Borderline personality disorder (BPD) and substance abuse tend to go hand in hand. According to Dr. Joseph Troncale, MD, for Psychology Today, people with BPD’s make up about 1 percent of the U.S. population. Of that number, most if not all struggle with some kind of addiction.1 There are a variety of reasons why the two conditions tend to exist simultaneously, but the important thing to remember is that when BPD and substance abuse are treated through a dual diagnosis program, real recovery is possible.
A BPD diagnosis doesn’t mean a person has dual personalities or is somehow on the border between sanity and illness. The Mayo Clinic defines BPD as a type of mental illness characterized by a distorted self-image, unstable and intense relationships, extreme emotions and impulsiveness.2 If left untreated, the symptoms of BPD make normal functioning on a daily basis almost impossible.
The moniker “Borderline Personality Disorder” doesn’t describe the illness in any way. It’s a problem that the medical community is aware of, but hasn’t yet set out to solve. When researchers began discussing BPD in the late 1960s, some believed they were working with an unusual form of existing mental illness. The label “borderline,” seemed to fit right in with other conditions if the symptoms were slightly adjusted.
This all changed in 1980, according to the National Institute of Mental Health (NIMH), when the condition was included in the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III).3 When a condition is included in this manual, it’s considered its own separate disorder. Doctors can then begin to separate people who have this specific disorder from people who have other similar mental health issues.
Symptoms of BPD
For people who have BPD, the world is seen in strict black-and-white terms. People are either all good or all bad. Things are either happy or sad. Judgments are made quickly, and there is no room for negotiation. In addition, people with BPD may have difficulty accepting negative situations, trying hard to get involved and force things go a certain way.
They may also have a significant amount of difficulty maintaining relationships with others, as their behavior is often erratic, dangerous or negative. While people with BPD are often desperately afraid of being abandoned, their behavior may serve to push people away. Other symptoms of BPD include the following:
- Explosive tempter
- Often feel empty or bored
- Unable to plan for the future or set goals
- Severe depression
People with BPD are also impulsive. They may spend money recklessly, drive too fast or eat huge amounts of food in one sitting. This impulsivity may also lead to drug or alcohol abuse. Resisting the temptation to use drugs and alcohol means weighing the pleasures felt in the moment with the consequences that are sure to come down the line. Those with BDP are unable to process these thoughts in a balanced way. Instead, they only see the benefits that might come in the moment, making substances hard to resist.
While it might be easy to see how living with BPD could drive someone to substance use and abuse, it’s also possible that substance abuse could cause symptoms of BPD to appear. This is especially true for people with a family history of mental illness and substance abuse. According to the Mayo Clinic, some studies suggests that some personality disorders are inherited or strongly associated with other mental disorders than run in a family.
Other studies associate BPD with changes to the brain, either from trauma or some type of developmental delay, related to the areas of impulse control, emotions and aggression.2 Substance abuse can also give a person with BPD a greater opportunity to do harm. People with BPD may already feel an urge to commit suicide or harm themselves in some other way, and it may lead them to take stronger doses of drugs or even try to overdose on the drugs. Substance abuse can also further isolate the person from friends and family, leading to even greater feelings of isolation and depression.
Goal of Treatment
Regardless of whether BPD caused the substance abuse, or if the substance abuse triggered BPD, treatment is designed to help the person leave behind destructive behaviors. In Dual Diagnosis treatment, this often means that early stages of treatment are focused on helping the person stop abusing substances. People with a dual diagnosis are often encouraged to go through withdrawal stages in a facility, with the help of a therapist. Weaning away from drug and alcohol use can cause anxiety in almost anyone, but people with BPD may have even greater sensations of anxiety and need additional help to get through detoxification in a safe way.
Once detoxification is over, therapy begins in earnest. Some of the most common approaches to BPD treatment include:
- Cognitive Behavioral Therapy helps the person to change core beliefs and learn to steer clear of dangerous situations.
- Dialectical Behavior Therapy helps the person learn to live in the moment, accepting what comes, and reducing the emotional response to given triggers.
- Schema-focused therapy addresses how the person views the self and his/her place in the world.
- Family therapy allows the entire family to learn new ways of communicating with one another.
In some cases, medications are also used to help those struggling with BPD and addiction. Each individual is different, so treatment plans for the disorder will be unique to the person.
Finding Help for BPD and Addiction
If you or a loved one struggles with BPD or BPD and substance abuse, we are here for you. Call our toll-free helpline 24 hours a day to speak to an admissions coordinator about available treatment options. You are not alone. Call us now.
1 Troncale, Joseph. “Borderline Personality Disorder and Addiction.” Psychology Today, Sussex Publishers, 17 Aug. 2014. Accessed 15 December 2018.
2 “Borderline personality disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 July 2015. Accessed 15 December 2018.
3 “Borderline Personality Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services. Accessed 14 Dec. 2017. Accessed 15 December 2018.
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