Borderline Personality Disorder & Addiction

October 17, 2022

Table of Contents

Around 1 person in 100 lives with borderline personality disorder (BPD), a mental health condition causing emotional dysregulation.[1] People with BPD feel intense, overwhelming emotions that are hard to control.

BPD is associated with impulsivity, which manifests as substance misuse for some people. Frequently, people with BPD also develop substance use disorders (SUD).

Both BPD and SUD are treatable, and the therapies used for one condition are often effective for the other. But people with BPD may not understand the need for treatment, and they can react to heavy-handed approaches with anger.

Families that spot the signs of SUD in a loved one with BPD can help support them in getting treatment for both conditions. 

BPD & SUD: By the Numbers 

Borderline personality disorder and substance use disorders often coexist. Researchers say about 78% of people with BPD develop an SUD at some point during their lives.[2] One study found the rates of substance use among people with BPD to be as high as: [3]

  • Opioid use: 33.8%
  • Cocaine use: 22.3%
  • Alcohol use: 16.99%

The relationship between BPD and SUD can wax and wane. One study found that more than 90% of people with both BPD and SUD had remission of substance abuse symptoms within a 10-year span.[4] 

3 Reasons Why BPD & SUD Co-Occur

Doctors use the term co-occurring conditions to describe multiple illnesses that appear in the same person simultaneously. Borderline personality disorder and substance use disorder often co-occur for three main reasons. 

1. Underlying Mental Health Issues 

People with BPD often struggle with other mental health issues, including anxiety or depression. Researchers say about 85% of people with BPD have anxiety disorders, making this the most common co-occurring condition with BPD.[2] Underlying mental health conditions often increase the risk for substance misuse. 

Impulsivity

BPD is characterized by impulsive and reckless behaviors.[5] People with BPD may do the following:

  • Spend money they don't have
  • Engage in unsafe sex 
  • Binge eat
  • Drive too fast

Substance misuse can also be on of these dangerous behaviors.

People with borderline personality disorder may appreciate the high that comes with breaking rules and tearing apart expectations. They may not have the ability to control what they do, and they may lack the insight to see how dangerous these activities, including substance use, are. 

Self-Medication

When people with BPD are under stress, they feel intense emotional pain.[6] To an outsider, this may look like a tantrum or an attention-getting scheme.

But for someone with BPD, the distress is both real and painful. They may use drugs to distract them from these feelings. Or they may lean on substances to quiet their anxiety. 

Symptoms of BPD

Borderline personality disorder is a recognized mental illness with shared characteristics. Doctors can't run tests like blood screenings to find the disorder.

Instead, they conduct interviews and ask their patients to describe their symptoms. A close match between the description and known characteristics merits a BPD diagnosis.

Common symptoms of BPD include the following:[4]

  • Fear of abandonment: Patients with BPD often describe fearing that they will be left or abandoned by their friends or loved ones. 
  • Turbulent relationships: They experience intense highs and lows in connection with other people. They may form a tight connection in one day and then never speak to that person again. 
  • Self-harm: They may engage in impulsive acts, like speeding while driving or unprotected sex. They may self-mutilate or attempt suicide. 
  • Hurtful emotions: They may feel empty, angry, paranoid, or dissociated.

Some people develop symptoms during the teen years, while other people present later in their twenties or early thirties. Adults with BPD may elude diagnosis for years, as they tend to push caring people away and may not be identified and get the help they need. 

Symptoms of SUD 

People with SUDs may show the following signs: [4]

1. Control 

They take more of a substance than intended. They may try to cut down on their use without success. They may spend more and more time getting, using, or recovering from drugs. 

2. Social Ties 

They may skip work, family, or community obligations due to drug use. They may keep using drugs despite these problems. 

3. Risk

They may use drugs in situations in which use is dangerous. For example, they may get high and drive, or they may go to work while drunk. They may face consequences due to use, such as a suspended license, and keep using anyway.

4. Tolerance 

They need more of the drug to achieve the same effect. And they may experience withdrawal symptoms, such as nausea or shaking, between doses. 

Treatment Options for BPD & Addiction

The goal of treatment is to help people with BPD control their thoughts, feelings, and behaviors rather than treating them with drugs. Unfortunately, there are no medications that have been shown to treat BPD, although their are medications that may help with some of the symptoms, such as depression or anxiety. At this time, the mainstay of treatment for BPD is psychotherapy.

Psychotherapy is the most effective treatment approach for BPD. Doctors use approaches like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) to help their clients understand how negative thought patterns and unchallenged assumptions directly lead to harmful behaviors. With the help of a therapist, people with BPD can gain control.[8]

Just like all patients, Patients with BPD can benefit from Medication for Addiction Treatment (MAT) for a substance use disorder. 

Risk Factors for BPD

Researchers aren't entirely sure what causes borderline personality disorder, but they suspect several factors combine to change the way people think and feel about themselves and the world.

Those factors include the following:[9]

  • Genetics: People with parents who had BPD are more likely to develop the condition too.
  • Environment: Difficult life events in childhood such as assault or neglect increase the risk of BPD. 
  • Neurology: Portions of the brain responsible for judgment and control may not work as effectively in people with BPD, although this has not been definitely proven. 

How to Help Someone With BPD

If someone you love has borderline personality disorder, whether or not they use drugs, you can help. By reading this article and trying to understand how the mental health disorder works, you're already taking the first step.

Next, you can encourage your loved one to get treatment. BPD is treatable, and counseling does work incredibly well for many individuals.

Remember that people with BPD worry about abandonment. It is important to reassure your loved ones that you'll stay engaged and involved in their treatment.  While having a friend or family member with BPD can be challenging, your support may be the thing that eventually encourages them to get the treatment they deserve.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Borderline Personality Disorder (BPD). Rethink Mental Illness. https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/borderline-personality-disorder-bpd/. Accessed September 2022.
  2. Borderline Personality Disorder and Comorbid Addiction. Deutsches Ärzteblatt International. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010862/. April 2014. Accessed September 2022.
  3. Borderline Personality Disorder and Substance Use Disorders: An Updated Review. Borderline Personality Disorder and Emotion Dysregulation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145127/. September 2018. Accessed September 2022.
  4. An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders. Substance Abuse and Mental Health Services Administration. https://sprc.org/sites/default/files/resource-program/CoOccurringBPD_SUD2014.pdf. 2014. Accessed September 2022.
  5. Borderline Personality Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder. April 2022. Accessed September 2022.
  6. Substance Use Disorders in Patients with Borderline Disorder. Borderline Personality Disorder Demystified. http://www.bpddemystified.com/what-is-bpd/co-occuring-disorders/substance-use-disorders-in-patients-with-borderline-disorder/. Accessed September 2022.
  7. Treating BPD. National Education Alliance for Borderline Personality Disorder. https://www.borderlinepersonalitydisorder.org/what-is-bpd/treating-bpd/. Accessed September 2022.
  8. Treatment: Borderline Personality Disorder. NHS. https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/treatment/. July 2019. Accessed September 2022. 
  9. Borderline Personality Disorder. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder. December 2017. Accessed September 2022.

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