Borderline personality disorder (BPD), is a persistent condition characterized by unstable relationships, an unstable sense of self, and unstable emotions[1], particularly an intense fear of abandonment. Sadly BPD is also often accompanied by self-injurious behaviour. There is also frequent dangerous behavior and self-harm.

Onset typically begins by early adulthood. Co-occurring addiction, depression, and eating disorders are commonly found in addition to BPD and BPD had a high rate of associated suicide, around 10% of people affected die by suicide.

About 1.6% of people have BPD in a given year, though that number is probably a very conservative estimate as there will be many more people who are not diagnosed but could be. Females are diagnosed about three times as often as males.

BPD is less common among older people and around half of people diagnosed with BPD improve over a ten-year period.

Borderline Personality Disorder is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a personality disorder, along with nine other such disorders.

Causes

As is the case with most mental disorders, the causes of BPD are complex and multifaceted. Most researchers agree that a history of childhood trauma can be a contributing factor and there is also some evidence that suggests that congenital brain abnormalities, genetics, neurobiological factors, and environmental factors also play a part in the development of Borderline Personality Disorder

Stressful or traumatic life events can trigger PD onset

• often feeling afraid, upset, unsupported or invalidated
• family difficulties or instability
• sexual, physical or emotional abuse or neglect
• bereavement

You might also experience BPD without having any history of traumatic or stressful life events, or you might have had other types of difficult experiences.

Genetic factors

Some evidence suggests that BPD could have a genetic cause, because you’re more likely to be given this diagnosis if someone in your close family also has a diagnosis.

It is hard to know to what extent the genetics of your parents and your environment impacts your ways of thinking, coping and behaving.

Symptoms

If you have Borderline Personality Disorder you may experience some combination of the following symptoms;

• an unstable sense of self
• a sense of imminent abandonment that you put a lot of energy into avoiding
• black and white thinking
• impulsivity
• a tendency to engage in dangerous behaviour
• Intense or uncontrollable emotional reactions that often seem disproportionate to the event or situation
• Unstable and chaotic interpersonal relationships
• Self-injurious behaviour
• Dissociation
• Accompanying mental health issues such as depression, anxiety, or addiction.

BPD can make quite difficult to manage, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions, and impulsivity.

Why is addiction common in those with BPD?

Many people who have Borderline Personality Disorder as have a co-occurring addiction. This is because using drugs and alcohol seems like an effective coping mechanism for coping with the symptoms of BPD in terms of;

• Emotions

A core characteristic of BPD is affective instability, which generally manifests as unusually intense emotional responses (including being quick to anger), additionally if you have BPD it may take you longer to return to a baseline state of feeling settled. People may begin using drugs or alcohol, or engaging with other process addictions, as a way of regulating feelings.

• Behaviour

Impulsive behavior is common, including substance abuse, eating disorders, reckless sexual behaviour, impulsive spending. This kind of impulsive behaviour can impact personal, social and work life. Substance misuse is one such dangerous behaviour.

• Self-harm and suicide

Scars from self-harm is a common sign in borderline personality disorder. Self-harming or suicidal behavior is one of the core diagnostic criteria in the DSM-5Self-harm occurs in 50 to 80% of people with BPD.

The lifetime risk of suicide among people with BPD is between 3% and 10%. People with BPD may begin using drugs as a way of ‘self-medicating’ feelings which are very difficult to cope with.

• Unstable Sense of Self

If you have BPD you may have trouble seeing a clear picture of your identity, what it is you prefer, what you value and what is important to you. You may also have difficulty in identifying goals in terms of career and personal life. This can lead to a profound sense of being lost. Drug use can provide some initial relief but substances can only mask feelings temporarily and addiction may soon become its own problem.

You may have developed an addiction if you

• Require larger and larger amounts of your substance of choice to achieve the same effects.

• You experience physical detox symptom when you try and reduce your intake or stop using.
• You find it impossible to stop and stay stopped.

Treatment Options

A dual diagnosis of BPD and addiction may be complex to treat. There are rehab programmes, therapies and medications that are specifically tailored to treat both disorders. If you have BPD and addiction you may benefit from some combination of;

• rehab,
• medication, and
• therapy

Rehab

Dual Diagnosis programmes for co-occurring addiction and mental health issues will offer a holistic approach to BPD and Addiction. The programme may include;

• Supported medical detox
• Medication for co-occurring illnesses
• 12 Step work
• Dialectical Behaviour Therapy
• Group therapy
• One-to-one therapy
• Regular sessions with a key worker
• Skills workshops
• Holistic treatments
• Relapse prevention
• Group activities
• Gender Groups
• An Introduction to meditation

Rehab can help you to learn manage emotions without the use of substances or addictive behaviours. The combination of therapies and holistic approaches on offer in dedicated rehabs can help you to replace addictive behaviour with healthy and effective strategies.

Rehab will work on both BPD and Addiction by;

• Decreasing dependence on substances.
• Self-care through the detox process
• Taking the power out of cravings and urges to use

• Awareness of triggers as part of relapse prevention
• Developing a support network whilst working on interpersonal ad relational skills
• Developing and becoming skilled in recreational and vocational activities that support abstinence

> Our rehab programme for Borderline Personality Disorder and Addiction

Medication

The Four Classes of Medications Most Useful in Reducing Specific Core Symptoms of Borderline Disorder

• Antipsychotic Agents
• Mood Stabilizers
• Antianxiety Agents
• Nutraceuticals

Drug class: Antipsychotics (FGAs; Neuroleptics):

• • thiothixene (Navane)*
  • haloperidol (Haldol)*
  • trifluoperazine (Stelazine)*
  • flupenthixol (Depixol)*

Symptoms Improved

• mood dysregulation (labile & hyper-reactive)
• self-injury, suicide attempts, hostility, assaultiveness
• illusions, suspiciousness, paranoid thinking, psychoticism
• poor general functioning

Drug class: Atypical antipsychotics (SGAs):

• • olanzapine (Zyprexa)*
  • aripiprazole (Abilify)*
  • risperidone (Risperdal)*
  • quetiapine (Seroquel)*
  • lurasidone (Latuda) –
  • clozapine (Clozaril)*/li>

Symptoms Improved

• severity, anxiety, anger/hostility
• depression, self-injury, impulsive aggression
• suspiciousness, paranoid thinking
• split thinking, personal sensitivity
• interpersonal problems
• positive, negative, and general symptoms

Drug class: Mood stabilizers:

• • Antiepileptics
  • topiramate (Topamax)*
  • lamotrigine (Lamictal)*
  • divalproate (Depakote)*

Symptoms Improved

• unstable mood, anger, irritability,
• anxiety, depression, impulsivity,
• interpersonal problems

Drug class: Antianxiety agents:

• • buspirone (BuSpar) –

Symptoms Improved

Anxiety, irritability, depression, agitation

Drug class: Nutraceutical agent:

• • omega-3 fatty acids*

Symptoms Improved

• • severity, anger, depression, aggression

Therapy

There are various approaches that can be adapted to tackle both addiction and Borderline Personality Disorder. Dialectical Behaviour Therapy (DBT) is an approach that was developed in the 1980’s by Dr Marsha Linehan. DBT was originally used in the treatment of people who were suffering with suicidal thoughts and Borderline Personality Disorder. DBT has now proven to be successful in the treatment of many people with a wide range of different conditions including addiction and eating disorders.

Therapy can help you to explore and understand your process, and also help you to learn effective skills sets. Counselling can help you to accept your uncomfortable thoughts, behaviors, and feelings instead of fighting against them or denying them, at the same time as developing emotional and cognitive skills that improve your capacity for emotional regulation.

. There are four skill sets particular to that DBT these are:

1. Core Mindfulness Skills – Practicing mindfulness can help you to identify thoughts and emotions and to make healthy, informed decisions about how to manage.
2. Distress Tolerance Skills -Distress Tolerance skills are used when it is difficult or impossible to change a situation. These skills will help cope effectively during a crisis.
3. Emotion Regulation Skills – help you to process and tolerate your emotions when you can’t change them or reduce their intensity.
4. Interpersonal Effectiveness Skills– teach you to nurture your relationships through building communication and assertiveness skills.

Recovering from a dual diagnosis can be challenging, unsurprisingly so after a life of drinking and using. Through engaging with the therapeutic process you will be able to leave addiction behind and start to live and enjoy life, and reach your potential.

[1] Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington [etc.]: American Psychiatric Publishing. 2013. pp. 645, 663–6. ISBN 9780890425558.