don’t have to turn to drugs or alcohol to cope.

Co-occurring substance abuse is treated with the help of a physician that oversees the patient’s withdrawal from drugs or alcohol.

Addiction and BPD can be treated on an inpatient or outpatient basis, depending on the severity of the disorders.

If you or your loved one is struggling with co-occurring BPD and addiction, please call us now for help finding a dual diagnosis program.

Sources & Author Last Edited: January 22, 2016

  1. National Institute of Mental Health. (2015). "Borderline Personality Disorder". Retrieved on October 2, 2015 from: http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
  2. Substance Abuse and Mental Health Services Administration. (2014). "An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders". Retrieved on October 2, 2015 from: http://store.samhsa.gov/shin/content//SMA14-4879/SMA14-4879.pdf
  3. PsychCentral. (2012). "The Challenges Of Treating Addicts With Borderline Personality Disorder". Retrieved on October 2, 2015 from: http://blogs.psychcentral.com/addiction-recovery/2012/02/challenges-addicts-borderline-personality-disorder/
About the Writer, Kayla Smith

Kayla Smith is the editorial director for Addiction Center. After working for years as a journalist, she joined the Addiction Center team in hopes of spreading awareness about addiction and mental health issues and helping people get treatment.

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