The Relationship Between Borderline Personality Disorder And Addiction

Borderline personality disorder (BPD) is a mental health condition that affects an individual’s pattern of moods, self-image, and behavior. Those with BPD experience a distorted perception of themselves and reality, in general. These inner experiences often lead to a tendency for impulsive actions and unstable relationships. Like most mental health conditions, and especially personality disorders, people with BPD may turn to substance use as a way to cope with their disorder. This can easily become an addiction, also called a substance use disorder (SUD).

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What Is Borderline Personality Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes borderline personality disorder as a pervasive, unstable pattern of interpersonal relationships and self-image resulting in impulsivity. The inner thoughts that lead to a warped sense of reality can cause those with BPD to exhibit a set of destructive behaviors that can make certain aspects of their life more difficult. BPD typically begins in early adulthood which means these behaviors can affect how an individual with BPD develops.

Because a person with borderline personality disorder feels uncertain about themselves and their place in the world, their interests and values can change very quickly and frequently. Opinions of others can often change suddenly as well. Someone who is a friend one day may seem like an enemy the next. This affects the ability to form strong, stable relationships with others. Other behaviors that contribute to struggling to connect include living in fear of abandonment. This fear may be warranted for some but it can also be imagined for others. The combination of impulsivity, fear of abandonment, and hesitancy to trust tend to result in a series of rapidly initiating intimate relationships or cutting off communication with others at any moment.

Other signs and symptoms of borderline personality disorder include: 

  • Experiencing intense and highly changeable moods. 
  • Viewing things only in extremes (all good or all bad). 
  • Participating in impulsive and sometimes dangerous activities such as spending sprees, unsafe sex, reckless driving, and binge eating. 
  • Self harm (cutting).  
  • Having thoughts or threats of suicide. 
  • Persistent feelings of emptiness. 
  • Inappropriate fits of anger. 
  • Struggling to control anger. 
  • Being skeptical of others intentions. 
  • Intense feelings of dissociation. 

Risk Factors For Borderline Personality Disorder

Currently, an exact cause for borderline personality disorder has not been established. Despite this, research has shown that there are factors that can increase a person’s risk for developing BPD. The presence of these risk factors do not necessarily mean that an individual will form BPD. Studies have shown that BPD affects women and men equally, although women seek treatment more often. Potential risk factors for BPD fall into the categories of genetics, brain chemistry, past experience, and factors of environment.


A family history of mental health conditions may put an individual at a higher risk for forming BPD. This is especially true for those who have an immediate family member, such as a parent or sibling, with borderline personality disorder.

Brain Chemistry

Some studies have shown that those with borderline personality disorder have structural and functional changes to the brain. These changes are often seen in impulse control and emotion regulation areas. It has not been proven whether these changes occur as a result of BPD or if they are a risk factor.

Past Experiences

Many individuals with BPD have reported experiencing traumatic life events. Physical, sexual, or emotional abuse, abandonment, and childhood adversity are all examples of events that can cause trauma.

Factors Of Environment

The environment of one’s upbringing may present risk factors for borderline personality disorder. This can include a child’s family life being disrupted, frequent hostile conflicts, and poor communication.

Addiction And Borderline Personality Disorder

Mental health disorders and addiction, unfortunately, oftentimes go hand-in-hand. Studies have shown that about 50% of those with borderline personality disorder have a history of prescription drug use. Because individuals with BPD have feelings of emptiness and disconnect, they may begin using substances to cope. While substances, like alcohol or Cocaine, can provide a high and escape from the symptoms of BPD, the relief is only temporary. People who use substances to cope frequently feel worse after the fact because their prior situations remain unchanged. Despite this, the use of substances tends to continue as individuals chase temporary relief feelings. This begins the cycle of addiction.

When borderline personality disorder co-occurs with an addiction, the effects of both are magnified. Impulsive and destructive behaviors, mood swings, depression, lack of concern for safety and health, and instability are some of the symptoms that can worsen when these disorders are simultaneous.

Diagnosing And Treating BPD And Addiction

Diagnosing borderline personality disorder can be difficult as many symptoms overlap with other mental health conditions, such as ADHD and bipolar disorder. Medical professionals use interviews and exams to determine symptoms and their root causes. Because of the impulsive nature of borderline personality disorder, patients with BPD may be resistant to treatment. The treatment process is even more challenging when drugs or alcohol are present. Coordination between an individual’s therapists and medical professionals may be needed to keep the patient accountable and on track. 

Dialectical Behavioral Therapy (DBT), specifically created for treating borderline personality disorder, is considered the most effective treatment approach for this disorder. A 2014 study observed 47 people with BPD who were treated with DBT for 1 year. After 1 year of treatment, 72% of the patients no longer met the criteria for BPD. This approach is aimed at building the skills needed to regulate and cope with difficult emotions. Similar to Cognitive Behavioral Therapy (CBT), DBT uses talk therapy to manage thoughts and behaviors. The 4 skills developed through DBT include:

  • Mindfulness: being aware of what is happening in the present moment and accepting thoughts and feelings without judgement. 
  • Distress tolerance: distracting self in stressful situations until calm enough to deal with emotions. 
  • Interpersonal effectiveness: knowing how one feels and what they want to help build fulfilling connections. 
  • Emotional regulation: dealing with reactionary emotions before they can become a chain of distressing secondary emotions.

Get Help Today

Because those with borderline personality disorder struggle to trust and form relationships, seeking treatment may go against natural instincts. It is important to remember the symptoms and outcomes of borderline personality disorder can be heightened when combined with substances. Addiction is a progressive disorder which means the longer one waits to get treatment, the more difficult the process will be. There is help available. For more information on online therapy options, click here.

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