Borderline Personality Disorder (BPD) is extremely common among individuals struggling with addiction. This dual diagnosis—a term for when an individual suffers from both a mental health illness and a substance abuse disorder simultaneously—is one of the more complex situations facing mental health professionals today. BPD is an emotionally disruptive and painful disorder. When combined with addiction, the results can be devastating for everyone involved. Let’s take a closer look at borderline personality disorder and its relationship with addiction in order to better understand the complexities of both issues.
What is Borderline Personality Disorder?
By definition, Borderline Personality Disorder is characterized by unregulated emotions, behaviors, relationships, thinking processes and a volatile self-image. Many individuals with BPD also suffer from mood disorders such as anxiety or depression and sometimes eating disorders. Individuals with BPD have elevated rates of suicidal behaviors and substance abuse disorders. Often, those with BPD or borderline symptoms will lose their tempers easily and without much provocation. Relationships tend to be fragile as their low self-worth and feelings of emptiness tend to influence the way they empathize with their peers.
Most people struggling with BPD tend to take things personally and view much of their social interactions through an accusatory lens. These volatile social interactions often induce feelings of intense anger causing individuals to feel depressed or anxious for several days afterwards. In short, chaos defines the life of an individual with BPD. Both their cognitive and emotional filters are malfunctioning, with distortion and misinterpretation part of their everyday life. This chaos often amplifies their lack of self-worth, causing them to engage in a lot of risky behavior.
The relationship between Borderline Personality Disorder and substance abuse is often compounded by the difficulties a person experiences in their relationships and their lack of emotional regulation. Drugs and alcohol may act as a type of substitution for those relationships. Often an individual can achieve a perception, albeit a false one, that by using drugs or alcohol, they can achieve some level of control over their relationships, emotions, behaviors and self-image.
Risk Factors for BPD
Current research shows there are several factors which contribute to a person’s development of borderline personality disorder. These factors include:
- Genetics – Research shows that BPD often runs in the family, with genetics playing a substantial role in the disorder. Specific personality traits, such as aggression, may be an inherited temperament and can increase risks of BPD when combined with other factors.
- Environment – Specific environmental factors seem to contribute to BPD, including childhood trauma, unstable family situations and increased exposure to family members with mental disorders or substance abuse disorders.
- Neurotransmitters – Individuals with BPD display altered functioning of neurotransmitters in the brain, specifically dopamine, serotonin and noradrenaline. These transmitters regulate certain emotions and urges. Drug and alcohol abuse also affects the way the brain’s neurotransmitters function, making this an especially destructive risk factor for those individuals with substance abuse disorders.
- Neurobiology – Clinical studies have found that certain areas of the brain are often smaller and/or more active in individuals with BPD. The three regions in particular are the hippocampus, the orbitofrontal cortex and the amygdala.
Borderline Personality Disorder and Addiction
BPD and addiction are two frequently occurring diagnoses. Although individuals with BPD only make up roughly 1-3% of the general population, two-thirds of individuals with BPD have struggled with drug or alcohol addiction at some point in their lives. Many people with BPD begin using drugs or alcohol to disguise or mitigate their symptoms in order to feel better about themselves. The pain, emotional instability and impulsive behavior of borderline personality disorder place these individuals at risk of drug or alcohol abuse. Most do not realize they have borderline personality disorder and instead are trying to self-medicate symptoms for which they have no name or diagnosis. Unfortunately, drug and alcohol abuse typically worsen symptoms of BPD, contributing to a dangerous and interconnected cycle of use and abuse.
Symptoms of Borderline Personality Disorder
The symptoms of BPD and addiction tend to be very similar. Both disorders are characterized by self-destructive behaviors, volatile mood swings, dishonest actions and general instability in relationships and careers. Many times, these similarities make it difficult to separate the symptoms of BPD from those of addiction. However, statistics show that BPD most often precipitates addiction or substance abuse problems rather than the other way around. Because the symptoms of borderline personality disorder include high-risk and impulsive behaviors as well as volatile moods, addiction easily follows.
Some of the primary signs and symptoms associated with BPD include:
- Unstable sense of self or lack of awareness
- Inability to establish and maintain relationships
- Instability of mood/emotions
- Chronic feelings of emptiness/chronic depression
- Deep-seated fears of abandonment (both real and imagined)
- Uncontrollable episodes of anger
- Suicidal thoughts and tendencies
Substance abuse is common to many people living with BPD. Additionally, individuals with BPD are more likely to struggle with poly-drug abuse—taking multiple drugs at once to enhance or change a high. Recent studies show that people with BPD represented about 40% of those who sought buprenorphine for opioid addiction treatment. Also, about 50% of people with BPD reported a history of prescription drug abuse, with over half of those reporting use in the past twelve months.
Although, many people with BPD successfully complete a rehab program and maintain sobriety, research shows that these individuals are more likely to relapse than those with mood disorders. Clinical studies showed that 40% of users relapsed to alcohol abuse, and 35% of users relapsed to drug abuse. Among those who relapsed, 21% developed an additional or new drug addiction, while 23% developed a supplementary addiction to alcohol. Tobacco and alcohol addictions are the two most common substances abused by those with BPD, with almost two thirds of those surveyed reporting a lifetime prevalence for tobacco and alcohol addictions.
Treatment of BPD and Addiction
Treating a co-existing addiction and BPD is challenging and complex. In the past, each disorder was treated separately, which may be a significant factor in individual’s tendency to relapse. As new research methods develop, mental health professionals and therapists are recognizing the importance of an integrative treatment approach which addresses both disorders simultaneously.
Because individuals with BPD are already vulnerable to emotional instability, adding drugs and/or alcohol to the equation can make their choices and behaviors even more unpredictable. One of the primary struggles of treating co-occurring disorders is getting individuals to complete their rehabilitation programs. Many programs report that addicts with BPD are often both treatment resistant as well as treatment demanding. Studies of patients in detox programs report that individuals with BPD are more likely to discharge early than those without BPD. However, statistics also show positive outcomes the longer an individual stays in a program.
The National Institute on Drug Abuse (NIDA) recommends Dialectical Behavior Therapy(DBT), a specific type of behavioral therapy, as one of the most effective for individuals with BPD and an addiction. DBT is based on the principle that change can be balanced with self-acceptance, helping those with borderline personality disorder build stable and meaningful lives. Research shows DBT to be especially effective at breaking down self-destructive habits and emotions, motivating individuals to facilitate active change.
Diagnosis therapies for DBT include helping clients identify motivation to change, teaching clients to manage their moods and triggers through mindfulness and to eliminate environmental and social cues which promote their abuse behaviors. By setting and achieving manageable recovery goals, patients are more likely to stay sober.
In addition to DBT, patients will often receive psychiatric medication and/or anti-addiction drugs as part of a comprehensive treatment plan. Often, BPD patients benefit from medications which work to restore balanced levels of neurotransmitters in the brain— examples include SSRI (serotonin re-uptake inhibitors) antidepressants. Other anti-addiction medications may be included in treatment such as methadone, buprenorphine, and naltrexone, depending on the intensity of cravings for either opiates or alcohol.
Choosing the right rehabilitation program is often the key to a successful treatment for individuals with BPD and a substance abuse disorder. Because of the likelihood of poly-drug abuse, alcohol abuse and other prescription drug abuses, treatment can be complex and should be done with the oversight of medical professionals. As for any dual diagnosis, detox and rehabilitation should be done together for the most effective results.
Blu by the Sea Rehabilitation Program
At Blu by the Sea, our experienced mental health professionals have developed an integrated treatment program for individuals living with both BPD and addiction. Our program has been shown to successfully treat this dual diagnosis and help clients maintain long-term sobriety. Clients with BPD who enter our program will undergo various types of therapy, including Cognitive Behavioral Therapy, individual psychotherapy and group therapy. Relapse prevention training is an essential component of our rehabilitation program for dual diagnoses. Relapse rates are high for individuals with coexisting disorders, so our program focuses on helping clients develop coping strategies. Through group sessions, individuals can share their challenges and stories with others who can relate to their struggles.
If you or someone you love is living with Borderline Personality Disorder and/or struggles with an addiction, it is never too late to get help. Contact Blu by the Sea today to find out more about our successful dual diagnosis rehabilitation program.