What is borderline personality disorder and does it relate to addiction?

Mental Health

What is borderline personality disorder and does it relate to addiction?

Borderline personality disorder was a recently recognized disorder in 1980. When you compare it to other psychiatric disorders, it is quite behind on research. This has caused it to be misunderstood by the public which perpetuates the feeling of isolation the disorder causes. Some people are highly functional with BPD but it’s likely their private relationships are suffering.

The main symptoms of borderline personality disorder are behavioral. As patients have a hard time controlling emotions and thoughts, they become impulsive, and reckless. This causes relationships to become unstable. This can make them more susceptible to abusing substances compared to those without the disorder, which can quickly lead to addiction. Other disorders can coincide with BPD which include:

  • Depression
  • Anxiety
  • Eating disorders
  • Substance abuse
  • Bipolar disorder

Borderline Personality Disorder and Addiction

Borderline personality disorder is primarily the inability to manage emotions effectively and can heavily relate to addiction. Patients with borderline personality disorder make up 2.7% of the population in the U.S. Within this group, close to 80% of them will develop an addiction or substance-related disorder. It centers around the inability to manage emotions properly. It occurs in the context of relationships that are deeply affected due to the disorder. Sometimes, it’s all or just one relationship that is affected.

Part of the disorder itself is to display reckless and impulse behavior. Patients who do abuse or become addicted substances have shown to be less stable clinically than those who don’t have a substance dependency. When a borderline personality disorder patient has an addiction, they are more likely to attempt suicide. They drop out of treatment for the disorder more frequently and are less likely to stay sober for long. There are special therapeutic approaches in place to manage the combination for the disorder and addiction.

When borderline personality disorder was termed, it related to the psychosis and neurosis of a persons’ state. Although it doesn’t properly represent what the disorder is, the name stuck. The name itself has created a stigma that isn’t helping those with the disorder. Since the 1980’s, it was labeled as a medical disorder, and has a history of prejudice. The condition is based on having troubles with emotions, thoughts, behaviors, relationships, and self-image. In this generation, it is believed that borderline personality disorder should be called “Emotional Dysregulation”.

Misdiagnosis of Borderline Personality Disorder

As there hasn’t been much research in comparison to other disorders, there is little known about it. Often times, it won’t be diagnosed at all or it can be misdiagnosed. Many of the symptoms are similar to other personality disorders but there are slight differences. Bipolar disorder includes mood instability but the conditions are still much different. For someone with bipolar disorder, their mood will change and remain for weeks or months. Mood changes in borderline personality disorder occur much more quickly. They can change many times within a day. As such a high amount of patients do abuse substances when they have BPD, the longer they go without treatment, the more likely addiction will set in.

What Causes Borderline Personality Disorder?

There are a variety of factors associated with BPD.

  • It is believed that a dysfunctional family environment growing up can contribute to BPD. This can be anything from emotional neglect to trauma at a young age.
  • Borderline personality disorder can be hereditary and patients may have a genetic predisposition.
  • Abnormalities in the brain are believed to contribute to the impulsive behavior and emotional instability in patients. It is believed that there may be something wrong in the area of the brain that controls mood, behavior, and emotions.
  • An imbalance in neurotransmitters that prevents certain chemicals from functioning properly, affecting the patient’s feelings and behaviors.

Symptoms of Borderline Personality Disorder

Symptoms for patients with borderline personality disorder differ. Studies have shown that women are more likely to have BPD than men. The following common symptoms will all be experienced by someone with BPD. Some may be more regular than others.

  • Feelings of isolation, boredom, and emptiness.
  • Patients have a hard time feeling empathy.
  • A distorted sense of self.
  • A history of unstable relationships that mimic a roller coaster. Intense love followed by intense hate.
  • A constant fear that they will be rejected or abandoned with irrational behaviors that ensue.
  • Intense mood changes that last for hours or days.
  • Intense feelings of anxiety, worry, and depression.
  • Risky, self-destructive behavior.
  • Substance abuse that can become addiction.
  • Having unsafe sex.
  • Intense anger.
  • Unstable career with no clear direction.

Why Addiction is So Prevalent in BPD Patients

BPD is a condition that is often not represented properly with pop culture, making it highly misunderstood. Patients will distort their own self-perception which gets in the way of having healthy relationships. They are viewed as manipulative and dramatic but they are dealing with a great deal of fear and emotional pain. The emotional pain and impulsive behaviors put patients at a high risk of substance abuse which can easily become addiction over time.

One of the main symptoms of borderline personality disorder is the need to self-destruct. Many times, this is a way of hurting those around them. They want help but instead, they are more prone to pushing people away. They look to find reckless ways to hurt themselves as well. There is also a high level of emotions at play here. With anxiety and depression as well as the need to self-destruct, this becomes a recipe for substance abuse.

As it can take time for BPD to be properly diagnosed, addiction may have already set in. The disorder can be maintained and symptoms can be reduced but it must first be diagnosed. The addictive tendencies with a patient who suffers from BPD is high as well. If trauma occurred through childhood, one of the contributing factors to BPD, the patient may abuse substances to numb the pain. The emotional turmoil constantly occurring while feeling isolated from others can lead to chronic drinking or drug use easily.

Overlapping of Borderline Personality Disorder and Addiction

The co-occurrence of personality disorder and addiction have many similarities. This makes it challenging to make a proper diagnosis. BPD is even more difficult to diagnose because the symptoms include being difficult and manipulative. There are many signs of substance addiction that are also symptoms of BPD. Here are their similarities:

  • Addiction and borderline personality disorder can both be characterized by impulsive, self-destructive behaviors.
  • Intense mood swings.
  • Both can cause the patient to carry out manipulative, deceitful actions.
  • Both may show no concern for their own health or safety.
  • They may pursue dangerous behaviors intentionally.
  • Suicidal tendencies
  • Moodiness, depression, and paranoia.

Dual diagnosis is challenging to treat and often requires special treatment for those struggling with addiction while dealing with BPD.

Borderline Personality Disorder and Addiction Relapse Risk

The relationship that exists between borderline personality disorder and addiction is volatile. Drugs and alcohol will promote the dangerous symptoms within the disorder. When someone drinks or uses drugs, they may get incredibly angry or depressed. When they abuse substances, it is often to numb the pain they’re feeling. Every time they use or drink, they put themselves at risk of harming themselves. Therefore the risk of relapse, which is high, is so much greater in those with BPD.

Addictive patterns for those with dual diagnosis that include BPD may come from issues that haven’t been addressed. This is one of the reasons that people with BPD have a high risk of abusing substances even if they’ve gone through treatment. True sobriety would have to come from integrated dual diagnosis treatment from a team that is knowledgeable in all aspects. The prevention of relapse includes addiction treatment, preventing self-harm, and preventing use of medications and risky behaviors.

Treating Dual Diagnosis of BPD and Addiction

The treatment that seems to be effective for these factors is Dialectical Behavior Therapy, or DBT. This includes managing mood swings through mindfulness practice, reducing cravings of substances, finding meaning in life, and eliminating social situations where substance abuse may take place. Individual psychotherapy is also necessary for those with borderline personality disorder. They will get integrated treatment, enter relapse prevention, and take part in counseling.

Relapse prevention is important with BPD treatment because the relapse rates are so high. It will involve peer groups that are designed to listen and support. Coping strategies can be shared and challenges can be talked about. As borderline personality disorder impairs a patients’ social life, it’s good to have a support group to talk with. If necessary, anti-addiction drugs can also help greatly as part of a total treatment plan.

Borderline personality disorder affects about 14 million people in the U.S. at one point in their life. It affects more people than schizophrenia and bipolar disease combined. In psychiatric hospitals, 20% of patients are admitted for BPD. In outpatient mental health treatment, borderline personality disorder affects 10% of patients. When the disorder is properly diagnosed and therapy is administered, there’s a high success rate of symptoms reduced. There may be a bigger problem with staying sober from the addiction they acquired. Further treatment for addiction may be necessary but in time, patients can live a normal life with very little symptoms.


NIMH (August, 2016) Borderline Personality Disorder. Retrieved from,


NCBI, Dtsch Arztebl Int (April, 2014) Borderline Personality Disorder and Comorbid Addiction

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Harvard Review of Psychiatry (September/October 2016) Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped Care. Retrieved from,


NCBI, Innovations in Clinical Neuroscience (May 2011). Gender Patterns in Borderline Personality Disorder. Retrieved from,


2020-01-30T16:49:08+00:00July 23rd, 2017|0 Comments

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