Borderline Personality Disorder and Addiction

People who have a mental health disorder are found to be more likely to struggle with addiction, known clinically as substance use disorder (SUD).¹ In fact, as of 2023, an estimated 20.4 million people in the U.S. had co-occurring mental health and substance use disorders.²

When a mental health disorder and SUD exist at the same time, it is considered a co-occurring disorder.¹ This article will look at what borderline personality disorder (BPD) is, common symptoms, the connection between BPD and addiction, and ways to effectively treat co-occurring disorders.

What is Borderline Personality Disorder?

Borderline personality disorder is a mental health condition that affects a person’s ability to effectively manage and regulate their emotions, interfering with their daily functioning.³ This condition is mainly marked by impulsive behavior, emotional reactivity, unstable interpersonal relationships, and poor self-image.³

Those with borderline personality disorder may  engage in self-harming behaviors (e.g., cutting), exhibit promiscuity, and experience greater likelihood of developing other conditions, such as eating disorders and substance use disorders.⁴ Additionally, it is common for BPD to co-occur with other mental health disorders, including anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD).^3,5

Types of Borderline Personality Disorders

Personality disorders like BPD are not categorized by type; instead, they fall into 1 of 3 “clusters” based on types of thoughts and behaviors. Out of the three established personality disorder clusters (A,B, and C), borderline personality disorder falls under Cluster B, along with others like antisocial personality disorder and narcissistic personality disorder.⁴

While traits and symptoms of BPD can vary from person to person, common traits of Cluster B personality disorders tend to include include:^4,6

• Low self-esteem.
• Emotional sensitivity.
• Emotional reactivity.
• Fear of rejection from others.
• Conflicted and unstable relationships with others.
• Impulsive, unpredictable, and often risky behaviors.

Causes of Borderline Personality Disorder

The exact cause of BPD is largely unknown. However, researchers theorize that various risk factors play a role in the development of BPD. Some of the risk factors that can contribute to the development of BPD can include:³

• Having a family history of BPD.
• Being chronically invalidated by caregivers.
• Experiencing trauma during childhood, such as abuse, neglect, and abandonment.
• Having unstable and unhealthy interpersonal relationships with family members while growing up.
• Changes in the areas of the brain that are responsible for emotional regulation and impulse control. (Note: It is unclear as to whether these brain changes are a result of BPD or contribute to the development of BPD.)

Signs of Borderline Personality Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), signs of borderline personality disorder, or the diagnostic criteria for BPD, include the following:⁴

1. Frantic attempts to prevent abandonment (real or perceived). These can be portrayed as manipulative or attention-seeking behaviors.
2. Persistent intense and conflicted interpersonal relationships from alternating between idolizing and devaluing others. This can present as jumping from one romantic relationship or friendship to another with no stable long-term relationships.
3. Lack of self-identity and unstable self-concept, which can present as neediness, codependency, or clinginess to others.
4. Impulsive behaviors, such as excessive spending, binge eating, and engaging in risky sexual behaviors.
5. Chronic suicidal thoughts and behaviors or recurrent thoughts and/or behaviors of self-harm such as cutting.
6. Instability from reactions to moods, which can include intense dysphoria, irritability, or anxiety that can last for a few hours or a few days.
7. Ongoing feelings of emptiness.
8. Trouble controlling anger that can result in intense, irrational, and inappropriate anger outbursts.
9. Paranoid thoughts and disassociation.

Because BPD often occurs with other mental health disorders, it can be difficult to diagnose and identify an effective course of treatment.³ Therefore, while it is important to be aware of what some of the signs of borderline personality disorder are, it is equally important to obtain an official diagnosis from a qualified professional in order to obtain the appropriate care.

What’s the Relationship Between Borderline Personality Disorder and Addiction?

Borderline personality disorder and addiction commonly co-occur with one another. In fact, in an analysis of over 70 studies, it was determined that nearly 50% of people with BPD also meet the criteria for at least one type of SUD.⁵

Researchers believe that factors such genetics, personality traits (e.g., impulsivity and emotional reactivity), certain behaviors, and the use of drugs or alcohol to self-medicate can all contribute to the co-occurrence of BPD and SUD.^5,7

Specifically, drug and alcohol use can cause changes in the brain, which can increase a person’s risk of developing a mental illness. Drugs and alcohol are considered risk factors for the development of borderline personality disorder, assuming the individual has other underlying risk factors as well.⁷

Treatment for BPD and Addiction

For many with borderline personality disorder and a substance use disorder, the idea of getting treatment for this co-occurring condition can feel overwhelming, and, at times, even hopeless. They may feel that:⁶

• There is no effective treatment for BPD.
• The stigma associated with a BPD diagnosis can make providers less likely to make a BPD diagnosis.
• A similarity in symptoms of BPD and other mental health disorders can make it difficult to accurately identify and diagnose BPD
• Gender bias exists, contributing to women being more likely to receive a BPD diagnosis than men.

While treatment for co-occurring mental health and substance use disorders is a complex process, the most important thing to know is that the points above are rooted in fear, not fact. Both borderline personality disorder and addiction are highly treatable conditions, and co-occurring disorder treatment is available and effective. Effective treatment is that which addresses the whole person, including factors such as underlying mental health disorders, substance use, and one’s social support system.⁸

Those who seek treatment for this type of co-occurring condition can look forward to working with a team of professionals and specialists who can offer this type of effective care in the following ways:^6,8

• Address co-occurring disorders simultaneously
• Be flexible and make modifications according to the patient’s treatment progress
• Include treatment settings (e.g., inpatient, outpatient) in line with the level of care needed
• Include aftercare planning and services such as mutual support groups and community support.
• Include culturally appropriate and individualized protocols, interventions, and services.
• Identify meaningful benchmarks and objectives that signify progress.
• Address short and long-term needs such as housing, employment assistance, and childcare services.

Therapy for Co-occurring Disorders

Treating a co-occurring borderline personality disorder and a substance use disorder involves several components. One common component of integrated treatment is psychotherapy, which may include modalities such as:⁹

• Dialectical behavioral therapy (DBT).
• Cognitive-behavioral therapy (CBT).
• Contingency management (CM).

Therapy, in general, is beneficial during treatment because it teaches a variety of skills that patients can use to improve their overall wellbeing. Additionally, patients can further benefit from participating in family therapy, group counseling, and individual therapy, all of which can aid in creating a more solidified standing in recovery.⁶

Medication for Co-occurring Borderline Personality and Addiction

There are several different types of treatment medications used to treat both mental health disorders and certain types of substance use disorders. For example, medications such as antidepressants, mood stabilizers, and low-dose antipsychotics may help relieve symptoms related to BPD.⁹

The U.S. Food and Drug Administration (FDA) has approved medications to help treat certain types of substance use, which may be used in combination with medications for mental health conditions like borderline personality disorder. Some of these FDA-approved medications for SUDs include:^6,10

• Disulfiram and Acamprosate to treat alcohol use disorder (AUD).
• Methadone and buprenorphine to treat opioid use disorder (OUD).
• Naltrexone to treat both AUD and OUD.

The medications listed above can help to reduce cravings and decrease withdrawal symptoms, which may improve treatment outcomes and strengthen recovery efforts.¹⁰

Find Treatment for Co-occurring Disorders Near Me

If you or a loved one is struggling with co-occurring disorders like borderline personality disorder and addiction, treatment may be an important step in starting a new path toward a healthier, full life. American Addiction Centers (AAC) specializes in providing comprehensive care for co-occurring disorders at several locations across the U.S. If you’d like to know more about treatment options for co-occurring disorders and how to pay for treatment, and check your health insurance, our caring admissions navigators are available at to talk 24/7. Call today to get the help you need.