Personality disorders are a form of mental illness that may be often misunderstood. Borderline personality disorder (BPD) is thought to affect between 1.6 and 5.9 percent of the American population, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). It is a personality disorder involving difficulties with intimacy and relationships, unstable moods, and a distorted image of the self. Symptoms for BPD include:
- Feelings of emptiness
- Impulsivity and engaging in high-risk behaviors
- Excessive and unwarranted fear of abandonment
- No image of self or an unstable self-image
- Extreme reactions and sudden mood swings
- Feelings of being “out of body”
- Intense and often inappropriate anger and aggression, and difficulties controlling them
- Self-harming and/or suicidal behaviors
Individuals suffering from BPD may abuse substances at rates greater than the general population. A study published in Psychiatric Times found that between 50 and 70 percent of bipolar patients in residential treatment also battled substance use disorder. Comparatively, only 8.2 percent of the US adult population (age 12 and older) were considered to have a substance use or dependency issue in 2013, the National Survey on Drug Use and Health (NSDUH) published. Drugs and alcohol can make mental illness worse, and mental illness may increase the likelihood that an individual will abuse substances and become addicted to them.
Individuals at Risk for BPD and/or Substance Abuse
Borderline personality disorder may appear in childhood and generally presents itself in adolescence or at least by early adulthood. SAMHSA reports that three-quarters of those diagnosed with BPD are women, although this could merely be due to the fact that women are more likely to be impaired physically or mentally by the disorder than men.
The National Institute of Mental Health (NIMH) publishes that of the individuals diagnosed with BPD, most of them (a staggering 85 percent) also battle another form of mental illness as well. Women may be more prone to also have an eating or anxiety disorder or suffer from major depression or post-traumatic stress disorder (PTSD), while men may also suffer from antisocial personality disorder, have more episodes of aggression or intense anger, and battle a co-occurring substance use disorder (SUD).
There doesn’t seem to be one main cause for either BPD or addiction; however, someone who suffers from both may have overlapping risk factors or specific vulnerabilities that may involve genetics, environmental factors, or regions and chemicals in the brain.
Researchers are continually studying the potential connections between mental illness and possible genetic links, or the heritability of these traits. Results are mixed. Studies published in the journal Molecular Psychiatry likely point to a mixture of genetics and shared environmental factors being involved, with the potential heritability of mental illness within families. If a close relative has BPD or battles addiction, an individual may be more prone to suffering from these disorders as well, although many other things may also be involved.
The biological makeup of a person’s brain may predict the onset of borderline personality disorder, for instance. Certain parts of the brain help individuals control their emotions, impulses, and decision-making abilities. These regions, including the amygdala, hippocampus, and prefrontal cortex, may be underdeveloped or smaller in an individual battling BPD, the National Health Services (NHS) reports. These regions of the brain are not fully developed until early adulthood. Trauma, neglect, abandonment, or chronic stress may disrupt their functions and normal development, possibly making someone more prone to developing BPD. Brain chemicals, or neurotransmitters, may also be impacted by BPD, as someone with lower levels of serotonin, norepinephrine, and dopamine may have difficulties regulating moods, feeling pleasure, controlling impulses, and making sound decisions. Abusing substances like drugs or alcohol at a young age may also damage these same parts of the brain and potentially result in future mental illness or addiction.
Side Effects of Addiction and BPD
Addiction affects many of the same brain regions and chemical messengers that a mental illness like BPD may potentially disrupt. Drugs and alcohol elevate the levels of neurotransmitters in the brain during intoxication and disrupt their natural production over time. This results in drug cravings and withdrawal symptoms, like anxiety, irritability, hostility, mood swings, depression, and impaired cognitive functions, making BPD symptoms worse. All of the potential side effects of BPD may be heightened by using drugs or alcohol, even when it may seem that these substances may be helpful in increasing pleasure and stabilizing moods in the short-term. Treatment for BPD may also be disrupted by the use and abuse of psychoactive substances.
Individuals suffering from borderline personality disorder may have an irrational fear of family and friends leaving, or abandoning them, and may overreact to any real or perceived threat of being left. Couple this with mood swings, difficulties controlling emotions, and excessive outbursts of anger or aggression, and interpersonal relationships are likely to suffer. Those battling BPD may get into a lot of fights or physical altercations. Intoxication may lower inhibitions and increase risky behaviors, impulsivity, sexual proclivities, and financial irresponsibility as well as the odds of being the victim of a violent act that may already be impacted by BPD. Low work production and difficulties fulfilling family obligations are negative consequences of addiction that may be compounded by BPD as well.
Individuals suffering from BPD may also be highly critical of themselves and have a very low or unstable self-image. Self-harming behaviors are some of the major risk factors of borderline personality disorder, and these actions or thoughts may be exacerbated by substance abuse as well. The U.S. Department of Health and Human Services (HHS) estimates that someone suffering from borderline personality disorder may have a suicide risk of more than 50 times that of an individual without the disorder, as 8-10 percent will successfully commit suicide. NIMH publishes that 80 percent of individuals battling BPD have suicidal ideations.
In addition to suicide, self-harming behaviors not intended to be life-threatening are also common to the disorder. SAMHSA reports that three-quarters of those diagnosed with BPD will cut themselves, bang their heads, pull their hair, pick at their skin, or burn themselves in a possible attempt to feel something, get attention, alleviate emotional pain, punish themselves, or regulate their emotions.
It’s Never Too Late to Get Help
Help for Borderline Personality Disorder and Substance Abuse
At this point, there are no approved medications specifically for the treatment of borderline personality disorder; however, medications may help to manage specific symptoms, like antidepressants for depressed moods, for example. Medical detox for drug or alcohol dependence may include a pharmacological approach to reduce withdrawal symptoms and prevent relapse.
Both addiction and BPD are considered behavioral health concerns. When they co-occur, or when they are present in the same person at the same time, an integrated and team-oriented approach is ideal to reduce symptoms of both disorders. Medical and mental health professionals, as well as substance abuse counselors, should all work as a team to treat both disorders simultaneously and in a comprehensive fashion.
Treatment programs may be residential, where an individual stays onsite for a period of time, or outpatient, where the person returns home each night to sleep. A supportive environment is highly beneficial to recovery, and family members or loved ones should learn as much as they can about the disorders so everyone knows what to expect during treatment and recovery. It is important for loved ones to set boundaries and take care of themselves since BPD may seem all-consuming to all involved at times. Family counseling may help to repair and manage relationships between the person with BPD and family members.
A form of Cognitive Behavioral Therapy (CBT), known as Dialectical Behavior Therapy (DBT), is often considered one of the go-to therapies for treating borderline personality disorder, as published by Psych Central. DBT helps individuals to learn how to regulate their emotions, tolerate distress, improve interpersonal relationship skills, and focus on the concept of mindfulness and an acceptance of self, while understanding the need to change negative behaviors. DBT treatment usually involves an hour of individual therapy per week, a group session that teaches life skills and may last 1.5-2.5 hours per week, and a meeting of treatment providers to discuss what is working and what isn’t during treatment, the journal Psychiatry reports. DBT usually follows a specific timeline and a research-based treatment approach, although each individual’s plan may be slightly different depending on specific circumstances, such as other co-occurring mental health disorders or substance abuse. Other therapy methods may be adopted or integrated into a treatment plan as well.
Addiction and BPD are both considered treatable disorders. Early intervention and care are beneficial for long-term recovery and can help individuals and families to lead full and healthy lives.