What is Borderline Personality Disorder?

A borderline personality disorder (BPD) is a serious mental illness marked by recurring patterns of mood swings, changes in body image, and behavioral ups and downs. These symptoms can lead to extreme impulsive behaviors, relational difficulties, and even episodes of self-harm and suicidal ideation.

People with borderline personality disorder will often experience severe periods of depression, anger, anxiety, or isolation that can last from hours to days. 

Signs and Symptoms of Borderline Personality Disorder

Patients experiencing borderline personality disorder may encounter severe mood swings and serious uncertainty about how they view themselves and their place in the world. As a result of these symptoms and other unpredictable behaviors, their interests and values can appear to change rapidly.  

Patients with borderline personality disorder also tend to experience emotions in extremes, such as elation and depression. In addition, their opinions and treatment of others can seem to change quickly. Someone seen as an ally one day may be viewed as an enemy tomorrow. These changing moods can lead to difficulty in maintaining healthy relationships. borderline personality disorder and substance abuse

Other signs or symptoms may include:

  • Extreme relational “clinginess” or isolation in an effort to avoid feeling abandoned. Those suffering from BPD constantly fear abandonment, and as a result they may rapidly jump in and out of relationships.  
  • Distorted sense of self, body dysmorphia or extreme swings in self-image 
  • Engaging in impulsive or even dangerous behavior such as eating disorders, reckless driving, risk-taking, financial irresponsibility, etc. 
  • Self-harm and suicidal ideation 
  • Intense mood swings lasting hours to days 
  • Chronic depression or intense loneliness 
  • Difficulty controlling anger or tendency to lash out
  • Having a hard time developing trust 
  • Feelings of disassociation such as feeling out of place constantly or uncomfortable in your own skin

While these symptoms are common, not everyone experiences any disorder in the same way. Some patients may experience only a few symptoms while others may have many. Symptoms can be triggered for many reasons and sometimes for no reason at all. The severity and frequency of symptoms will vary from person to person based on their diagnosis and other potential co-occurring disorders such as addiction.

Risk Factors for Borderline Personality Disorder

Although causes of borderline personality disorder are not clear, research suggests that many factors, such as genetics, brain function, and varying environmental factors may play a role. 

  • Family history: For most personality disorders, risk factors are significantly higher if there are one or more family members who also have a disorder. 
  • Brain factors: Research shows that those suffering from borderline personality disorder may have structural differences in the brain-particularly in the areas that control impulse and behavior. However, there is not a clear distinction between whether these changes have caused BPD or were caused by it. 
  • Environmental, cultural, and social factors: Many people who struggle with borderline personality disorder share a history with trauma, abuse, or abandonment. In addition, there are often relational difficulties such as divorce, or unstable home lives. 

These factors may contribute to a risk of BPD but do not by any means guarantee it. Although these factors may increase a person’s risk, it doesn’t mean that the person will develop borderline personality disorder. Likewise, there may be people without these risk factors who will develop borderline personality disorder in their lifetime. 

Diagnosing a Borderline Personality Disorder

Because there is no specific medical test to diagnose borderline personality disorder, medical determinations are not based on one specific sign or symptom. The most accurate way to diagnose BPD is for a licensed mental health professional to seek a thorough clinical interview that may also involve previous therapists or even friends and family. 

A diagnosis of borderline personality disorder is generally made in adults, not in children or teens. Although some symptoms of BPD may be present in younger patients, they can often be attributed to other, more common disorders such as ADHD. Generally, these can be treated or will go away as a patient gets older.  

Treatment for Borderline Personality Disorder

Although there is no single definitive test, a licensed mental health professional can generally make an accurate BPD diagnosis if given thorough access to medical history and a successful interview.   

Borderline personality disorder is often found in patients with other underlying mental health concerns, such as depression, eating disorders, substance abuse disorders, or anxiety disorders. Often, when a co-occurring disorder is present, a patient will see improvement in both disorders if the BPD is treated successfully. For example, if a patient is struggling with BPD and alcohol abuse, they will often see improvement in their abuse if BPD can be treated. 

In the past, borderline personality disorder has been viewed as difficult to treat. However, new evidence-based treatment methods and modalities have been used in BPD treatment over the last several years, and individuals report fewer and less severe symptoms. 

Therapy

borderline personality disorder and substance abuse

Therapy is generally believed to be more successful than medication at treating the symptoms of BPD. The most successful modalities have proven to generally be individual or group therapy, dialectical behavior therapy, or cognitive behavioral therapy. 

The therapist-client relationship is especially important in a BPD treatment scenario. There must be earned trust as well as patience and understanding support. These relational aspects are extremely pivotal to successful treatment for BPD.   

It is extremely important to receive treatment with a personality disorder and particularly so with borderline personality disorder. If left untreated, BPD can wreak havoc on someone’s relationships and personal life. Experts believe professional therapy, in conjunction with support from family and emotional skills training, is the best way to conquer this disorder. 

Studies show that patients with presenting BDP who do not receive treatment are significantly more likely to develop other co-occurring disorders such as depression, or addiction. They may also be more at risk for self-harm or suicidal ideation. Seeking help is the first step on the road to recovery.  

What Is Substance Abuse Disorder?

Substance abuse disorder (sometimes referred to as substance use disorder) occurs when someone cannot control themselves from using an unhealthy amount of a substance, such as alcohol or various drugs. 

Substance abuse will look different for everyone and it can be difficult to detect if someone is truly abusing or addicted to something. 

Commonly abused substances include:

Opioids

Opioids and similar narcotics are powerful painkillers that can cause euphoria, drowsiness, or extreme highs. This group includes heroin, opium, hydrocodone, or other prescribed pain medications. They can be purchased over the counter or bought illegally. 

Stimulants

Stimulants are drugs that jump-start the brain or nervous system. They can be prescribed for disorders such as attention-deficit hyperactivity disorder (Ritalin) but also include illegal drugs such as cocaine and methamphetamine. These drugs quickly lead to increased dependency and eventually addiction.

Depressants

Depressants are a category of drugs that can slow down response time and give the user a “mellow” effect. This group includes prescribed medication for disorders like anxiety. Alcohol is the most commonly abused depressant

Symptoms of Substance Abuse

While they will vary greatly from person to person (and depend on the substance), some symptoms and behaviors of drug or alcohol abuse may include:

  • Disorientation or lack of memory
  • Continued use even when faced with harmful results of abuse
  • Potentially volatile mood swings 
  • Denial or hostility when confronted about the abuse
  • Demonstrated lack of ability to stop using 
  • Constantly making excuses for drug or alcohol use 
  • Withdrawal from work or school environments
  • Need for daily or regular drug use to function
  • Neglecting to eat
  • Neglecting physical appearance
  • Withdrawal from relationships or family members

Borderline Personality Disorder and Substance Abuse

Borderline personality disorder and substance abuse have an extremely volatile relationship because drug or alcohol abuse can exacerbate many of the most dangerous BPD symptoms. Substance abuse as a co-occurring disorder with BPD can lead to dangerous bouts of rage, depression, or suicidal ideation. borderline personality disorder and substance abuse

Sadly, those who suffer from borderline personality disorder are significantly more likely to turn to drugs or alcohol to numb their loneliness and pain. It is extremely important to seek treatment for a dual diagnosis of BPD and substance abuse disorder together. Treating just one of the two conditions may not lead to any improvement, and both conditions can prove extremely harmful or fatal if left alone. 

Those who suffer from both of these disorders may often turn to self-harm, such as cutting. They are also more prone to suicidal ideation or suicide attempts. 

The similarities in symptoms between BPD and addiction can make it difficult to obtain a proper diagnosis or appropriate treatment. Antisocial or manipulative behaviors are often common in both disorders. This makes it all the more important to seek help from trained professionals for both disorders at the same time.

Treating Personality Disorders and Substance Abuse

Dialectical behavior therapy (DBT) is one of the most successful approaches to treating substance abuse and BPD together. Dialectical behavior therapy focuses on the idea that self-acceptance is the key to recovery. It seeks to help individuals adapt to change and improve coping mechanisms through self-care. 

In addition to utilizing DBT, clients who receive treatment for a dual diagnosis often attend classes or counseling in relapse prevention. Relapse prevention training is extremely important in treating a dual diagnosis because relapse rates are extremely high. 

Relapse prevention often involves group therapy or a twelve-step program where they can share stories and coping strategies. 

Find Help for Borderline Personality Disorder Today

It is extremely important to seek help for substance abuse disorder and BPD, and even more so if they occur together. If you or a loved one are suffering from these issues, contact Phoenix Rising today. Our trained professionals are ready and eager to help you begin your journey to recovery!