Borderline Personality Disorder and Addiction

Borderline Personality Disorder (BPD) is a psychological condition that causes severe emotional dysregulation. A person with BPD experiences emotions with much higher intensity than those without BPD. Moreover, a person with BPD’s feelings last longer, and it is more difficult to return to an emotional baseline after an event triggers dysregulation.

A person living with the emotional dysregulation of borderline personality disorder may experience by the following:

  • Impulsivity
  • Negative self-image
  • Volatile, intense, and short relationships
  • Emotional fragility
  • Vulnerability to stress

Furthermore, the emotional strain of BPD may become so great that the person living with it resorts to dangerous or self-harming behaviors, such as cutting oneself.

Nearly 75% of all people diagnosed with BPD are women. Recent studies, however, suggest that men may be correspondingly affected by BPD but are often misdiagnosed with another condition such as depression or post-traumatic stress disorder.

Key Signs and Symptoms

Individuals with borderline personality disorder tend to experience wide mood swings and exhibit insecurity and instability.

  • Desperate efforts to avoid abandonment by friends and family.
  • Unstable relationships that alternate between idealization and devaluation. This is sometimes referred to as “splitting.”
  • A skewed and unstable self-image that greatly impacts moods, values, opinions, goals, and relationships.
  • Impulsive, risky behavior that can have dangerous outcomes, such as unsafe sex, substance abuse or reckless driving.
  • Self-harming behavior including cutting and suicidal threats or attempts.
  • Periods of severely depressed mood or anxiety lasting a few hours to a few days.
  • Frequently being bored or feeling empty.
  • Inappropriate or uncontrollable rage often followed by shame and guilt.
  • Dissociative feelings – disconnecting from one’s thoughts or sense of “out of body” type of feelings and stress-related paranoid thoughts. Severe cases of stress can also result in brief psychotic episodes.


There is no one exact cause of BPD, but rather several contributing factors that include the following:

Brain function – Researchers have found that emotional regulation system may be different in people who experience BPD, suggesting there may be a neurological explanation for at least some symptoms.

Genetics – Although no specific gene or gene profile has been shown to be the direct cause of BPD, studies have suggested this disorder has strong hereditary links. Moreover, BPD is about five times more prevalent among those who have a first-degree relative with the condition.

Environmental factors – Persons who have experienced traumatic events in their youth, such as physical or sexual abuse during childhood, are at increased risk of developing borderline personality disorder.


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Rage. Instability. Impulsivity. Mood swings. These are characteristics that make people with BPD vulnerable to substance abuse, as well as promiscuity, eating disorders and other compulsive behaviors.

According to a 2014 study, borderline personality disorder affects an estimated 2.7% of adults, and more than three-quarters (78%) of adults with BPD also develop a substance abuse disorder at some point in their lives.

“These persons are more impulsive and clinically less stable than BPD patients without substance dependency. They display suicidal behavior to a greater extent, drop out of treatment more often, and have shorter abstinence phases. The combination of borderline personality disorder with addiction requires a special therapeutic approach.”

A substance use disorder is characterized by the habitual use of alcohol or drugs that causes significant impairment, including health problems and failure to meet major responsibilities at school, work, or home.

Treatment for Borderline Personality and Addiction

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Persons who suffer from both BPD and addiction require a comprehensive treatment approach that concentrates on both conditions simultaneously. Treating addiction without targeted the main underlying cause of substance abuse will serve only to mitigate the symptom temporarily.

BPD patients who also suffer from addiction are known as some of the most difficult patients to treat – but it CAN be done.

Both BPD and addiction can be approached using psychotherapies such as cognitive-behavioral therapy. One of the essences of CBT is the learning of healthier coping skills and can be geared toward both addiction (coping with triggers) and BPD (coping with emotional dysregulation.)

While there is no one medication specifically designed to treat BPD, there are several that can treat some of the core symptoms, such as mood stabilizers, antidepressants, and antipsychotics. Symptoms of addiction, such as cravings, can often be treated with pharmaceuticals as well, such as naltrexone in the case of opioid and alcohol use disorders.

We offer comprehensive, evidence-based treatment for persons diagnosed with both BPD and substance abuse in both residential and intensive outpatient formats. Our inpatients receive around-the-clock medical supervision and support, while outpatients take advantage of greater scheduling flexibility to attend to essential life responsibilities outside the center.

And because recovery from addiction is a lifelong process, we also offer aftercare planning services and alumni activities for former patients that foster long-term recovery goals and peer support.

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