Borderline Personality Disorder and Addiction
Borderline Personality Disorder (BPD) is a mental disorder that affects between 1-3 per cent of the adult population.
BPD distorts the way one feels and thinks about themselves and others, which can cause problems with normal functioning.
It is often characterized by a negative self-image, difficulty managing behaviour and emotions, and unstable relationships.
Persons with borderline personality disorder tend to have a lot of instability in their lives and an intense fear of being alone. However, given their frequent mood swings, impulsiveness, and inappropriate anger they tend to push other people away.
For the most part, people will show symptoms of BPD in early adulthood though the symptoms tend to wear off as one age.
Causes and Risk factors for BPD
Similar to many disorders, it is not very clear what causes borderline personality disorder.
However, research suggests that persons that develop the disorders exhibit several common characteristics.
Some of the suspected risk factors for the development of BPD include:
- Genetics: Studies have shown that persons who have relatives who suffer from BPD are more likely to develop the disorder. More specifically, you are up to 10 times more likely to develop the condition persons in your family suffering from it are your first-degree relatives
- Physical: Research has shown that people with borderline personality disorders tend to have brain abnormalities that may interfere with proper function. The abnormalities are in the specific circuits and pathways most responsible for impulse control, reasoning, perception and information processing. When these pathways are interfered with, a person will develop BPD
- Environmental: It has been shown that environmental factors such as separation from a loved one, neglect, emotional abuse, chaotic home environment, or history of child abuse can significantly increase the risk of developing BPD
Symptoms of Borderline Personality Disorder
There are many different manifestations of BPD though there are several symptoms that mental health professionals use. To have a BDP diagnosis one needs to have at least five of the symptoms.
Moreover, these symptoms need to have been present (typically from young adulthood) and impact your daily functioning.
A. Fear of Abandonment
People with BPD tend to have an intense or irrational fear of being left alone or abandoned.
Since they have such low self-image, leaving them alone for a weekend or even coming home late can make them feel like they are a terrible or worthless person that has been abandoned.
This can result in intense fear that can result in manipulative and desperate actions such as threatening suicide, starting fights tracking a loved one’s movements, begging, and even blocking the person from leaving.
This of course results in alienating the loved one or caregiver who will not want to deal with such insecurity.
B. Unstable Relationships, Attitudes, and Behaviors
People with BPD will develop a pattern of unstable relationships that tend to be short-lived though intense. Given that their emotions and perspectives and moods are in a constant state of flux, they find it hard to stay in relationships long term.
A relationship with a person with BPD is hard since they can only be either horrible or perfect with little in between. For instance, they could go from thinking the world of you and making you their confidant to thinking you are planning on tormenting or hurting them.
This causes an emotional roller-coaster as family members, friends and lovers have to deal with rapid mood swings, which often result in low satisfaction in relationships.
C. Self-Destructive Impulsive Behaviors
BPD makes a person more likely to seek out risky, harmful and sensational behaviours particularly when they are upset. They may engage in sex with strangers or unprotected sex, abuse alcohol or drugs, gamble, drive recklessly, and spend money they cannot afford among other impulsive behaviours.
While engaging in such behaviours can relieve their pain in the short term, they tend to hurt them and those they love over the long term.
D. Tendency to Self-Harm
Persons who have BPD tend to have ranging emotions that often leads them to deliberate self-harm and suicidal behaviour as a form of release.
According to the National Institute of Mental Health, up to 80 per cent of people with BPD have at one time or another attempted suicide or self-harm.
Self-harm may involve anything from headbanging, hitting and cutting themselves. They may also manifest suicidal tendencies by making threats, gestures and actually attempting suicide.
E. Extreme Shifts in Mood
Persons with BPD are prone to extreme mood swings that sees them move from anxiety, irritability, happiness, and despondency which can last for hours and sometimes days. They are very sensitive to their interactions with others and happenings in their world and any negative event however small can send them into a tailspin.
The thing with BPD-related mood swings is that the reaction is not predictable as a situation may cause intense despair one time and paranoia the next time.
F. Drastic Shifts in the Sense of the Self
Persons with BPD tend to have dramatic shifts in their image and self-worth which can result in them making dramatic decisions in a heartbeat. They may change priorities, friends they hang out with, their careers and hobbies seemingly out of nowhere.
Given the unpredictability of their behaviour, they may present as irresponsible at work and at home, where they may shirk their responsibilities while taking up new ones that take their fancy.
G. Extreme Aggression and Anger
Many people with BPD have a short fuse and are easily provoked. They may exhibit aggressive behaviours such as throwing things and being completely subsumed in their rage.
Most will have a bitter and sarcastic bent. In some instances, it can result in violence as it has been evidenced that BPD is correlated with sexual, physical and psychological aggression.
For some, the anger will not be projected outwards but inwards leaving them feeling angry at themselves.
Comorbidities of Borderline Personality Disorder
Several common symptoms of BPD are also symptoms of other mental conditions. Moreover, just like with any other mental illness, a person with BPD often suffers from one or more related conditions.
According to research, up to a quarter of all people with BPD have another related mental disorder.
The reason for the high comorbidity with BPD is not yet known but it may have something to do with risk factors of genetics or neurobiology.
The following are some of the common conditions that may occur alongside BPD:
- Bipolar Disorder – Up to 20% of bipolar persons have BPD. Bipolar Disorder is characterized by drastic fluctuation between manic highs and depressive lows that make it hard for persons suffering from it to regulate their emotions resulting in impulsive or risky behaviour
- Post-Traumatic Stress Disorder (PTSD) – 53% of people with BPD can be deemed to be suffering from PTSD. PTSD is a mental health condition that afflicts persons that have been exposed to upsetting, shocking or traumatic events such as military combat, sexual assault or natural disasters
- Major Depressive Disorder – Between 38-71 per cent of people with MDD also have BPD. MDD typically causes prolonged periods of fatigue, lack of interest, low moods and sleep problems
- Substance Use Disorder (SUD) – Studies show that between 14-72 per cent of persons with BPD could have SUD. Substance abuse disorder is a result of recurrent use of alcohol or drugs that cause noticeable distress or impairment of everyday functions
- Eating Disorders – Up to 90 per cent of people with BPD also fit the criteria for eating disorders such as bulimia, anorexia and other unspecified eating disorders. The reason for this is that people with BPD may abuse substances in trying to find an outlet for their emotions
- Anxiety Disorders – Between three quarters to 90 per cent of people suffering from BPD also have a type of anxiety disorder. This is any of the conditions marked by constant, overwhelming, and uncontrollable worry and fear
- Other Personality Disorders – BPD is a personality disorder that may present alongside other personality disorders such as narcissistic personality disorder, dysthymia, and antisocial personality disorder
Comorbidity of Addiction and Borderline Personality Disorder
While the prevalence of BPD is only between 1-3 per cent of the adult population, people with a BPD diagnosis have a higher probability of also developing substance abuse disorders.
According to research up to two-thirds of persons that have BPD have at one time or another abused some substance.
It has been theorized that persons with borderline personality disorders often resort to substance abuse to relieve their extreme emotions. Substance abuse is an outlet that lets out these emotions.
As such, it can be a form of destructive self-medication that allows them to attain a sense of normalcy if only for a time.
Comparing Addiction and BPD
Addiction and BPD tend to have very similar manifestations and effects, which can often result in the wrong diagnosis. Both can manifest with unstable relationships, extreme emotions, self-destructive and risky behaviours, and aggression.
This can make it almost impossible to differentiate one from the other. Most of the time, persons will be diagnosed with one condition before the other is discovered alongside it.
Moreover, it can be quite a challenge to treat BPD alongside an addiction problem since the effects of BPD such as emotional instability and erratic behaviour are heightened by substance abuse.
With rehabilitation most of the time being voluntary, the erratic decisions of a person with both addiction and BPD can make completing therapy difficult.
Comorbidity of Alcohol and Borderline Personality Disorder
According to research, the substance most abused by people with BPD was alcohol. In fact, studies have shown that people who abuse alcohol may be up to three times more likely to have BPD.
On the other hand, another study showed that up to 63% of participants in a BPD study also presented symptoms of alcohol use disorder.
This shows that there is a strong correlation between alcohol disorders and BPD.
While it is not yet clear why there is such a high correlation between the two a few theories have been put forth.
- The Genetic Theory – Since BPD is to some extent correlated with genes, the same also predispose them to a higher risk for alcoholism which shares the genetic pathways
- Environmental Theory – Experiences in childhood such as neglect, emotional abuse, physical abuse and maltreatment in childhood can trigger alcoholism and BPD
- Need to Release Emotional Tension – Since BPD is associated with strong emotions, persons with the disorder find alcohol a good way to self-medicate which eventually leads to addiction
- Dysfunctional Endogenous Opioid System (EOS) Theory – Research has shown that some symptoms of BPD result from a dysfunctional EOS. EOS is responsible for relieving pain and reinforcing and rewarding behaviour and since alcohol activates the EOS, it is more likely to be abused by the person with BPD
Treatment for Comorbid BPD and Addiction
It can be quite a challenge to treat substance abuse when it occurs alongside BPD. This is not only because of the erratic behaviour of the patient but also because people with substance abuse can very easily develop other addictions.
In the absence of professional medical supervision, persons with comorbidity can work the system resulting in prescription drug abuse, polydrug abuse, and addiction.
Nonetheless, a combination of treatment that involves dual diagnosis followed by addiction treatment using detox and rehabilitation programs is an approach that has been proven to work.
According to the National Institute on Drug Abuse (NIDA), it is critical to treat both BPD and substance abuse disorders concurrently for rehabilitation to be effective.
The most effective treatments for BPD may involve psychotherapy, cognitive behavioural therapy, and dialectical behaviour therapy.
Cognitive-behavioural therapy is particularly effective as it helps patients identify thoughts that lead them to destructive and impulsive behaviours.
While there are no specific medications for BPD, a patient may benefit from antidepressants, mood stabilizers, and antipsychotic medications that reduce aggression and anxiety.
Dialectical Behavioral Therapy can also be used to treat substance abuse disorders. DBT uses a staged approach that helps the patient develop a baseline of behavioural control and safety before moving to the resolve trauma.
Using a targeted intervention of DBT specifically develop for substance abuse disorders, it provides skill training to groups and individuals aimed at preventing recurrence of drug abuse.