Treating Borderline Personality Disorder (BPD) & Drug or Alcohol Addiction

Borderline personality disorder is a mental health disorder that can impact many areas of a person’s life. Borderline personality disorder (BPD) commonly co-occurs with substance use disorder (SUD), and is the most common personality disorder seen in treatment settings.^1,2 This article will cover what BPD is, what the symptoms of it are, and how it co-occurs with substance use disorder.

What is Borderline Personality Disorder?

BPD is a personality disorder that belongs to a cluster of personality disorders distinguished by appearing emotional, erratic, and dramatic.^1,3 People with BPD tend to have unstable relationships with others, poor impulse control, negative self-image and affect, and heightened impulsivity.^1,3 People with BPD tend to have difficulty seeing people and their actions in shades of gray, but instead view them as strictly good or bad.³

Symptoms of BPD

People who have BPD commonly experience extreme fluctuations in the way they see themselves and others, vacillating between intense hatred to intense feelings of intimacy, making it difficult to maintain meaningful relationships.³ Criteria for diagnosing BPD are outlined in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-V),which states that a person with BPD must have at least 5 or more of the following symptoms:^3,4

• Engaging in at least two impulsive and potentially harmful behaviors, such as substance use, reckless spending, sex, or binge eating.
• Experiencing persistent feelings of emptiness.
• Going to extremes to prevent abandonment, whether it is real or imagined.
• Having a persistently unstable sense of self or self-image.
• Highly intense mood swings that last for several hours to a couple of days.
• Patterns in interpersonal relationships that are intense and unstable, alternating between extremes of idealizing and devaluing the other person.
• Episodes of intense despondency, irritability, or anxiety usually lasting a few hours and sometimes, but rarely, more than a few days.
• Periods of stress-related paranoia or dissociative symptoms, including feeling as though you are outside of your body or detached from yourself.
• Recurring suicidal threats, gestures, or behavior, or self- behavior.
• Strong, intense periods of inappropriate anger, or having difficulty controlling anger.

How is BPD Diagnosed?

While it can be helpful to be aware of the symptoms of BPD, only a licensed mental health professional can diagnose you with a mental disorder.³ If some or all of the symptoms listed previously sound like they fit your symptoms, the next step should be to see a psychiatrist, psychologist, social worker, or mental health counselor. They will conduct a thorough assessment and speak to you about your symptoms and how they affect various areas of your life.³ Once other potential causes have been ruled out, they will offer a diagnosis and discuss the next steps for you to take.

The Connection Between BPD and Addiction

If a person has BPD and addiction, this is known as a co-occurring disorder, or dual diagnosis. Co-occurring disorders are when 2 or more mental disorders occur at the same time. Generally speaking, each disorder can affect the course, progression, and treatment of the other.^1,3 In addition to SUDs,  other mental disorders that commonly co-occur with BPD include depressive and bipolar disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, eating disorders, as well as other personality disorders.^3,4

Does BPD Cause Addiction?

Although BPD doesn’t cause addiction and vice versa, both disorders share several common risk factors, such as genetic and environmental influences, which may help explain the high rate at which BPD co-occurs with SUD.^1,5 Since deficits in impulse control and potentially self-damaging behavior is one of the features of BPD, it’s likely that people with BPD are predisposed to SUDs or behaviors like binge drinking and drug misuse which can lead to substance use disorders.¹ Likewise, increased substance use can lead to greater emotional instability, which may influence the development or worsening of someone predisposed to BPD.

Risk Factors for Co-Occurring BPD & Addiction

There are several risk factors shared by both BPD and substance use disorders.

Some shared risk factors for BPD and SUDs include:³

• Genetic predisposition towards one or both disorders.
• Family history of BPD or SUD or both, especially a close family member (such as a parent or sibling).
• Affecting similar areas of the brain that impact impulse control and emotion regulation.
• Environmental factors, including adverse childhood experiences or trauma (i.e., sexual and physical abuse), neglect or abandonment, or other traumatic events.

Having these factors doesn’t necessarily mean that you will develop BPD and/or SUD; some people develop one or both these disorders without any risk factors. The presence of one or more risk factors means that you are at increased risk vs. someone without any risk factors.³

How Common is Co-Occurring BPD & Substance Use Disorder?

BPD is estimated to be present in 1.6% to 5.8% of the general population.¹ However, SUDs are among the most commonly diagnosed co-occurring disorders alongside BPD.¹ In addition, one large review study found that approximately 22% of people diagnosed with a SUD or being treated for addiction also had co-occurring BPD.¹ The same study found that approximately 75% of people with a BPD also had a co-occurring SUD at some point in their life, and about 45% of all people with BPD have a SUD currently, with alcohol use disorder, opioid use disorder, and cocaine use disorder occurring most often.¹

How to Help Someone with BPD and Drug or Alcohol Addiction

If someone you love is struggling with co-occurring BPD and SUD, it can be scary and overwhelming. However, there are many ways for you to help a loved one get into treatment. This family addiction resources guide is available to provide more information about steps you can take to help and support your loved one through the recovery process while also getting the support you need.

Treatment for Co-Occurring BPD and Substance Misuse

Finding treatment for co-occurring borderline personality disorder and addiction may seem overwhelming, but many substance use rehab facilities have the expertise needed to provide effective care for both disorders. Greenhouse Treatment Center is a luxury addiction treatment facility near Dallas, Texas that offers a comprehensive, combined mental health and addiction treatment program where co-occurring disorders are both treated at the same time. Our facility offers a full range of care, including varying levels of addiction treatment such as:

• Medical detox, where you can withdraw from substances in a safe, monitored environment.⁶
• Inpatient rehab, where you stay at the facility for the duration of treatment and receive group and individual therapy to learn how to manage BPD symptoms and stay sober.⁶
• Outpatient, where you live at home and participate in your normal daily routine while attending scheduled group and individual counseling sessions either virtually or at a treatment facility.⁶
• Co-occurring disorder treatment, where integrated treatment is designed to treat both SUD and mental illness at the same time to provide the most effective results.³ Therapies used commonly include dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT), both of which can be especially helpful for BPD.^3,5

To learn more about starting the treatment process to reclaim your life from co-occurring BPD and SUD, call our admissions navigators at 469-256-7567. Our compassionate staff can answer any questions you have about using insurance to pay for rehab, other rehab payment options, and what to expect from the treatment process.