Borderline Personality Disorder and Addiction

Around 1 in 100 people live with BPD. Whilst some elements of the media have acted to perpetuate negative stereotypes around personality disorders, BPD remains somewhat misunderstood. Borderline personality disorder most commonly manifests in the ways that people experience their feelings and relations with others. BPD is linked with intense emotional distress, increased risk of self-harming (or adjacent maladaptive behaviours) and overwhelming concerns about the nature of our relationships. 78% of adults with BPD develop ‘a substance-related disorder or addiction at some time in their lives.’  This makes BPD and addiction a likely dual diagnosis for many people. This means that knowing how to identify and access support for BPD symptoms is a key stepping stone in managing addiction-related harm.

Borderline-Personality-Disorder text as image

Borderline personality disorder and addiction

What is borderline personality disorder?

Borderline personality disorder (BPD) is described as both a mental health condition and a personality style. BPD is also known as:

  • Emotionally unstable personality disorder (EUPD)
  • Emotional intensity disorder (EID)
  • Borderline pattern personality disorder [4]

BPD is defined as a

‘condition characterised by pervasive patterns of instability in mood, self-image, and interpersonal relationships, as well as marked impulsivity.’

BPD is thought to affect individuals in three key areas:

  1. Emotional wellbeing and control
  2. Social connections
  3. Self-perception

Difficulties in these areas can lead to high distress, a sense of overwhelm and repeated instances of self-harm and/or suicidal behaviour. This means that individuals with BPD often experience significant difficulties with emotional wellbeing and are likely to develop a comorbid condition, such as an addiction or an anxiety or mood disorder.

Types of personality disorder

Whilst several different names know BPD, there are no different borderline personality disorder types. There are, however, different kinds of personality disorders that individuals can be diagnosed with – of which BPD is one diagnosable condition.  There are three types of personality disorder:

  1. Emotional and impulsive
  2. Anxious
  3. Suspicious

A personality disorder diagnosis will typically fit into one of these categories.

For example, BPD fits under the umbrella of a category referred to by clinicians as emotional and impulsive personality disorders. Other conditions in this category include:

  • Antisocial personality disorder
  • Borderline personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder

Anxious personality disorders encompass the following diagnoses:

  • Avoidant personality disorder
  • Dependent personality disorder
  • Obsessive-compulsive personality disorder

And finally, the suspicious personality disorders are:

  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Signs of borderline personality disorder

  • Acting on impulse
  • Fear of abandonment
  • Feeling empty
  • Very intense emotions (anxiety, fear, anger, depression)
  • Changeable emotions
  • Feeling insecure
  • Feeling paranoid
  • Having a ‘fluid’ personality depending on your surroundings
  • Engaging in self-harm
  • Feeling suicidal
  • Dissociating
  • Experiencing psychotic episodes

What is an addiction?

The American Society of Addiction Medicine defines an addiction as:

‘a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behavio[u]rs that become compulsive and often continue despite harmful consequences.’

This definition as useful as it tells us several things about addiction:

  1. Addictions can be treated with appropriate support
  2. Addictions are complex phenomena and are not often related to ‘choice’
  3. Addictions, by nature, have a negative impact on our bodies, brains and lives
  4. We can become addicted to substances or behaviours

Signs of an addiction

  • Increased use / engagement with a substance or activity
  • Social isolation
  • Emotional distress
  • Anxiety
  • Withdrawals
  • Appearing to be ‘distant,’
  • Trouble sleeping
  • Weight change
  • Memory issues
  • ‘Personality changes,’
  • Difficulty maintaining previous routines
  • Physical health complications
  • General deterioration in wellbeing

What is the link between BPD and addiction?

A 2014 research paper states that ‘the combination of borderline personality disorder with addiction requires a special therapeutic approach,’ due to the ways that these conditions can worsen the presentation of the other. BPD and addiction are often linked due to the pairing of intense experience of emotions, high and prolonged levels of distress and increased impulsivity.

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Borderline personality disorder and alcohol addiction

Across studies, around 48.8% of individuals with BPD experienced an alcohol use disorder.

Borderline personality disorder and drug addiction

Research indicates that individuals with BPD experience a high risk of drug addiction in comparison to control populations. Specific substances involved often include:

  • Opiates
  • Cannabis
  • Cocaine
  • Nicotine
  • Methamphetamine

Borderline personality disorder and addiction treatment

BPD treatment

BPD is commonly managed with psychological interventions and medication.

The therapeutic approaches shown to be the most effective in treating BPD include:

  • Dialectical behavioural therapy (DBT)
  • Group therapy
  • Holistic therapy

The medication you may be prescribed to help you manage BPD may depend on the specific symptoms that may require more management. Specific medication routes may include one (or a combination of) the following prescription medications:

  • Antidepressants
  • Sedatives
  • Mood stabilisers
  • Antipsychotics

Addiction support

The psychological impact of addiction can act to deepen the emotional distress associated with BPD. This means that in order for these symptoms to be managed effectively, excessive drug use or behavioural reliance needs to be addressed. Many people find that accessing this support through a specialist mental health and addiction service allows them to focus on addiction and BPD management at the same time.

Rehab treatment incorporates pharmacological, psychological and physical treatments with social and wellbeing support. This aims to address the impact of addiction on all levels to improve the general quality of life substantially.

Seek Help

Here at Banbury Lodge, we can help you to take the steps towards an addiction-free future.  Contact us today for a free, confidential consultation with a member of our team. We are here to lend a listening, non-judgmental ear and guide you through potential options for specialist, holistic addiction and mental health support. We are available to talk you through the bespoke rehab packages we offer to help identify the most appropriate treatment for your needs.

Frequently Asked Questions

What causes borderline personality disorder?
Clinicians often consider BPD through an interactionist lens. This means that it is tricky to indicate one key cause of the condition, suggesting, rather, that a personality disorder develops as a result of several of the following factors:

  • Genetics
  • Neurochemical imbalances
  • Differences in functional anatomy and structure of the brain
  • Experience of abuse
  • Exposure to ‘long-term fear or distress as a child’
  • Childhood neglect
  • Experiencing serious mental health or addiction issues in the family home
Can addiction lead to borderline personality disorder?
Some research suggests that the neurochemical changes associated with excessive drug use can have psychological effects that mimic some of the symptoms of BPD. This has led BPD charity Borderline in the ACT to explain that ‘individuals with neurobiological vulnerabilities to BPD may be more susceptible to effects of substance abuse.’
Is borderline personality disorder a type of OCD?
BPD is not a type of OCD. However, there is a type of anxious personality disorder known as obsessive-compulsive personality disorder (OCPD). This diagnosis is ‘marked by an intense focus on perfection, a strong sense of order, and a rigid need for control.’ Symptoms include:

  • Preoccupation on details
  • Perfectionism
  • Obsessive organisation
  • Excessive doubt and caution

These symptoms typically lead to difficulty completing tasks, intense self-judgement and both social and emotional challenges.

(Click here to see works cited)

  • https://mentalhealth-uk.org/help-and-information/conditions/borderline-personality-disorder/
  • https://www.borderlineintheact.org.au/living-with-bpd/bpd-myths-and-facts/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010862/
  • https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/about-bpd/#WhatIsBorderlinePersonalityDisorderBPD
  • https://www.ncbi.nlm.nih.gov/books/NBK430883/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/
  • https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/types-of-personality-disorder/
  • https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/types-of-personality-disorder/#BorderlinePersonalityDisorderBPD
  • https://www.asam.org/quality-care/definition-of-addiction
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354400/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010862/
  • https://bpded.biomedcentral.com/articles/10.1186/s40479-018-0093-9#:~:text=Across%20studies%20that%20reported%20rates,for%20an%20alcohol%20use%20disorder
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010862/
  • https://www.borderlineintheact.org.au/living-with-bpd/bpd-comorbidities/bpd-substance-use-disorders/#:~:text=Some%20research%20suggest%20that%20substance,to%20effects%20of%20substance%20abuse
  • https://www.ncbi.nlm.nih.gov/books/NBK597372/
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