Borderline personality disorder (BPD) and addiction have much in common. Their side effects and causes are similar.
Having both BPD and a substance use disorder can be challenging and seeking help can be even harder. Fortunately, treatment for addiction with BPD as a dual diagnosis is available. At Castle Craig, our experienced team is here to help.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a common mental health condition. It is a type of emotionally unstable personality disorder  that can have a significant impact on someone’s personal and social life.
There are many types of personality disorders. Some people don’t fit into one type and may have signs of BPD alongside other types. 
How do people with BPD behave?
In the UK, medical professionals use a set of symptoms to diagnose borderline personality disorder. Someone does not need to have all of these to receive a diagnosis.
People can express many different behaviours and signs, including:
- Negative thoughts and feelings
◦ Variable mood or mood swings
◦ Feeling empty or unworthy
◦ Fear of abandonment
◦ Difficulty accepting criticism
◦ Unclear identity, including self-expression or sexual preference
- Challenging behaviours
◦ Creating intense and unstable relationships with others
◦ Acts of self-harm
◦ Outbursts of emotion
◦ Being disruptive in social situations
◦ Impulsive acts
Anybody could display the symptoms of borderline personality on occasion, so these alone cannot diagnose BPD. Characteristics include symptoms which are :
- Present all the time, including in personal and social situations
- Causing severe distress to the person experiencing them
- Perceived by others as extreme or unusual
- Still present and have been since childhood
- Resulting in challenges like losing a job or loved one
Is someone with a personality disorder more likely to develop an addiction?
People with this personality disorder are more likely to develop an addiction. 
Addiction is when a harmful habit or behaviour becomes difficult to stop. There are substance and non-substance types of addiction.  A substance addiction refers to an addiction to a harmful substance, such as drugs or alcohol. A non-substance addiction refers to an addiction to a certain behaviour, like gambling or shopping.
There is a clear link between addiction and BPD. Around 78% of people with BPD will develop an addiction to drugs or alcohol at some point.4 Roughly 25% of people with addiction will have BPD. 
What kind of addictions might people with BPD develop?
People suffering from BPD can develop substance and non-substance addictions.
Addictive substances can be divided into two categories: sedatives and stimulants. Many of these substances are legally prescribed, like medication from a doctor. Others are illegally obtained, like street drugs.
Sedative substances are calming and relaxing. They are also known as downers. Sedatives include:
- Opioids – heroin, tramadol, oxycodone
- Benzodiazepines – diazepam, valium
Stimulant substances cause feelings of euphoria and are often referred to as uppers. These include:
People with BPD can also develop non-substance addictions. These are addictions to behaviours or habits rather than alcohol or drug abuse. Some non-substance addictions include:
- Shopping addiction
- Gambling addiction/Gaming addiction
- Love, or sex addiction
- Social media addiction
- Eating disorders
Alcohol and Borderline Personality Disorder
The commonest addiction in people with BPD is alcohol. Misuse of sedatives, like alcohol, is more common than stimulants. 
Why do people with Borderline Personality Disorder develop an addiction?
There are many reasons why someone with a borderline personality disorder might develop an addiction.
- To temporarily reduce their symptoms 2
People with BPD often form addictions as a way to cope with the effects of their illness.2 Addictive substances and behaviours can reduce negative feelings, or heighten positive emotions. For example, drugs such as stimulants can make someone feel much more energised. Drug abuse may also improve their confidence and mood. Likewise, sedatives can soften anxiety and emotional distress. Sedatives are more commonly misused to manage emotions. 
- To help them cope with physical illness
Rates of physical illness are much higher in people with BPD than those without.  People with BPD may turn to substances to provide them with relief from their physical symptoms. Continuous self-medicating may lead to drug abuse and later, addiction.
- To boost mood
Individuals with BPD may have lower levels of important signalling molecules like endorphins. These endorphins give us a euphoric feeling, similar to the one experienced when taking opioids and other sedative drugs. People with low endorphin levels may experience a strong desire to use sedatives.5 There is a particularly high link between BPD and using sedative drugs like opioids.5
The overlap between BPD and substance abuse
There are many similarities between addiction and borderline personality disorder. Some of the symptoms of BPD can lead to, and worsen, addiction.  These include impulsivity and difficulty controlling mood. One study found that 42% of people with alcohol addiction also meet the criteria for BPD.6 This shows that there is an overlap of symptoms in borderline personality disorder and substance use disorder.
Treatment for addiction and BPD
Dual diagnosis of BPD alongside addiction
A dual diagnosis (or co-occurring disorder)is when someone has a diagnosis of two conditions. Being diagnosed with borderline personality disorder alongside drug addiction is a dual diagnosis.
A specialist doctor will carry out a detailed assessment before making any diagnoses.1 They will review the person’s emotions, behaviours and thoughts. The doctor will ask how certain symptoms have affected their life. Sometimes they might speak to the person’s family and friends, with their permission.
Like any other medical diagnosis, doctors will rule out other conditions first. This could involve anything from further consultations to medical investigations, like blood tests.1
After carrying out the assessment the doctor will make the appropriate diagnosis or diagnoses. Making the correct diagnosis is really important and allows patients to receive the most appropriate treatment.
BPD and addiction recovery
There are many treatment options available for BPD and addiction. It is often preferable for people with dual diagnoses to stay at a medical facility during treatment, as it can make it easier to manage their symptoms.
Treatment can be particularly challenging for people with borderline personality disorder and addiction.7 It is important that a medical professional assesses your needs before treatment commences. They will ensure appropriate support is in place.
The route to recovery is variable for each person. There is no set time frame or immediate cure for such a diagnosis. With patience and time, you can recover and learn to manage your conditions.
What are the treatment options for BPD and addiction?
There are various ways to manage borderline personality disorder with addiction.4 Professionals can treat each condition separately or together.
Therapy to treat the addiction as well as address the symptoms of borderline personality is preferable. This is because the symptoms of addiction and an accompanying mental health disorder can worsen the other.
Emotional distress can lead the person to seek comfort in their addiction, and relapse and so leads to a vicious cycle that is hard to break.
There is evidence to suggest that when both conditions are treated, people are more likely to complete their therapy.7,8
There are two main types of treatment: pharmacological and psychological.4 Pharmacological management involves prescribed medications that improve symptoms. Psychological treatment is when professionals help someone recognise and manage their harmful thoughts. It provides tools and mechanisms for managing these thoughts independently.
Psychological therapy is the main treatment for people with BPD and addiction.8 There are many types of psychological therapies available. The commonest type for this kind of diagnosis is dialectical behavioural therapy (DBT).
It is a type of cognitive behavioural therapy. DBT can be alone with a therapist or with a group of people who also have a co-occurring disorder. DBT can help develop a sense of community and motivate people to achieve their treatment goals.
Professionals can provide other forms of treatment based on the person’s specific needs. These include:
- Family therapy
- Trauma therapy
- Holistic therapy, such as acupuncture
- Relapse prevention groups
How to get help for addiction and BPD?
If someone requires urgent help, it is vital to phone emergency services. Suicide prevention charities may also be available to talk to in your area.
Residential rehab with a Consultant Psychiatrist leading the clinical team is the ideal option for someone struggling with an addiction complicated by BPD. People with co-occurring disorders will benefit from a longer length of time in rehab, so their addiction and mental health disorders can receive intense treatment. Speaking to a doctor is a good starting point. They can guide you, or your loved one, to a safe recovery.
Our professionals at Castle Craig specialise in the treatment of co-occurring illnesses. Castle Craig offers confidential and successful treatment for substance abuse alongside other dual diagnosis disorders. For your personalised assessment and treatment plan, contact Castle Craig today.
Written by Dr Lisa Kilday
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- World Health Organisation. The ICD-10 Classification of Mental and Behavioural Disorders. Geneva, Switzerland: World Health Organization; 1993:154-162.
- Trull TJ, Freeman LK, Vebares TJ, et al. Borderline personality disorder and substance use disorders: an updated review. Bord Personal Disord Emot Dysregul. 2018;5(15).Â
- Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. Behavioral addiction versus substance addiction: correspondence of psychiatric and psychological views. Int J Prev Med. 2012;3(4):290-294.
- Kienast T, Stoffers J, Bermpohl F, Lieb K. Borderline personality disorder and comorbid addiction: epidemiology and treatment. Dtsch Arztebl Int. 2014;111(16):280-286.Â
- Richmond JR, Tull MT, Gratz KL. The roles of emotion regulation difficulties and impulsivity in the associations between borderline personality disorder and frequency of nonprescription sedative use and prescription sedative/opioid misuse. J Contextual Behav Sci. 2020;16:62-70.Â
- Helle AC, Watts AL, Trull TJ, Sher KJ. Alcohol use disorder and antisocial and borderline personality disorder. Alcohol Res. 2019;40(1):arcr.v40.1.05.Â
- Tull MT, Gratz KL. The impact of borderline personality disorder on residential substance abuse treatment dropout among men. Drug Alcohol Depend. 2012;121(1-2):97-102.Â
- Dimeff LA, Linehan MM. Dialectical behavior therapy for substance abusers. Addict Sci Clin Pract. 2008;4(2):39-47.Â