Borderline Personality Disorder and Addiction: Causes and Treatment

It is common for people with borderline personality disorder (BPD) to have a substance use disorder at some point in their lifetimes. Using substances can soothe painful emotions, but this relief comes at a cost. Chronic substance use worsens mood over time and increases the risk of accidental or intentional self-injury. Over time, with repeated substance misuse, a person with BPD may develop an addiction.

Fortunately, people with BPD can receive concurrent treatment that addresses both BPD and substance misuse within an integrated treatment program.

The Link Between Borderline Personality Disorder and Addiction

Borderline personality disorder can cause significant distress for a person living with the mental health condition. People with the diagnosis may misuse substances to cope with intense emotions and other symptoms of mental distress. Over time, borderline personality disorder and addiction can occur hand-in-hand since substance misuse is not a healthy way to cope with mental health problems.

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is one of ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, which is the formal book that mental health clinicians use to make diagnoses. A personality disorder is diagnosed when a person’s way of thinking, behaving and feeling deviates significantly from what is expected. As one of the personality disorders, BPD comes with the following symptoms:

• Chronic feelings of emptiness

• A disturbed or unstable sense of self
• Frantic efforts to avoid abandonment
• Recurrent suicidal or self-harming behavior
• A pattern of unstable and intense relationships
• Emotional reactivity and rapidly changing moods
• Intense and inappropriate anger

What Causes Borderline Personality Disorder?

Mental health professionals increasingly recognize BPD as a trauma-related disorder like post-traumatic stress disorder and dissociative disorders. Research shows that BPD is often a maladaptive response to early childhood adversity, and up to 80% of people with BPD have a childhood history of emotional neglect, physical abuse or sexual abuse.

While trauma is strongly linked to BPD, this is not the only cause of the disorder. Other causes include:

• Genetics: Research suggests that BPD is about 50% explainable by genetic factors.
• Problems in the maternal relationship: People who are separated from or who have poor attachment with their mothers are more likely to develop BPD.
• Dysfunction in the family of origin: People who grew up in families with poor boundaries are at increased risk of developing BPD. Growing up with a parent who misuses substances or who has a serious mental illness is also linked to BPD.

Addiction and Borderline Personality Disorder

It is common for people with BPD to have co-occurring disorders, which means they have BPD alongside one or more other conditions. Having co-occurring addiction and BPD is also common. Research has revealed the following information:

• Among people in treatment for addiction, 26.7% have BPD.
• 75.28% of people with BPD will experience a substance use disorder at some point during their lives.
• Different studies show different co-occurrence rates, but research on addiction and BPD shows that 45.5% to 86.2% of people with BPD have an addiction at some point during their lives.

Substance Misuse as a Coping Mechanism

People with BPD experience intense and painful emotional reactions, and many behaviors associated with BPD reflect ways of preventing or coping with these reactions. People with borderline personality disorder may cut themselves; the physical pain is more tolerable than the emotional pain and can temporarily distract from it.

Using substances can be another way to manage or soothe emotional reactions. Some substances induce dissociative states, while others can help people with BPD connect with their emotions in ways they otherwise can’t. Some substances can do both, depending on the context in which they are used. The research seems to suggest that substances can temporarily help a person regulate emotions.

Complications with Substance Misuse and BPD

Unfortunately, the relief a person derives from substances tends to be short-lived. The temporary relief of dysphoric moods or anxiety that substance use can provide usually leads to long-term worsening of depression and anxiety symptoms, as well as other negative outcomes. People with BPD are already nine times more likely than those without the condition to make repeated suicide attempts, and using substances increases their risk of acting on suicidal thoughts.

Misusing substances is also linked to other problems for people with BPD:

• Worse psychological functioning
• Unemployment
• Poor academic performance
• Promiscuity

Over time, substance misuse is likely to worsen the course of BPD, making it harder for someone who lives with this condition to cope with stressors in daily life.

If you or a loved one is experiencing suicidal thoughts or tendencies, contact the Suicide & Crisis Lifeline by dialing or texting 988. 

Treatment Options for Borderline Personality Disorder and Addiction

Psychiatrists and other mental health professionals once believed that BPD was impossible to treat. However, advances in treatment and research have revealed the opposite. Not only can people with BPD reduce their emotional reactivity, many of them even experience a full remission of symptoms. There are several treatment options commonly used for patients with BPD.

Dialectical Behavior Therapy (DBT)

DBT was specifically developed to treat BPD and remains one of the most effective interventions for it. In the first phase of DBT, people learn skills that improve their distress tolerance, emotional regulation, impulse control and interpersonal effectiveness. In the next phase, they move on to do more individualized work in therapy.

Research shows that DBT significantly lowers suicide and hospitalization rates for people with BPD. A specific form of DBT has been developed to treat co-occurring BPD and substance use disorders (DBT-SUD), and research shows that it improves outcomes for both conditions.

The DBT-SUD intervention uses an integrated treatment approach. While earlier approaches to the treatment of co-occurring disorders were based on the idea that substance use disorders had to be treated first, research actually shows that treating substance use and mental health conditions at the same time is more effective.

Other Therapeutic Treatments

Several other interventions can effectively treat BPD:

• Trauma-focused therapies like eye movement desensitization and reprocessing therapy (EMDR) can address underlying trauma.
• Mentalization-based therapy (MBT), acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) can help people with BPD improve their social functioning and emotional stability.

Most integrated programs use a variety of interconnected services to address multiple disorders and treatment needs at the same time. At an integrated program, people may participate in treatment groups, individual therapy, complementary therapies and medication management.

Integrated Treatment for Addiction and BPD at The Recovery Village Palmer Lake

The Recovery Village Palmer Lake provides integrated treatment options at different levels of care: inpatient, partial hospitalization, and intensive outpatient. Our facility offers breathtaking mountain views and a wide range of therapy modalities, such as EMDR, to support your recovery. Our team consists of diverse professionals, including medical doctors, addiction counselors, dieticians, occupational therapists and fitness trainers, who work together to promote holistic recovery.

If you are struggling with the challenges of co-occurring borderline personality disorders and substance use disorders, contact a Recovery Advocate to learn more about integrated treatment.