Borderline Personality Disorder and Addiction


Published On: December 6, 2023

Drug and alcohol addiction is often related to intense, negative feelings, distressing thoughts and painful experiences.

Sometimes addiction can come as a way of managing these feelings – sometimes the feelings come after addiction begins.

For some people, it’s not always clear which comes first, but the two are often linked.

Because of this, it’s quite common for individuals seeking addiction treatment to have a diagnosis of a mental health disorder.

This means that it is very important that addiction specialists, individuals struggling with dependence on drugs/alcohol and their loved ones are aware of the varying ways that different mental health conditions can manifest.

This page will you give you some key information on  the symptoms and treatment of Borderline Personality Disorder, as well as how this condition may be related to a heightened risk of addiction.

What is Borderline Personality Disorder (BPD)?

A person with clasped hands, thinking

Borderline Personality Disorder (BPD) is a mental health condition.

It is sometimes also known as Emotionally Unstable Personality Disorder (UPD).

It belongs to a group of conditions known as personality disorders. It’s also known as a mood disorder.

It’s very important to remember that ‘personality disorder’ might not mean what you think it does.

Unfortunately, these types of disorders are frequently used tropes in different media. Often though, these representations are not very accurate, and they can risk spreading harmful information and perpetuating stereotypes of what personality disorders actually are. [1]

So What are Personality Disorders?

sleeping

There are several different kinds of personality disorders.

These are often put in groups or ‘clusters’.

First, there is Cluster A.

Diagnoses in Cluster A are linked with finding it hard to relate to others for various reasons.

Cluster A diagnoses include:

  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder [2]

Then there is Cluster B.

Cluster B personality disorders are linked most commonly with strong, difficult emotions.

Borderline Personality is a Cluster B Diagnosis, but other Cluster B conditions include:

  • Antisocial Personality Disorder (ASPD)
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder

Finally, there are Cluster C diagnoses.

These conditions are characterised by very intense anxiety and stress. [3]

These include:

What about Mood Disorders?

nose

Mood disorders are any kind of mental condition that has an impact on mood.

BPD is also a mood disorder, as it is characterised by intense ‘mood swings’ and high levels of frequent distress. [5]

Borderline Personality Disorder: What Are The Symptoms?

So we know that BPD is a condition related to intense and difficult feelings.

But what does that actually look like?

Medical professionals tend to look for symptoms in four key areas:

  1. Emotional Instability
  2. Distorted Patterns of Thinking
  3. Impulsive Behaviour
  4. Difficulties in Interpersonal Relationships [6]

It can often be tricky to know what terms like these are actually referring to.

Some people even suggest that the use of these kinds of terms can be a barrier to diagnosis, as we don’t tend to use this kind of language in our everyday lives. [7]

So let’s look at some specific examples of these symptoms in clearer terms.

Symptoms of Emotional Instability

Two people holding hands across a table

One of the key parts of BPD is the way it can impact your emotions.

In these contexts, emotions can be defined as being ‘chronic feelings’ as they can be so intense to experience.

This could include:

These are classed as examples of emotional instability as not only are the feelings so intense, that they can also be quite quick to shift.

It’s not uncommon for people to experience intense mood swings from one extreme to the other in a short period. [8]

These feelings can be so intense that they can lead to dissociative symptoms.

Dissociation can feel like you’ve ‘checked out’ of your body and your mind. It can sometimes feel like an out-of-body experience, or as though you’re in a bit of a haze.

It can limit your ability to engage and respond to things as you usually would, and it can be very distressing to experience. [9]

Symptoms of Distorted Thought Patterns

Woman looking sad

Distorted thought patterns are also known as cognitive distortions.

It refers to different kinds of thoughts that can be common in people with this diagnosis.

These thoughts commonly relate to:

  • seeing yourself negatively, thinking you are a very bad person
  • hallucinations (seeing or hearing things that others can’t)
  • delusions (strong beliefs in something that is not real, for example, that you are in danger of being harmed by a love one) [10]

This kind of thought can risk tipping into psychosis.

Psychosis is the word for when our thoughts and feelings become extremely out of touch with reality, meaning it can be tricky to identify what is real. [11]

Symptoms of Impulsive Behaviour

A man turning away

The two main kinds of impulsive behaviours are grouped into two categories:

  1. self-harm
  2. having a lack of caution

Self-harm refers to any activity that could cause you bodily harm.

Common forms of self-harm are cutting oneself or seriously under or overeating. 

The strength of these feelings and impulses can often mean that individuals with this diagnosis struggle with suicidal ideation – that is, seriously thinking about and engaging in suicidal behaviour. [12]

Sadly, one study states that around 10% of individuals with a diagnosis of BPD end their own lives. [13]

Any activities that could be thought of as irresponsible or potentially dangerous can class as having a lack of caution.

This could include the following:

  • drug misuse (of both prescription or illegal drugs)
  • drinking heavily or binge drinking
  • engaging in sexual acts without protection
  • spending a large amount of money very quickly, typically  through shopping or gambling [14]

We will talk a little bit more about how these impulsive behaviours an potentially lead to the use of illicit drugs, alcohol addiction or substance use disorder a little bit later on.

Symptoms of Unstable Relationships

A lot of the time, when we’re struggling with difficult thoughts and feelings, it can begin to really impact our relationships and the way that we are able to interact with those around us. [15]

A lot of people with a diagnosis of BPD experience difficult feelings of rejection and loneliness. This can lead to a fear that people will leave us.

Whilst this far is very upsetting, it can often mean that we act in ways to try and avoid this abandonment.

Some examples of this are:

  • contacting someone very regularly (across different apps)
  • contacting someone at unexpected or inopportune times (when they are in meetings, appointments, out with friends or sleeping)
  • initiating physical contact with someone and being upset if they do not reciprocate in the same way
  • suggesting that you are in danger if the person leaves you (both in the long or short term)

These actions can sometimes come across as intense, and can sometimes be difficult for other people to understand.

This can also work the other way – sometimes people with a diagnosis of BPD feel that relationships – especially romantic relationships can at times become too much.

In these instances, individuals may then become avoidant, or even purposefully reject or insult the other party in the relationship in order to get some space.

The move between fear of abandonment and fear of being controlled can sometimes leave friends or partners confused by our actions, and risks becoming a co-dependent relationship. [16]

What Factors Can Contribute to Borderline Personality Disorder?

A woman with her hands clasped and eyes shut

It’s not always easy to say in a black-and-white way exactly why some people experience difficult symptoms and mental illness whilst others do not.

But, there has been some research that can help us to highlight why some people may be more likely to develop a certain condition whilst others might not.

There are 3 key factors that researchers have linked to a higher chance of developing BPD.

1. Genetic Factors

Some research suggests that BPD could be inherited.

This means there is a chance that BPD is genetic.

Some scientists found that there is a 40% chance of inheriting BPD via the genes of a close family member.

This suggests that if you have a close family member with BPD (such as a parent or sibling) then you could have a higher chance of developing it yourself. [17]

2. Neurology/ Brain Chemistry

Different research into the structure of the brain (neurology) and the chemicals inside the brain (brain chemistry) could indicate that BPD is linked to how the brain functions.

Some scientists suggest that BPD is linked to lower levels of brain chemicals called neurotransmitters. 

Specific neurotransmitters, such as serotonin and dopamine are related to feelings of happiness and reward. [18]

If these feelings are reduced, it is natural that you may need to go to extra lengths to get that buzz to feel good.

Other people think that BPD is linked to specific areas of the brain.

The belief if that the amygdala (a system that assesses threat) and the limbic system (associated with memory, emotion and unconscious function) may be more active in people who have BPD. [19]

3. Traumatic Experiences

Research into the childhood experiences of people who develop BPD at a young age suggests that a high number of individuals with the diagnosis have experienced some kind of difficult event in their youth.

This suggests that the childhood experience of:

can potentially lead to the development of BPD in later life. [20]

This can be linked to the need to self-protect from intense fear, the difficulty of harmful or poor communication and the exposure to intense feelings in family life from a young age.

4. The Diathesis Stress Model

Explaining things through genes and the structures of the brain think about BPD through a biological lens.

Explaining things through past experiences and trauma thinks about BPD through a personal or situational lens.

Both approaches have been criticised, as they can fail to take each other into account.

Increasingly, researchers and medical professionals believe that the development of mental disorders is due to a mix of the two – biology and experiences.

This is known as the diathesis-stress model, and it asserts that whilst someone may have the genetic predisposition or biological makeup for a specific disorder, it might not actually show up via symptoms unless a difficult of traumatic event ‘triggers’ it. [21]

This explains why not every child who has a parent with a diagnosis of a depressive disorder, for example, also has the same diagnosis.

This is often thought of as a friendlier way of explaining mental health conditions and their development, as it doesn’t try to blame either circumstance of genes, but rather thinks of the person and their situation as a whole human being.

Borderline Personality Disorder and Addiction

Man looking off to the left, behind him a tree

Now that we know the basics about what BPD is and what the key symptoms are, we can begin to think about how these experiences can be linked to or even lead to alcohol use disorder or drug addiction.

As we’ve already mentioned, impulsive behaviour in BPD can be one of the risk factors for developing a comorbid addiction.

1. Dual Diagnosis

A high percentage of people with substance use disorder also have a co-occurring disorder.

This means that they also have a diagnosis of another mental health condition.

This is sometimes known as a dual diagnosis. 

Borderline Personality Disorder is a common dual diagnosis.

One piece of research estimated that 2.7% of adults have a diagnosis of BPD. Over three quarters (78%) of individuals with the diagnosis have also encountered addiction at some stage during their lifetime. [22]

This doesn’t mean that people with BPD are ‘bad’ or ‘irresponsible.’

(In fact, there are many other conditions that are linked to addiction, such as anxiety, depression, bipolar disorder, post-traumatic stress disorder and schizophrenia). [23]

Instead, it means that individuals with this diagnosis are faced with a variety of difficult thoughts, feelings and impulses that are difficult to control, and that, without appropriate support, these can become very overwhelming and risk leading to dependency on substances.

2. Treating BPD & Addiction

At Rehab 4 Alcoholism, we understand that addiction doesn’t come from anywhere.

Its very uncommon for a drug or alcohol problem to happen out of the blue.

In most cases, there is a reason (and often, several reasons) that may be contributing to drug or alcohol abuse.

There are a multitude of reasons that addiction could manifest, including:

Because of this, we know that people dealing with addiction shouldn’t be blamed for needing to find a method of emotional regulation.

Instead, everyone should be treated as individuals with a set of experiences, thoughts, feelings and values that need to be taken into account in formal treatment.

This is why our treatment teams will ask you questions about you before you start formal addiction support with us.

During assessment, we may ask you a little about:

  • your current use of drugs and alcohol
  • your current emotional state
  • a bit about your family history
  • any environmental factors that might be contributing to your situation

By doing this, we can make sure we design a treatment plan that has a double focus:

  1.  to allow you to regain enough control to stop engaging in dangerous behaviours
  2.  to give you space and encouragement to learn new ways of coping with difficult thoughts and feelings that you may have been using substances to mask or deal with [24]

Rehab Support for Borderline Personality Disorder

Man lying down with his hand over his head

At Rehab 4 Alcoholism, we know everyone is different.

For this reason, we offer a range of support options that take the thoughts, feelings and experiences of each individual into account.

This means that we are very committed to offering treatment for people who may also have additional needs.

Additional needs could be anything.

We aim to have a rehab programme for anyone who may need it, and aim to design support that takes any specific requirements in mind.

For example, some women may find it more comfortable to stay in a female only rehab.

Neurodivergent individuals also may require some changes to the usual rehab setting in order to feel comfortable.

The same goes for people with a dual diagnosis such as borderline personality disorder.

Before you begin your support journey with us, we will have a chat with you to establish what needs you have that need to be met.

In this assessment, it is important that you let us know if you have a diagnosis of a mental health condition (such as BPD) so we can ensure that we design your treatment plan around this too.

Some of the treatment options we can offer to support you to recover from addiction and find new ways to cope with the symptoms of BPD include:

Contact Us Today

Life with addiction is complicated. It can sometimes feel like there’s no way out, as though the walls are closing in.

This is why Rehab 4 Alcoholism was created. Our primary goal is to help those struggling with addiction (and their family and friends) to access a range of specialist services in a supportive, non-judgmental environment.

We offer professional advice and treatment options to suit a range of people in a range of different situations. By doing this, we hope to help you find your way to sober life.

If you are concerned about the wellbeing of a loved one, or think that you would benefit from contact with staff at our specialist centres, you can contact us today to find out how we can help you.

You can contact us by calling 0800 140 4690, or internationally on +44 345 222 3508.

Alternatively, you can speak to us online on our free chat service to find out how we can start to help you.

References

[1] https://ijmhs.biomedcentral.com/articles/10.1186/s13033-022-00558-3

[2] https://mentalhealth-uk.org/help-and-information/conditions/personality-disorders/types-of-personality-disorders/

[3] https://mentalhealth-uk.org/help-and-information/conditions/personality-disorders/types-of-personality-disorders/

[4] https://mentalhealth-uk.org/help-and-information/conditions/personality-disorders/types-of-personality-disorders/

[5] https://www.ncbi.nlm.nih.gov/books/NBK558911/

[6] https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/symptoms/

[7] https://bjgpopen.org/content/3/2/bjgpopen18X101641

[8] https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-023-00439-0

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081699/

[10] https://journals.sagepub.com/doi/abs/10.1177/036215378901900109

[11] https://www.nimh.nih.gov/health/publications/understanding-psychosis

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6632023/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6632023/

[14] https://pubmed.ncbi.nlm.nih.gov/21158600/

[15] https://journals.sagepub.com/doi/full/10.1177/0004867417723990

[16] https://pubmed.ncbi.nlm.nih.gov/1967012/

[17] https://pubmed.ncbi.nlm.nih.gov/24456942/

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1863557/

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621316/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495240/

[21] https://psycnet.apa.org/record/1999-02156-001

[22] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010862/

[23] https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness

[24] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782444/

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