The Connection Between Borderline Personality Disorder and Addiction

For many people, addiction is not the only battle they are fighting. Substance use disorders often present alongside other mental illnesses. These are known as co-occurring disorders and can make diagnosis and treatment even more complex.¹

Borderline personality disorder (BPD) is a type of mental illness commonly linked to addiction. Read on to learn more about borderline personality disorder, its association with substance abuse, and how to get help if you or someone you love is suffering with co-occurring disorders, such as BPD and addiction.

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a severe personality disorder characterized by a pattern of impulsive acts and suicidal behaviors, and dysfunctional or unstable interpersonal relationships, self-image, and emotional responses. These traits often surface by early adulthood and cause significant distress in multiple areas of one’s life.²

Borderline personality disorder is the most frequently diagnosed personality disorder in both inpatient and outpatient mental health facilities.³ Research also indicates a relatively high prevalence in the general population with an estimated range of 1%–6% meeting the criteria for BPD.²

BPD commonly occurs with other mental illnesses including:²

• Depression and bipolar disorders.
• Eating disorders (notably bulimia nervosa).
• Post-traumatic stress disorder (PTSD).
• Attention-deficit/hyperactivity disorder (ADHD).
• Substance use disorders.

How Is Borderline Personality Disorder Diagnosed?

Medical professionals diagnose borderline personality disorder based on criteria laid out in the Diagnostic and Statistical Manual of Mental Health Disorders, 5^th edition, published by the American Psychiatric Association. The criteria includes:²

• Desperate efforts to avoid abandonment. (There may or may not be an actual basis for these feelings.)
• Recurring intense and unstable relationships, ranging from extreme devaluation (disgust, hatred, etc.) to extreme idealization toward the person or caregiver.
• Highly unstable self-image or sense of self.
• Repetitive threats of suicide, gestures of committing suicide, suicidal behaviors, or self-mutilation (e.g., cutting oneself, burning oneself with a lighter, etc.).
• Severe impulsivity that occurs in at least two aspects of one’s life and has a potential to injure the person in some way, such as driving erratically, substance abuse, binge eating, etc.
• Intense emotional responses and mood swings (e.g., unpredictable and irrational unhappiness, irritability, or anxiety).
• Longstanding feelings of emptiness.
• Difficulty managing one’s anger or displaying inappropriate outbursts of anger.
• Stress-related paranoia or dissociation (e.g., feelings of being detached from one’s body or from reality, or severe issues recalling events that may have been associated with extreme emotional states).

An individual must consistently display 5 or more of the 9 criteria above to receive a borderline personality disorder diagnosis.

Read more about the DSM-5 and history of co-occurring disorders.

Co-Occurring Borderline Personality Disorder and Substance Abuse

An individual with borderline personality disorder is at increased risk of developing an addiction. The traits associated with BPD—like impulsivity, unstable personal relationships, extreme mood swings and insecurity, and fear of abandonment—produce a great deal of distress.

Experiencing any of these qualities could be a precipitating factor for substance abuse, and individuals with BPD suffer from several of these issues at the same time.

How Common Is It to have BPD and Substance Use Disorder?

It is very common for people with borderline personality disorder to also have a substance use disorder. Studies show that about half of those with BPD also suffer from at least one substance use disorder (SUD).³

Alternately, of those diagnosed with a current substance use disorder, about 25% also meet the criteria for borderline personality disorder.³

Alcohol use disorder is the most common co-occurring SUD with borderline personality disorder, followed by opioid and cocaine use disorders.³

Because borderline personality disorder and other mental illnesses frequently occur with addiction, patients who appear to have one condition should undergo tests for other co-occurring disorders.¹ If two or more disorders are present at once, experts recommend that both disorders be treated simultaneously.⁴

How to Treat Someone With BPD and Substance Abuse

Mental health professionals generally recommend an integrated approach to treat someone with co-occurring borderline personality and substance use disorders. This means physicians, psychiatrists, therapists, counselors, case managers, and other specialists all work together as a team to treat both disorders at the same time, setting the same goals and keeping the treatment plan consistent.

Due to the severity of borderline personality disorder and its complex interaction with substance use disorders, it is essentially impossible to treat BPD without addressing addiction issues if they are present. People with BPD tend to not follow treatment plans or suddenly drop out of treatment, demonstrating the disorder’s impulsive and unstable nature. When the individual is also using alcohol or drugs, these characteristics, along with the associated propensity for self-harm and suicidal behaviors, are further amplified.

A combination of evidence-based addiction therapies, treatment medications, and counseling may be used throughout the course of care. During group and individual therapy, patients learn to tolerate the experience of stressful and uncomfortable emotions, fears of abandonment or rejection, and issues with suicidal thoughts and self-harm, and develop positive coping and problem-solving strategies.

Addiction rehab addresses a person’s use of drugs or alcohol, teaches coping and relapse prevention skills, and may also include vocational counseling to assist those with job or school issues.

There is no single medication that treats borderline personality disorder. However, psychiatrists will typically prescribe medications that help manage specific symptoms, such as depression or anxiety, which may contribute to the distress associated with BPD and SUD.

At our inpatient treatment facility in Las Vegas, Nevada, we specialize in the treatment of co-occurring disorders and provide a full spectrum of care starting with medical detox. We also have an outpatient rehab facility in Las Vegas for patients to move into after their inpatient treatment is completed. During outpatient rehab, you may wish to reside near the facility in our Las Vegas sober living facility. We also provide customized rehab programs for veterans and first responders, who may be suffering from co-occurring mental disorders.

To learn more about our high-quality programs, what to expect in inpatient rehab, how to pay for rehab, or how to help a loved one with addiction, call us at today. Our admissions navigators are available around the clock to answer any questions and start the rehab admissions process.

Or you can find out whether we accept your insurance and verify your benefits by filling out this simple and secure .

Although your situation may feel hopeless right now, it’s important to remember that co-occurring disorders like BPD and addiction are treatable.⁴ Sometimes asking for help is the hardest part. At Desert Hope, we are here to support you through those critical first steps and every other step along the path to recovery.