Exploring the Connection Between Borderline Personality Disorder (BPD) and Addiction

Although virtually all mental health conditions have a close relationship with substance misuse, the connection is especially strong with certain conditions, like borderline personality disorder (BPD).

“Substance use may be used as a way to cope with intense emotions and mood swings,” says psychiatric mental health nurse practitioner (PMHNP) Valerie Puffenberger. “Additionally, individuals with BPD often struggle with identity issues and a sense of emptiness, and substances may be used to fill that void temporarily.”

Read more to discover the relationship between BPD and addiction and what treatment options are available

Understanding Borderline Personality Disorder

Borderline personality disorder is a mental illness, specifically a type of personality disorder. BPD severely impacts an individual’s ability to manage and control their emotions. As a result of their illness, many individuals with BPD have serious difficulties with impulsivity, negative self-esteem, and their ability to form and maintain relationships.

Borderline personality disorder is complex, and the causes behind it are not fully understood. It is widely believed that borderline personality disorder is the result of many factors working together, including:

• Genetics
• Brain structure, chemistry, and functioning
• Neurotransmitter imbalances
• Environmental factors, especially trauma, abuse, neglect, and loss or separation
• Life experiences, particularly growing up in an environment where emotions were not validated
• Possessing certain personality traits, especially impulsivity, emotional sensitivity, and difficulty managing distress

It is estimated that 1.6% of the American population suffers from BPD, and approximately 20% of patients at inpatient mental health treatment facilities experience the condition.

Symptoms of Borderline Personality Disorder

Borderline personality disorder has both primary (caused by BPD itself) and secondary (caused by primary symptoms) symptoms. An example of a secondary symptom could be misusing a substance, like alcohol, to cope with the emotional turmoil brought on by BPD (i.e., self-medication).

Some of the most common and serious symptoms of BPD include:

• Difficulty or inability to control emotions or reactions
• Intense and unstable relationships
• Rapid shifts between idealizing and devaluing others
• Fear or abandonment, coupled with extreme efforts to avoid it
• Unstable self-image
• Feelings of emptiness and uncertainty about oneself
• Impulsive behaviors
• Self-harming behaviors
• Substance misuse
• Risky sexual behaviors
• Binge eating
• Emotional instability
• Intense, long-lasting mood swings
• Frequent strong or severe emotions
• Paranoia
• Dissociation
• Inappropriate and intense anger
• Often unjustifiably high levels of stress
• Identity issues
• Suicidal thoughts or behaviors

Understanding Addiction

Addiction is a medical and mental health disease that falls into one of two broad categories:

• Substance use disorders: Addictions to a substance, like alcohol, Adderall, or fentanyl.
• Behavioral addictions: Addictions to a behavior, such as gambling or watching pornography.

To be considered an addiction, an individual must:

• Have a compulsion to use a substance/behavior that is relieved once they give in to using it.
• Experience some sort of withdrawal symptom or symptoms when they stop using the substance/behavior.
• Continue to use the substance/behavior despite repeatedly experiencing negative consequences as a result of use or engagement.

When a person repeatedly uses a substance or behavior, their body and mind eventually cannot function “normally” without that substance/behavior. For example, someone addicted to opioids will stop naturally producing opioids, and their body will become reliant on substances (e.g., fentanyl or heroin) to function normally. This is known as dependence.

A person with dependence will experience a collection of unpleasant symptoms known as withdrawal if they stop or reduce the substance or behavior they are addicted to. To avoid withdrawal and make up for the tolerance they’ve built up, the person will increase their use of the addictive substance/behavior. Eventually, they will be fully addicted and continue to use despite suffering repeated serious consequences.

The Complex Interplay: BPD as a Risk Factor for Addiction

BPD is a major risk factor for addiction. In fact, about 78% of those with borderline personality disorder will also have a diagnosable substance use disorder at some point in their lives. BPD makes addiction more likely for many reasons, but two of the most important are coping mechanisms and impulsivity.

The symptoms of borderline personality disorder are very difficult for most victims to deal with. Many individuals find that substance use alleviates or eliminates the distress BPD symptoms produce, at least in the short term. As a result, they begin to use greater and greater amounts as a method of self-medication.

Additionally, substance use may help some BPD sufferers mask their condition. For example, their emotional mood swings are less noticeable when they are in a group of intoxicated individuals. It is easy to see how addiction can serve as a coping mechanism.

One of the key characteristics of borderline personality disorder is impulsivity. Victims typically make decisions and take actions with little to no regard for the consequences. This impulsivity frequently appears during substance use, when BPD sufferers will engage in addictive behaviors despite the potential negative consequences.

The Impact of Addiction on BPD

Although substance use can temporarily alleviate BPD symptoms, addiction can greatly worsen the condition over time.

Certain substances, like alcohol or phencyclidine (PCP), can dramatically increase emotional instability. When an individual already has unstable emotions, as is the case with BPD, this can create a dangerous situation.

Substance use, and especially withdrawal, can cause a whole host of emotions that are often more severe than those brought on by BPD alone. In turn, substance misuse can trigger a dangerous and debilitating cascade of emotions. Addiction can also cause a whole host of negative life consequences, which can trigger borderline episodes.

Perhaps most damaging is that addiction and BPD can form a vicious cycle. Greater substance use worsens borderline symptoms, which motivates greater substance use. Worsening borderline symptoms motivate greater substance misuse, which worsens borderline symptoms. Eventually, the addiction and BPD reach a level where it is difficult, if not impossible, for the victim to regain control of their life.

Integrated Treatment Approaches for Borderline Personality Disorder and Addiction

As is the case with most co-occurring disorders, addiction and BPD must be treated at the same time. This is because the two conditions are so closely intertwined that if one or the other is left untreated, relapse is almost certain to occur.

Luckily, there are a number of integrated treatment approaches for BPD and addiction that can dramatically improve patients’ lives.

Dual diagnosis programs are the most effective treatment methods for BPD and addiction. These rehab programs are designed to treat mental health disorders and addictions concurrently so that patients can achieve a full recovery from both. Every dual diagnosis program differs, but most will be inpatient or outpatient.

Inpatient dual diagnosis programs require patients to live at a facility where they receive treatment. Residing at the treatment facility allows for around-the-clock medical and clinical supervision and enables the patient to fully remove themselves from the people, places, and things that fueled their addiction and BPD. Inpatient programs provide patients with the greatest likelihood of a lasting recovery, although they come at a higher price tag than outpatient rehabs and provide less flexibility.

Outpatient dual diagnosis programs require patients to attend treatment sessions but not to live at the treatment facility. Outpatient programs allow patients the flexibility to continue meeting life obligations and are generally less expensive than inpatient programs. However, they provide a lower likelihood of a complete recovery.

The specific therapies and treatments patients receive will vary dramatically from program to program. However, dialectical behavior therapy (DBT) is widely considered the most effective form of therapy for the treatment of BPD and addiction.

Dialectical behavior therapy is a form of cognitive behavioral therapy (CBT) developed specifically to treat borderline personality disorder. DBT helps individuals develop skills that can help them manage their emotions, improve their relationships, and achieve better overall life outcomes.

Living in Recovery: Borderline Personality Disorder and Addiction

Relapse, or a return to use or symptoms, is the biggest fear for many of those in recovery from addiction and BPD. Luckily, there are many strategies for preventing relapse.

“For someone living in recovery from BPD and addiction, it is important to prioritize self-care and emotional well-being,” says Puffenberger.

She provides the following recommendations for those living in recovery from BPD and addiction:

• Attend regular therapy sessions, which can provide ongoing support and help manage BPD and addiction symptoms.
• Build a strong support network of understanding friends, family, or support groups who can offer validation, empathy, and a sense of belonging.
• Engage in healthy coping mechanisms, such as practicing mindfulness, engaging in creative outlets, and developing healthy relationship boundaries.

Other things that can help prevent relapse include:

• Developing a relapse prevention plan with your doctor.
• Adhering to the medication schedule prescribed by your doctor.
• Identifying triggers and learning how to properly handle them.
• Living a healthy lifestyle.
• Establishing a structured daily routine.
• Avoiding high-risk situations.
• Setting and achieving realistic goals.

Get Professional Help with BPD and Addiction

If you or someone you love is suffering from BPD and addiction, it may seem as if your life is no longer in your control. Luckily, there are dual diagnosis treatment programs, like those at Legacy Healing Center, to help you get your life back on track.

At Legacy, we believe in healing mind, body, and spirit. To treat BPD and addiction, we look for the right mix of medication, evidence-based psychology, and peer support.

We are here to answer your questions about BPD and addiction and help you on the path to recovery. Call 888-534-2295 today to speak with a treatment staff member.

BPD and Addiction FAQs

What is the link between borderline personality disorder (BPD) and addiction?

Addiction and BPD have a bidirectional relationship. This means that both borderline personality disorder and addiction can cause and worsen one another. Because addiction worsens BPD symptoms and BPD symptoms motivate addiction, the two often cause a downward spiral that traps victims in an ever-worsening cycle.

How does BPD contribute to love addiction?

The following BPD symptoms can contribute to love addiction:

• Fear of abandonment
• Rapid swings of idealization and devaluation of partners
• Emotional intensity
• Identity issues
• Impulsivity
• Need for validation

What treatment options are available for individuals with BPD and addiction?

There are many treatment options available for individuals with BPD and addiction. The most effective are dual diagnosis programs that offer dialectical behavior therapy (DBT). If you would like to find out more about your addiction and BPD treatment options, call 888-534-2295 today to speak with a treatment staff member at Legacy Healing Center.

Are there any support groups specifically for people with BPD and addiction?

Yes, there are support groups for BPD and addiction throughout the country. In major metropolitan areas, you may be able to find support groups for co-occurring BPD and addiction. In suburban or rural areas, you may have to attend multiple support groups, some for addiction and some for BPD.

About the Author

Jeffrey Juergens

Jeff Juergens is a leading author in the addiction and recovery field, dedicating the last seven years of his life to helping those struggling with substance use issues find the help that they need. Jeff's work has been used in rehabs across the country as tools to help patients achieve sobriety.

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Dr. Olushola, MSW

Olushola Lawal, MSW, RCSWI Olushola (Shola) Lawal serves as a Primary Therapist at Legacy Healing Detox. Shola was born and raised in South Florida. He is a Florida State University double alumnus graduating with his Bachelor of Social Work in 2013 and his Master of Social Work in 2015. Shola’s...

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