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Borderline Personality Disorder And Addiction: A Common Co-Occurence

by Jeffrey Juergens ❘  

Borderline Personality Disorder and Substance Abuse

Addiction and mental illness often go hand in hand. In fact, SAMHSA estimates that 8.9 million adults with substance use disorders also have a mental health disorder. Some of the most common co-occurring disorders include alcoholism and antisocial personality disorder; marijuana addiction and schizophrenia; cocaine addiction and anxiety disorders; opioid addiction and PTSD; and heroin addiction and depression.

As Mental Health Awareness Month comes to a close, we thought we’d shed some light on a lesser known, yet prevalent, condition that co-occurs with addiction: Borderline Personality Disorder (BPD). BPD is a serious mental illness marked by instability in moods, behavior and relationships, according to the National Institute of Mental Health.

Approximately two thirds of people with borderline personality disorder abuse alcohol or drugs.

The co-occurrence of borderline personality disorder and substance use disorder causes extreme emotional imbalance, increases the likelihood of poor treatment outcomes and the chance of suicide. Because of these things, a proper diagnosis and specialized treatment program are paramount to recovery.

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Diagnosing Borderline Personality Disorder

Those with borderline personality disorder have difficulty regulating their emotions, which leads to severe mood swings, impulsivity, instability, poor self-image and trouble with personal relationships. These factors make those with BPD more prone to high-risk behaviors, such as promiscuity and substance use, and compulsive behaviors, like eating disorders and gambling.

There is no medical test to diagnose borderline personality disorder. Instead, a mental health professional must complete a comprehensive psychiatric interview, which can include a medical evaluation, a review of past medical records and speaking with not only the patient, but also their friends, family and previous doctors. A BPD diagnosis is not based off any one symptom. Instead, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the National Alliance on Mental Illness, five or more of the following symptoms indicate borderline personality disorder:

  • Frantic efforts to avoid real or imagined abandonment
  • Unstable personal relationships that alternate between idealization—“I’m so in love!”—and devaluation—“I hate her.” (also known as “splitting”)
  • Distorted and unstable self-image, which affects moods, values, opinions, goals and relationships
  • Impulsivity in at least two areas that are potentially self-damaging (such as spending, sex, substance abuse, reckless driving and binge eating)
  • Suicidal and self-harming behavior
  • Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days
  • Chronic feelings of boredom or emptiness
  • Inappropriate, intense or uncontrollable anger—often followed by shame and guilt
  • Dissociative feelings—disconnecting from your thoughts or sense of identity, or “out of body” type of feelings—and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.

Some people with borderline personality disorder use drugs and alcohol in an attempt to cope with their volatile moods or to “numb the pain.” However, the use of these substances can make many of the symptoms of BPD worse, especially rage and depression.

Similarities in Symptoms

Substance use disorders and borderline personality disorders often present with similar symptoms, making a dual diagnosis difficult. As stated on, the following symptoms characterize both BPD and addiction:

  • Impulsive, self-destructive behaviors
  • Mood swings ranging from severe depression to manic periods of intense energy
  • Manipulative, deceitful actions
  • A lack of concern for one’s own health and safety and an insistence on pursuing dangerous behavior in spite of the risks
  • A pattern of instability in relationships, jobs and finances

Treatment of Borderline Personality Disorder and Addiction

Given the volatile nature of both borderline personality disorder and addiction, treating these co-occurring disorders can be very difficult. One major challenge is getting the patient to not only follow the treatment plan, but also getting them to stay in it. Because of the mood swings and paranoia that present with BPD, the patient-therapist relationship can be rocky, leading many patients to drop out of treatment. Relapse rates for dual diagnoses are also very high, so sticking with treatment is critical for co-occurring borderline personality disorder and addiction patients.

Finding a program that specializes in treating co-occurring disorders, with experience working specifically with BPD patients, is extremely important.

Because of the physical dependence that can accompany drug and alcohol addiction, addressing the substance use issue is necessary and sometimes requires detox—the process of removing toxins from the body left over from extended drug and alcohol use. With the patient clean and clear headed, therapies to address both borderline personality disorder and substance use disorder will be much more successful.

Of the few studies that have researched the effectiveness of treatment for co-occurring BPD and addiction, several treatment options seem to show promise:

  • DBT-S: dialectical behavior therapy (DBT) is a common therapy for BPD that teaches patients to identify and change negative thinking, cope with stress, regulate emotions and change harmful patterns of behavior. This approach has been adapted to include treatment for substance use disorders (DBT-S).
  • Medications: there is no FDA approved medication for BPD, but there are medications to help with some of the symptoms, like depression and anger. There are also medications to help with symptoms of withdrawal and cravings for drug and alcohol addiction. A psychiatrist must evaluate the patient’s specific needs to determine which medications can be used together in treatment.
  • Therapy and support: individual and group therapy, mutual-help groups (such as Double Trouble in Recovery, AA, NA and  Smart Recovery) and skill-building exercises have proven helpful in treatment for those with co-occurring borderline personality disorder and addiction.

Although there is no official cure for borderline personality disorder or addiction, both conditions are completely treatable. If you or someone you know needs help finding a treatment program, please contact a dedicated treatment provider today. 

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