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Borderline Personality Disorder and Substance Abuse: Signs, Symptoms and Treatment

Treating Borderline Personality Disorder and Addiction

Many people with borderline personality disorder (BPD) abuse drugs or alcohol, which makes them vulnerable to developing an addiction. 1 People with BPD and a substance abuse disorder require a specialized dual diagnosis recovery program to treat both conditions.

Borderline Personality Disorder Definition

Borderline personality disorder is defined as “a pervasive pattern of instability in interpersonal relationships, self-image, affect, and marked impulsivity.” 1 The symptoms typically begin to surface in early adulthood and appear in a variety of settings. 1

  • Borderline personality disorder affects about 2% of people in the general population.
  • About 20% of people in psychiatric inpatient centers have the disorder.1, 5
  • About 75% of the people diagnosed with borderline personality disorder are women.1

Signs and Symptoms of Borderline Personality Disorder

For someone to be diagnosed with borderline personality disorder, he or she must demonstrate at least 5 of the following signs and symptoms: 1

  • Has an intense fear of abandonment, which the person tries to avoid at all costs.
  • Has intense but inconsistent relationships and fluctuates between idealization and devaluation of someone.
  • Has an ever-changing self-identity or self-image.
  • Engages in self-damaging activities, such as substance abuse, binge eating, dangerous driving, unsafe sexual practices or over-spending.
  • Demonstrates repeated suicidal or self-harming behaviors.
  • Has a pronounced reactivity of mood (intense anxiety, irritability or depression normally lasting a couple hours and not typically more than a few days).
  • Experiences persistent feelings of emptiness.
  • Has difficulty controlling his or her temper or displays inappropriate anger.
  • Experiences dissociative symptoms or paranoid ideation when stressed.

Borderline Personality Disorder and Addiction

People with borderline personality disorder engage in impulsive and risky behaviors, including substance abuse. This population commonly suffers from a co-morbid addiction to drugs or alcohol,2 and the risk of suicide increases for those who have a dual diagnosis of borderline personality disorder and a substance addiction.1 People with these co-occurring mental health conditions should seek out a dual diagnosis treatment center that has experience treating borderline personality disorder and addiction. The treatment plan will need to be comprehensive to address the unique needs of each person and decrease the risk of relapse.

Dual Diagnosis Treatment for Borderline and Substance Abuse

As mentioned above, many people who suffer from borderline personality disorder also have a substance abuse disorder, which is referred to as a dual diagnosis. The two conditions may influence and perpetuate each other. Over half of people with dual diagnoses don’t receive any treatment, while only about 7% of people get the comprehensive treatment that they need. 6

Both conditions should be treated simultaneously at a dual diagnosis recovery center so that you can decrease your risk of relapse and increase pro-social and positive behaviors. If the co-occurring disorders go untreated, you run the risk of: 1
  • Physical handicaps from self-harm or failed suicide attempts.
  • Completed suicide.
  • Repeated job losses.
  • Separation or divorce.
  • Disrupted education.
  • Jail for violent offenses.
  • Debt.
  • Consequences of unsafe sexual practices.
  • Car accidents.

Dual Diagnosis Treatment Services

The best inpatient dual diagnosis recovery centers will provide the following services:

Borderline Personality Disorder Causes

It is generally accepted that borderline personality disorder has both genetic and environmental influences. 2 Twin studies have suggested that borderline personality disorder and the traits associated with it (aggression and impulsiveness) may be inherited. 2

A few environmental factors that may influence the development of borderline personality disorder are:1, 2, 3, 4, 5

  • Childhood physical, sexual or verbal abuse.
  • Being a part of a community of unstable family relationships.
  • Loss of or separation from a parent in childhood.
  • Childhood neglect.
  • Hostile conflict.

The bio-social theory proposed by Marsha Linehan, the developer of DBT, suggests that borderline traits may develop from a “mismatch” between the child’s biological temperament and his or her environment. For example, a child may have difficulty regulating his or her emotions. Environments that fail to teach that child how to manage emotions can cause them to develop borderline traits.

Borderline Personality Disorder and Relationships

People with borderline personality disorder have unstable relationships with others. Initially, they may romanticize or idealize someone, setting unrealistic expectations of that person and sharing intimate experiences or feelings early on. 1 This can quickly change, though, if the lover or caregiver doesn’t seem to be present enough or give enough to the individual. Someone who was once highly valued can soon become de-valued and viewed as cruel or intentionally causing harm.1

This is a persistent pattern, and the sudden shift of perspective may be a source of distress and pain for the person, reinforcing self-harming and substance abuse behaviors.

Extreme Reactions

Borderline individuals have highly reactive moods and lack the ability to control anger. 1 The anger is often inappropriate to the situation and may manifest itself in verbal outbursts, excessive sarcasm and/or ongoing bitterness.1 This rage is typically a response to the perception that the lover or caregiver is uncaring, abandoning, withholding or neglectful.1 People with this disorder often feel shame and guilt after an outburst, which perpetuates their negative self-image.1 They may experience depersonalization (a state of feeling unreal), as a response to a real or imagined abandonment.1 They may become distressed if an idealized person goes on a vacation or a business trip, or has to change plans.2

Find a Recovery Center for Borderline Personality Disorder and Addiction

Call if you are looking for a treatment center that will address substance addiction and borderline personality disorder. A recovery support specialist can confirm your insurance coverage over the phone and help you find a treatment facility near you.

[1]. Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.

[2]. National Institute of Mental Health. Borderline Personality Disorder.

[3]. Gunderson, J. G., Shea, M. T., Skodol, A. E., Mcglashan, T. H., Morey, L. C., Stout, R. L., Keller, M. B. (2000). The Collaborative Longitudinal Personality Disorders Study: Development, Aims, Design, and Sample Characteristics. Journal of Personality Disorders, 14(4), 300-315. Retrieved February 15, 2016.

[4]. American Psychological Association. (2016). What causes personality disorders?

[5]. University of Michigan Department of Psychiatry. Borderline Personality Disorder.

[6]. Substance Abuse and Mental Health Services Administration (SAMHSA). Co-Occurring News.