Borderline Personality Disorder And Addiction

Medically Reviewed by Johnelle Smith, M.D. on April 19, 2021

Borderline personality disorder is the most commonly diagnosed personality disorder in the United States. People with BPD may be more susceptible to drug and alcohol abuse and can experience poor effects with substance use.

Co-Occurring Borderline Personality Disorder And Addiction

Borderline personality disorder is the most commonly diagnosed psychiatric personality disorder. Approximately 1.4% of the U.S has BPD.

A person with Borderline Personality Disorder (BPD) may be at an increased risk of substance abuse as a way to mask symptoms or create a positive self-image and calm.

People with both BPD and substance use disorders are said to have co-occurring disorders.

Read more about co-occurring addiction and borderline personality disorders

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a mental illness that is often accompanied by illnesses like depression, eating disorders, anxiety, and substance use disorders.

People with BPD may exhibit behaviors like impulsiveness, a distorted sense of self, unstable jobs and relationships, and intense emotional responses.

Symptoms Of Borderline Personality Disorder

Symptoms of BPD vary from person to person.

Some hallmark symptoms of borderline personality disorder include:

  • Feelings of emptiness
  • An altered self-perception and changes in self-identity: may include rapidly changing goals and values
  • Fear of abandonment: may lead a person to take extreme steps to maintain relationships and avoid rejection
  • Unstable relationship patterns: leading to changing perceptions of another person’s love and personality traits (perceptions that they love you one moment and hate you the next)
  • Rapidly shifting self-perception: a person may perceive themselves as bad or non-existent
  • Periods of stress-induced paranoia, which may last minutes or hours
  • Mood swings: ranging from happiness to anxiety or irritability
  • Bouts of anger: include frequent loss of temper, sarcasm, or engaging in physical violence
  • Suicidal behavior, self-injury, or threats: often as a reaction to perceptions of rejection or separation.
  • Impulsive, risky behavior: may include unsafe sex, drug use, gambling, unreasonable spending, or binge eating
  • Sabotaging success, such as ending good relationships or suddenly quitting good jobs

Signs Of Drug Or Alcohol Abuse

It can be difficult to recognize signs of drug and alcohol use in people with BPD because many symptoms involving mood and self-perception overlap.
Signs of drug or alcohol abuse may include:

  • not being able to stop or control drug or alcohol use
  • mood swings
  • avoiding friends or family
  • neglecting hygiene
  • neglecting physical health
  • being reliant on drugs or alcohol for normal functioning
  • lying about drug use
  • taking prescription medications in excess (against instructions)

Different substances may cause symptoms of anxiety, psychosis, or depression.

Certain substances can lead to physical signs like weight loss and poor skin or hair health. Other people may become evasive and jittery with certain addictions.

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What Causes Co-Occurring Addiction And Borderline Personality Disorder?

While there is not a firm understanding of how BPD occurs, it may present in people because of various factors.

People with BPD that use drugs and alcohol may self-medicate to feel “normal” and may engage in risky drug use as a result of these tendencies for people with BPD.

Shared risk factors for borderline personality disorder and substance abuse include:

  • a family history or genetic predisposition
  • brain chemistry or neurological function
  • environmental factors like childhood trauma or neglect

Co-Occurring Symptoms Of Both BPD And Substance Use Disorder

It can be especially difficult to diagnose both substance use disorders and BPD because many symptoms of BPD are also seen in people with substance use disorder.

Some of these overlapping symptoms include:

  • extreme mood swings
  • impulsive, self-destructive behaviors
  • not caring for self
  • suicidal thoughts or behavior
  • engaging in risky behavior
  • manipulative, deceitful behavior
  • depression and paranoia
  • instability with money, relationships, and jobs

How Common Is Substance Abuse And Borderline Personality Disorder?

Various studies have been conducted that provide evidence linking BPD with substance use disorders.

This does not mean that people with BPD will abuse substances, but rather that there is a correlation between this personality disorder and an increased incidence of substance use disorders.

Borderline personality disorder addiction rates:

  • About 40% of people that looked to buprenorphine for opioid addiction were diagnosed with borderline personality disorder.
  • Around 64% of people with BPD have had alcohol addiction at some point in their life.
  • A 12-month study showed that more than half of people with BPD had a substance use disorder. Nearly 10% of all people with substance use disorder in the same study had BPD.

What Are The Most Effective Treatments?

Borderline Personality Disorder and addiction can be difficult to diagnose – especially when a person uses multiple substances (polydrug abuse). Some treatments can be especially helpful for people with addiction recovery and BPD.

Dual diagnosis treatment may involve:

Detox And Rehabilitation

Detox and rehab are considered safe and beneficial ways to curb addictive behavior.

People that seek treatment for substance use disorders that have PBD may find that some combination of SSRI anti-anxiety medications plus medications like methadone, buprenorphine, or naltrexone can help curb withdrawals.

These medications are safest when directed by a medical professional. There are no known effective medications for treating BPD.

Dialectical Behavior Therapy (DBT)

The most recommended therapy for co-occurring BPD and addiction is Dialectical Behavior Therapy.

With the direction of a counselor, DBT encourages both self-acceptance and helps to direct focus onto positive growth, consistent change, and re-enforced stability.

DBT directly addresses behavioral symptoms of both BPD and addiction that could otherwise complicate recovery from a substance use disorder.

Both behavioral and environmental changes typically impact substance use. DBT encourages lasting change in these areas of life to keep people with this co-occurring condition from relapse.

Finding Dual Diagnosis Treatment For Addiction And Borderline Personality Disorder

Treating co-occurring substance use and BPD is possible through outpatient and inpatient rehabilitation programs as well as through individual treatment sessions.

Call us today to learn more about what is right for you. Our treatment specialists can help direct you or your loved one towards the best rehab center near you.

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This page does not provide medical advice. See more

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Medically Reviewed by
Johnelle Smith, M.D. on April 19, 2021
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