Borderline personality disorder (BPD) is a serious mental illness characterized by poor impulse control, difficulties regulating emotions, significant mood swings, trouble with interpersonal relationships, self-harming behaviors, and negative self-image, per the National Alliance on Mental Illness (NAMI).
One of the symptoms of BPD is risk-taking and impulsive behaviors, which include excessive drinking and drug use. Nearly three-quarters of people who have BPD also struggle with addiction at some point in life. These co-occurring disorders are more common in men than in women.
Co-occurring BPD and substance use can lead to more significant negative outcomes, including a higher risk for self-harming behaviors.
Treatment for BPD and addiction should be specialized and administered by trained professionals with experience treating these two disorders together.
Alcohol and drug abuse are common in individuals diagnosed with borderline personality disorder.
Addiction, particularly involving alcohol, is often a result of repeated and excessive substance abuse. This could in part be related to the fact that poor impulse control is one of the symptoms of BPD. Individuals who struggle with the disorder are less likely to think through the consequences of their actions and, therefore, are more apt to drink or use drugs to excess.
Drug use and binge drinking are examples of risk-taking behaviors that are often noted in someone with BPD. Parts of the brain that are related to reward-processing and decision-making may be dysfunctional in someone prone to addiction and also those who have BPD, both of which are heritable and have a genetic link.
The Mayo Clinic explains that someone struggling with borderline personality disorder may have dysfunctions in parts of the brain that manage emotional regulation as well as possible low levels of serotonin. Serotonin is a neurotransmitter produced by the brain to regulate moods and feelings of pleasure. Many drugs of abuse interact with serotonin levels in the brain.
Environmental factors, such as childhood trauma, can also be causal influences in the onset of both BPD and drug abuse.
Drug and alcohol abuse may be used as a form of self-medication by someone who has BPD. Substance use may offer an escape from reality, a way to boost moods, or a method to help a person “feel” something. Drugs and alcohol can produce a calming effect.
The Psychiatric Times reports that substance abuse may also serve to make a person diagnosed with BPD feel more attached and connected. Interpersonal relationship issues are a major component of BPD, as personal relationships are often unstable, ranging between extreme adoration (love) and devaluation (hate). Substance abuse may seem to bridge that gap temporarily.
Using substances to self-soothe complicates borderline personality disorder in the long run, and it also leads to drug dependence and addiction. While drug abuse in and of itself may not cause BPD directly, it can exacerbate the disorder.
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When someone struggles with both borderline personality disorder and addiction at the same time, the disorders are said to be co-occurring. When these disorders co-occur, the symptoms, side effects, and risk factors for each are amplified.
Someone battling BPD and addiction is likely to be more unstable, have a higher risk for suicidal behaviors, be more impulsive, have shorter periods of being drug-free, and drop out of treatment more often.
Treatment for co-occurring disorders should be specialized and comprehensive. Ideally, it should also be integrated.
The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that a team approach can be highly beneficial, with multiple trained professionals working together in tandem to manage the disorders.
Psychiatrists, therapists, primary care or medical providers, and substance abuse treatment providers should all be on the same page and consult with one another when treating co-occurring disorders.
Treatment methods for borderline personality disorder and addiction include:
CBT aims to develop coping strategies and emotional regulation skills.
DBT is a specialized form of CBT that serves to directly address self-harm. It uses a focused approach to minimize risky and negative behaviors.
A specialized treatment program that can cater to both borderline personality disorder and addiction is preferred over a general rehab program.
Treatment methods will differ for each individual. A comprehensive assessment and evaluation before admission into any program can help to define the best treatment and recovery plan for the individual.
A specialized treatment program for co-occurring addiction and BPD can address all ramifications of both disorders.
Someone who struggles with BPD often has trouble attaching to people. Trust issues, fear of abandonment, dissociation, distorted self-image, bouts of intense anger and possible violent outbursts, and unhealthy attachments can all be symptoms of BPD. These can be best managed by a highly trained professional with experience dealing with the disorder.
The symptoms of each disorder can be magnified by each other.
An inpatient treatment setting is often optimal to ensure the safety and stability of everyone involved.
There are many benefits of a specialized treatment program for these co-occurring disorders. Among them are:
Borderline personality disorder and addiction are both complex disorders on their own. When combined, the highs and lows, mood swings, physical and psychological side effects, and risk factors all increase.
A specialized treatment program can help a person to remain in treatment, manage suicidal ideations, and stay safe while they learn healthy habits and tools for regulating emotions and improving interpersonal relationship skills.
Borderline personality disorder and addiction can be managed with the help of trained professionals. Ideally, care will be given as part of a comprehensive addiction treatment program that caters to co-occurring disorders in an integrated fashion.
(December 2017). Borderline Personality Disorder. National Alliance on Mental Illness. Retrieved February 2019 from https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder
Borderline Personality Disorder. National Institute of Mental Health. Retrieved February 2019 from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
(September 2011). Substance Use Disorders and Borderline Personality Disorders. Innovations in Clinical Neurosciences. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196330/
(June 2018). Borderline Personality Disorder. Mayo Clinic. Retrieved February 2019 from https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237
(November 2006). Clinical Challenges in Co-Occurring Borderline Personality and Substance Use Disorders. Psychiatric Times. Retrieved February 2019 from https://www.psychiatrictimes.com/clinical-challenges-co-occurring-borderline-personality-and-substance-use-disorders
(April 2014). Borderline Personality Disorder and Comorbid Addiction. Deutsches Artzeblatt International. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010862/