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The Relationship Between Borderline Personality Disorder and Addiction

Medically Verified: 2/1/24

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All of the information on this page has been reviewed and verified by a certified addiction professional.

The relationship between borderline personality disorder (BPD) and addiction can cause a lot of dysfunction. BPD is a challenging mental illness that often causes mood swings, intense emotions, unstable relationships, and chaos for the individual suffering. The challenge of coping with this mental health disorder often leads individuals to cope with drugs or alcohol. Substance abuse may provide temporary relief, however, it will only worsen the symptoms of BPD over time and eventually result in addiction. Proper diagnosis and treatment for BPD and co-occurring addiction is essential.

What is borderline personality disorder?

Borderline personality disorder, or BPD, is a debilitating condition that is often misunderstood by the general public. This mental illness distorts an individual’s self-perception and interferes with their ability to maintain stable relationships. Individuals who suffer from BPD are often seen as manipulative, dependent, narcissistic, and overdramatic. However, mental health professionals have determined through several studies that this behavior arises as a dysfunctional coping mechanism to deal with overwhelming fear and emotional pain. 

According to DSM-5, nine criteria are used to formally diagnose an individual with BPD:

  • Emotional volatility due to an observable mood response.
  • A patter of volatile and intense relationships that alternate between idolization and devaluation.
  • Intense and irrational fear of being abandoned
  • Fleeting paranoid ideation related to stress or strong dissociative symptoms. 
  • Desperate attempts to avoid abandonment.
  • Impulsivity and destructive behavior in two or more areas that are potentially self-harming (substance abuse, reckless driving, binge eating)
  • Inappropriate, passionate anger or trouble regulating area (recurring physical violence, perpetual anger, consistent temper)
  • Markedly and persistently unbalanced sense of self
  • Consistent feelings of desolation
  • Suicidal behavior, suicidal threats, or self-harming behavior 

(Person must display at least 5/9 symptoms in order to receive a formal BPD diagnosis)

Types of BPD

Borderline personality disorder has the potential for many different presentations. Therefore, there have been several attempts to identify subtypes and severity of BPD. Current research continues to explore the exact number of BPD subtypes. However, some of the most commonly diagnosed subtypes of BPD include:

  • Impulsive – A major feature of this subtype of BPD is impulsivity. This particular group is often a high risk of suicidal ideation, attempted suicide, or self-mutilation. This subtype is also known for becoming bored and indulging in reckless and thrill-seeking activities, while also experiencing drastic mood changes.
  • Petulant – This subtype of borderline personality disorder often goes from one extreme of feelings of unworthiness to explosive outbursts of anger. This specific group is referred to as the “angry” subtype. These individuals suffer from an extreme fear of being abandoned or rejected. This ultimately leads to issues surrounding jealousy, controlling, manipulation, possessiveness, anxiety, and irritability.
  • Discouraged – The discouraged BPD subtype is often very passive, reliant on others, clingy, and even codependent. Feelings of rejection or abandonment are often turned inward. These factors often leave these individuals at risk for self-harming behaviors. Relying on others for approval, self-worth, and love, these individuals often experience chronic feelings of emptiness or intolerance with relationships.

Origin of Borderline Personality Disorder

The origins of BPD remain unknown, however, there are several theories about how this complex personality disorder begins. The Mayo Clinic outlines a few factors that may contribute to the development of borderline personality disorder:

  • A dysfunctional family environment – Children who grow up in a family in which they feel neglected or abandoned are more likely to develop BPD in adulthood. Physical or sexual abuse trauma also commonly contributes to borderline personality disorder.
  • Hereditary factors – Most personality disorders – including BPD – are often seen throughout immediate family members. In other words, there may be a genetic predisposition to BPD.
  • Neurological factors – Abnormalities in areas of the brain that control mood, behavior, and emotions often lead to impulsivity, emotional instability, and unpredictable behavior often associated with BPD.
  • Brain chemistry – Chemical imbalances within the brain, such as serotonin, are said to be linked to BPD. Imbalances within neurotransmitters can lead to BPD

Making the Connection: BPD and Addiction

Many of the environmental and neurological factors that contribute to BPD mirror the factors that often contribute to substance abuse. Individuals who struggle with addiction often come from households or families where there is a history of substance abuse. Furthermore, a history of childhood abuse or trauma increases the risk of substance abuse just as it does with BPD. Ultimately, the key factors that play a role in BPD also contribute to the likelihood of an individual struggling with substance use disorder and addiction.

Diagnosing substance use disorders in people who also have BPD is extremely important because both disorders often co-occur. Making the connection between the two diagnoses can be particularly challenging because the behaviors often trigger one another. In order for an individual suffering from BPD and addiction to receive the proper treatment, it is vital that both disorders are treated simultaneously at a dual diagnosis treatment center.

Borderline Personality Disorder and Addiction Treatment

Treatment for addiction and BPD must include the treatment of both conditions as well as any other co-occurring disorders. The overall effectiveness of treatment can be severely altered if all mental illnesses are not addressed simultaneously. BPD and addiction are often treated with a combination of therapy and if appropriate for the patient, medications. 

If you or your loved one has borderline personality disorder and is also caught in the grips of drug or alcohol addiction, give Carolina Center for Recovery a call today! We have the clinical experts on staff to help sort through both co-occurring disorders while also providing integrated care specific to the individual.