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Borderline Personality Disorder and Addiction

drunPeople who have a mental health disorder are found to be more likely to struggle with addiction, also known as a substance use disorder (SUD).1 In fact, as of 2020, an estimated 17 million people in the U.S. had co-occurring mental health and substance use disorders.11

When a mental health disorder and SUD exist at the same time, it is considered a co-occurring disorder.1 A mental health disorder can include mood disorders, such as depression or bipolar disorder, as well as personality disorders, such as borderline personality disorder, or BPD.

This article will look at what BPD is, the symptoms of BPD, the connection between borderline personality disorder and addiction, and ways to effectively treat co-occurring disorders.

What is Borderline Personality Disorder?

Borderline personality disorder impacts a person’s ability to effectively manage and regulate their emotions and interferes with their daily functioning in many aspects of their life.2 It is marked by impulsive behavior, emotional reactivity, unstable interpersonal relationships, and poor self-image.

Individuals with borderline personality disorder:3

  • May be very promiscuous and move from one relationship to another.
  • Often engage in self-harm behaviors such as cutting.
  • Have a higher likelihood of developing other mental health disorders like eating disorders and substance use disorders.

There are no formal types of borderline personality disorders; however, personality disorders (PDs) as a diagnosis can fall into 1 of 3 clusters: Cluster A, Cluster B, and Cluster C. BPD falls under Cluster B personality disorders, along with others like:3

Traits and symptoms of BPD can vary from person to person. Common traits of Cluster B personality disorders include:

  • Impulsive, unpredictable, and often risky behaviors.4
  • Emotional sensitivity.4
  • Emotional reactivity.4
  • Conflicted and unstable relationships with others.3
  • Low self-esteem.3
  • Fear of rejection from others.3

Borderline personality disorder is diagnosed by a mental health professional, and diagnosis usually occurs in early adulthood or late adolescence.2 BPD is diagnosed more in females than in males, with 75% of BPD diagnoses being given to females.3

It’s common for BPD to co-occur with other disorders like anxiety, depression, bipolar disorder, substance use disorders, and post-traumatic stress disorder (PTSD).2, 5

What Types of Borderline Personality Disorder?

There aren’t types of borderline personality disorder; however, there is some research that categorizes BPD into subtypes.6 That research is limited and not sufficient to warrant any formal diagnosis of a type of borderline personality disorder.

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. Risk factors that can contribute to the development of BPD can include:2

  • Having a family history of BPD or having a family member already diagnosed with BPD.
  • Experiencing trauma during childhood, which can include abuse, neglect, and abandonment.
  • Having unstable and unhealthy interpersonal relationships with family members growing up.
  • Being chronically invalidated by caregivers.
  • 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

Only a mental health professional can diagnose borderline personality disorder after a comprehensive assessment and evaluation.2 Because BPD often occurs with other mental health disorders, it can be difficult to diagnose and identify an effective course of treatment.2

That’s why it is important that you complete a formalized assessment by a trained and experienced mental health professional who can determine an accurate diagnosis and rule out or include other mental health disorders. You may also undergo a medical exam to rule out any other contributing factors.2

According to the Diagnostic and statistical manual of mental disorders, 5th Edition (DSM-5), the diagnostic criteria for BPD include:3

  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.

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

Borderline personality disorder and addiction commonly co-occur with one another. In an analysis of over 70 studies, researchers found that nearly 50% of people with BPD also meet the criteria for at least 1 SUD.5

Researchers have identified several theories that support the connection between the 2 disorders. First, researchers believe that impulsivity and emotional reactivity contribute to the manifestation of both BPD and SUD.5 Secondly, both disorders may share the same genetic vulnerability factors, which may make them more likely to occur together.5

Borderline personality disorder and substance user disorders have common personality traits, such as emotional instability, emotional reactivity, and mental disturbance, which increase the likelihood of co-occurrence.5

Researchers believe that people with mental health disorders may misuse drugs and alcohol to improperly manage and relieve the symptoms of a mental illness.7 When substances are used to manage symptoms of mental illness, this is known as self-medicating. Self-medicating does not only include drugs and alcohol but also food in the form of binging and/or purging.

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 However, it is important to note that the presence of co-occurring disorders does not mean that 1 disorder directly caused the other.7

Treatment for BPD and Addiction

Treatment for co-occurring mental health and substance use disorders is a complex process. Fortunately, addiction is treatable, and co-occurring disorder treatment is available to help you. Effective treatment is that which addresses the whole person including underlying mental health disorders, substance use, and your social support system.12

Upon your initial evaluation, you and your treatment team will work together to create a treatment plan that includes services and interventions specific to you and your needs.

Your treatment plan should:4, 12

  • Address co-occurring disorders simultaneously.
  • Be flexible and modified according to your progress in treatment.
  • Include treatment settings (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.

Treating borderline personality disorder and addiction can be challenging due to factors related to co-occurring disorders. These may include social, family, medical, and psychological challenges that all need attention.4 Some people also experience functional and cognitive impairments that make it difficult to follow through with tasks and understand the information presented.4

Additional challenges in effectively treating BPD and SUD include:4

  • 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, which can make it difficult to accurately identify and diagnose BPD.
  • A false belief that there is no effective treatment for BPD.
  • Gender bias that contributes to women being more likely to receive a BPD diagnosis than men.

Therapy for Co-occurring Disorders

Effective treatment of co-occurring borderline personality disorder and a substance use disorder involves several components. Two common components of integrated treatment are medication and psychotherapy. Dialectical behavioral therapy (DBT) and cognitive-behavioral therapy (CBT) are 2 therapeutic modalities commonly used in the treatment of borderline personality disorder.8

Therapy, in general, is beneficial during treatment because it teaches a variety of skills in emotional regulation, distress tolerance, and interpersonal effectiveness.8 Both CBT and DBT are used in the treatment of substance use disorder as well. CBT teaches healthy ways of thinking and behaving to end substance use.4, 9

Medication for Co-occurring Borderline Personality and Addiction

There are several different types of treatment medications to treat both mental health disorders and certain substance use disorders. Medications such as antidepressants, mood stabilizers, and low-dose antipsychotics may help relieve symptoms related to BPD.8 However, there isn’t one medication that’s designed to treat the primary symptoms of BPD.8

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. Commonly used FDA-approved medications for SUDs include:4, 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.

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