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Borderline Personality Disorder And Addiction: Co-Occurring Disorders

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Borderline personality disorder affects 1.6 percent of adults in the United States. This disorder makes it challenging for people to regulate their emotions and develop relationships, which increases the chance that they will develop an addiction. About 78 percent of people with borderline personality disorder struggle with substance use or addiction at some point in their lives.

What Is Borderline Personality Disorder (BPD)?

People with borderline personality disorder live on an emotional roller coaster. This disorder is characterized by extreme feelings of insecurity and irrational behavior. An individual with BPD craves closeness with others and is terrified that they will leave, yet they push people away with obsessive behavior and irrational cruelty.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that a BPD diagnosis consists of at least five of these nine symptoms of borderline personality disorder:

  • Fear of Abandonment: drastic attempts to keep people from leaving, whether the threat is real or imagined
  • Volatile Relationships: change from love to hate at a moment’s notice
  • Unstable Self-Image: uncertainty about one’s identity
  • Impulsive Behavior: doing irresponsible or dangerous things that are self-damaging (such as substance use)
  • Self-Harm: suicidal behavior or self-mutilation (cutting)
  • Mood Swings: sudden dissatisfaction, irritability or anxiety that lasts for days
  • Emptiness: chronically feeling alone in the world or that life has no meaning
  • Anger: unreasonable, uncontrollable temper that may manifest in physical fights
  • Dissociation: paranoia, disconnection from self, thoughts or reality

Most people (about 75 percent) who are diagnosed with BPD are women. While this may represent that the disorder is more common in women, researchers question whether it is actually a diagnostic bias. It is possible that many men experiencing BPD are misdiagnosed with other disorders, such as post-traumatic stress disorder (PTSD).

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What Causes Borderline Personality Disorder (BPD)?

It is difficult to say why some people suffer from borderline personality disorder, but it is likely the result of several factors. Studies have shown that BPD may have genetic contributors, as people with the disorder usually have a close family member who suffers from it as well.

Since BPD is a mental disorder, brain function may also play a role in its development. People who are susceptible to borderline personality disorder may have stunted communication in their brains, causing erratic emotions and behavior.

BPD may also result from environmental factors, such as past trauma. This is one reason that men may be misdiagnosed with PTSD when they actually suffer from BPD. Traumatic experiences, such as use or neglect as a child, can also raise someone’s risk of abusing substances and developing an addiction.

How Is BPD Related To Drug Use? How can I get Help?

Social isolation and the inability to form and maintain healthy relationships can lead someone to use drugs or alcohol. Depression, anxiety, insecurity and emptiness are all risk factors for substance use and addiction.

Borderline personality disorder and addiction exhibit some of the same symptoms, such as:

  • Impulsive Behavior: addiction is characterized by drug-seeking at the expense of personal relationships, finances and health
  • Mood Swings: stimulant drugs cause a high followed by a crash, and many substances come with unpleasant after effects such as depression and anxiety
  • Emptiness: an addicted brain craves drugs or alcohol in order to feel normal, leaving a void whenever the substance wears off
  • Dissociation: people suffering from addiction often feel disconnected from the world around them, as well as from the biological, psychological and social consequences of their addiction

Drugs and alcohol alter brain structure to make someone feel more relaxed or happy, at least at first. This may be a relief from the unstable emotional state of someone struggling with borderline personality disorder.

Over time, substance use changes the functionality of the brain. Dopamine, a chemical that regulates the brain’s reward system, plays a key role in addiction. Many drugs cause the brain to produce more dopamine or prevent it from being properly regulated. The surplus of dopamine creates a pleasant feeling of well-being.

When the brain is repeatedly altered by drugs or alcohol, it stops producing as much dopamine naturally. At that point, dopamine levels become very low. The brain depends on substances to make it feel good, and without them, the negative feelings that led to substance use in the first place become even worse.

When someone suffers from a mental disorder and substance use disorder, the two are referred to as co-occurring disorders. One disorder may cause the other, and their coexistence can make things very difficult.

Addiction actually worsens the symptoms of borderline personality disorder, and BPD aggravates the symptoms of addiction. Because of this, the most effective way to addiction recovery for someone with BPD is to address both issues at once.

Help, Treatment, and Recovery For BPD And Addiction

A common treatment method for both BPD and addiction is dialectical behavior therapy (DBT). Originally developed to treat borderline personality disorder, DBT focuses on mindfulness and positive change. It encourages the individual to accept that they have a mental disorder and acknowledge the hard work they have to do to overcome it.

Like many other behavioral therapies, DBT helps a person change their thoughts and behavior by learning to control their emotions and deal with stress in a healthy way. Quality addiction treatment programs combine behavioral therapy with methods like individual counseling and support groups to provide comprehensive care.

Some treatment programs use medications to combat symptoms of borderline personality disorder. These may be anti-anxiety medications or antipsychotics. This can make it easier for a person to regulate their emotions and remain in treatment longer.

Borderline personality disorder is difficult to treat. The characteristic mood swings, impulsivity and lack of trust may prevent a person with BPD from developing a positive relationship with a therapist and staying consistent with a treatment program.

People with a dual diagnosis of borderline personality disorder and substance use disorder may have even more trouble. They are more likely to drop out of treatment, leaving a program before lasting change can be made. Because of this, as well as their erratic personalities, they are also more likely to relapse.

Many rehab programs offer dual diagnosis treatment to deal with unique problems that arise with co-occurring disorders. In treating both disorders, this treatment reduces the likelihood of relapse and better prepares a person to live a healthy, substance-free life.