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The Relationship Between Borderline Personality Disorder and Addiction

borderline personality disorder

This is the fifth article in our series on Dual Diagnosis.  

Borderline personality disorder (BPD) is a serious mental illness that characterizes with the inability to regulate emotions. Therefore, the person experiences severe mood swings, a pattern of ongoing changes in behavior and poor self-image. People who have it often show impulsive behavior and form unstable relationships. As a result of the disease, these patients may experience intense anger episodes, depression or anxiety that last a couple of hours to a few days. So it’s not unusual for patients with this disorder to become suicidal. BDI often co-occurs with eating disorders, substance abuse, and self-harm, which, unfortunately, can lead to suicide. People with BPD sometimes may show uncertainty over who they are and rapidly change interests and values.BPD and addiction


According to the National Institute of Mental Health, the symptoms of BPD include:

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of intense or unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation).
  • Distorted and unstable self-image or sense of self.
  • Impulsive and often dangerous behaviors.
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting.
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days.
  • Chronic feelings of emptiness.
  • Inappropriate, intense anger or anger management problems.
  • Having stress-related paranoid thoughts.
  • Having severe dissociative symptoms, such as feeling cut from oneself, observing oneself from outside the body, or losing touch with reality.

The symptoms can be triggered by ordinary events, like minor separations with business trips or vacation from people they feel close to. People with borderline personality disorder see emotions in other people that aren’t exactly there. Like anger in someone’s face when it’s not present.


According to National Institute of Mental Health, 1.6% of the adult U.S. population has borderline personality disorder. Only 42.2% of the population suffering from BPD received treatment.

borderline personality disorder and addiction Some of the risk factors of BPD are:

  • Genetics – if the person has a close family member diagnosed with BPD, it’s five times more likely to happen.
  • Environmental and Social Factors – BPD may occur as a result of trauma, sexual abuse or abandonment during childhood. Unstable relationships or conflicts also affect the occurrence of the disease but are not a determining factor. Therefore, the causes of BPD are unclear as many people that have BPD don’t have a history of trauma, and many people that have trauma don’t have BPD.
  • Brain factors – studies show structural and functional brain changes in people with BPD. The changes are especially present in brain areas that control impulses and regulate emotions.

1. The Connection Between Borderline Personality Disorder and Addiction

As with almost every mental illness, the connection of borderline personality disorder and addiction is the same. Many patients who suffer from BPD use drugs and alcohol to deal with their instant changes of behavior, negative feelings, or to numb the pain. However, drugs and alcohol only make the symptoms worse, especially depression and anxiety.

Some of the symptoms of substance abuse and BPD are similar including, self-destructive behavior, sudden mood swings, intense energy and severe depression. There is also the pattern of destructive behavior, especially noticeable in relationships, job, and finances. These people lack the feeling of self-care and personal safety. They constantly involve in dangerous activities that can have negative consequences on their lives. Besides these symptoms, people with addiction or BPD tend to take manipulative actions to get what they want and need at the moment.

2. BPD Treatment

The symptoms of borderline personality disorder may be similar to substance abuse disorders. This puts difficulties when diagnosing the comorbidity. As a result of the symptoms BPD shows, these patients are more prone to high-risk behaviors, including promiscuity, substance abuse, eating disorders or gambling.BPD and addiction


There are no medical tests to diagnose borderline personality disorder, so the patient undergoes a comprehensive psychiatric interview from a mental health professional. Therefore, the interview includes a medical evaluation, past medical records review and interviews with friends, family or previous medical professionals.


Treating a patient with BPD and addiction is difficult. One of the challenges is to get a patient suffering from this condition into treatment. Another one is to get them to stay in and follow the treatment.

It’s important to find a good dual-diagnosis treatment program that specializes in this particular area. Finding the right treatment approach assures higher chances of success. Unfortunately, patients with BPD show high relapse rates, so it’s crucial to address all the co-occurrence disorders, starting from BPD to substance abuse, sex addiction, and others. The treatment often starts with detox, which helps their body clean from the substance. This is also useful when diagnosing since it gives a more precise image of which disorder causes the symptoms. Addiction often masks the symptoms of the mental disorder.

Psychotherapy (or talk therapy) is the main treatment for BPD. Studies show that this type of therapy relieves some of the symptoms, but further research is needed. Psychotherapy can be done individually or in a group. So, it’s crucial for the patient and the therapist to form a stable, trust-based relationship to make treatment more successful. It’s hard for people with BPD to trust people since many times they see them as their enemies, so they might find it hard to connect with their therapist.BPD

Some psychotherapy types used to treat BPD are:

  • Dialectical Behavior Therapy (DBT). This therapy approach helps patients start being aware of the situation and their moods. They also learn to control the intense emotions and reduce self-destructive behaviors.
  • Cognitive Behavior Therapy (CBT). This therapy approach helps patients understand and change behaviors that affect them in a negative way. These behaviors usually trigger the disease. The patient is taught to change the inaccurate perception of himself or herself. This may reduce the mood swings and suicidal or self-harm thoughts.
  • Schema-Focused Therapy. This type of therapy approach reframes the way people view themselves and changes other harmful schemes. For example, reframing the way these people look at themselves because of past negative childhood abuse.

Related: 8 Tips to Help you Get Through Rehab Treatment

  • Systems Training for Emotional Predictability and Problem Solving (STEPPS). STEPPS supplements other treatment approaches. It’s a type of group therapy with a goal to educate family and friends about borderline personality disorder. At this therapy approach, professionals also give the members a guidance on their future relationship with their loved one.
  • Medications. Medications are not recommended as primary treatment for borderline personality disorder. However, certain medications can be used to ease some of the symptoms, including depression or mood swings. Usually, doctors prescribe medications to these patients carefully, because of the fear of overdose.

Related: How to Help Someone Who Overdosed?BPD and addiction

3. How Can You Help?

Recognizing the symptoms of BPD is not easy. And you’ll have a hard time finding a good reason why your loved one behaves that way. We understand that you’re constantly stressed as a result of dealing with the mood swings, paranoia, and anger. However, you might be worsening your loved one’s symptoms. Therefore, it’s important for you to educate yourself on the symptoms, the disease, and the treatment. It’s the only way that you can help your loved one get better. Day by day, you’ll need to learn patience. Over and over again. But, after every period of suffering or dealing with something that looks like it’s destroying your life, comes the great reward.

How to help your loved one or a friend:

  • Understand their condition and offer emotional support.
  • Learn patience and encouragement.
  • Don’t react to their behavior by showing anger since it only makes things worse.
  • Talk to a therapist and learn how to encourage your loved one to seek treatment.
  • Talk to a friend or other family member (or support group or personal therapist) about what you’re going through.
  • Listen to your loved one or friend when they’re saying they may attempt to harm themselves (or someone else). Report it to the therapist immediately.
  • Find a way to deal with their mood swings, moments when they lose their temper or rage without provocation.

Even though you’ll find it difficult to deal with this condition, always remember what your loved one’s going through. They see the world through green glasses and think that the world sees them through red ones. Addiction only worsens the symptoms. Your loved one needs immediate help and there is a reason for their chaotic behavior. BPD is a serious condition that requires serious attention.

If you want to learn more on the connection between mental illnesses and addiction, read the following article

For more information please call our Addiction Treatment Helpline at (844) 439-4765. This is a Free and completely confidential call. We are available 24/7. In many cases, your health insurance company will cover 100% of the treatment cost. So please call now.

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