Last Updated:

September 24th, 2024

Borderline Personality Disorder and Addiction | Symptoms & Treatment

Borderline personality disorder (BPD) is a mental health condition characterised by intense emotions and unstable relationships. People with BPD often struggle with self-image and impulsivity, which can affect their everyday lives. This disorder typically involves difficulty managing emotions and behaviours, leading to challenges in maintaining healthy relationships. While BPD can be overwhelming, many individuals find relief and improvement through therapy and support.

A UK government study on personality disorders found that up to 17.3% of British participants screened positive for a personality disorder, highlighting the relatively high prevalence of this condition.

BPD illustration

What are the signs of borderline personality disorder?

Understanding and recognising the signs and symptoms of BPD is crucial. Knowing these signs can help you identify them in yourself and others you care about, leading to better support and management.

Intense emotional swings: Individuals with BPD often experience rapid and intense mood changes. One moment they might feel elated and the next they could be overcome with sadness or anger. These mood swings can be challenging to manage and often feel overwhelming.
Fear of abandonment: People with BPD typically have a profound fear of being abandoned or left alone. This fear can lead to frantic efforts to avoid real or imagined abandonment, such as clinging to others or trying to prevent people from leaving, sometimes through extreme measures.
Unstable relationships: Relationships can be very turbulent for those with BPD. They might idealise someone one moment and then suddenly believe that the person doesn’t care enough or is cruel, leading to intense and unstable relationships characterised by frequent conflicts.

Unclear or shifting self-image: A person with BPD might struggle with their sense of identity, experiencing frequent changes in their self-image and values. This can lead to frequent changes in goals, jobs, friendships and even sexual identity.
Impulsive behaviours: Engaging in risky and impulsive behaviours is common. This might include spending sprees, unsafe sex, substance abuse, reckless driving or binge eating. These actions are often attempts to cope with emotional pain or to feel something when feeling numb.
Self-harm and suicidal behaviour: Self-harm behaviours and suicidal thoughts or actions are serious and common signs of BPD. These actions are usually responses to emotional distress or a perceived threat of abandonment.

What causes borderline personality disorder?

BDP is a complex mental health disorder with no single cause for it. In fact, there can be different ways in which a person develops the disorder. These are:

Genetics: Genetic studies indicate a significant hereditary component in BPD, with an estimated heritability of around 40%. Research from a Swedish population shows the strongest familial association in monozygotic twins, followed by dizygotic twins, full siblings and half-siblings, suggesting that genetics play a crucial role in the development of BPD.
Brain structure and function: Some studies have shown that people with BPD may have differences in the structure and function of certain areas of the brain, particularly those involved in emotion regulation and impulse control.
Environmental factors: Traumatic life events, especially during childhood, can significantly contribute to the development of BPD. These might include physical or sexual abuse, neglect or prolonged separation from caregivers.
Social factors: Unstable relationships and a lack of a supportive social network can also play a role. Early experiences with inconsistent or emotionally unavailable caregivers can affect one’s ability to form secure attachments and manage emotions.

Woman with a personality disorder

The link between borderline personality disorder and addiction

Borderline Personality Disorder and addiction often intertwine, creating a tough situation for those affected. People with BPD might use substances to cope with intense emotions, impulsivity and feelings of emptiness.

On the flip side, substance abuse can worsen BPD symptoms, leading to even more unstable relationships and emotional struggles. This dual challenge deeply impacts mental health, relationships and overall well-being. It’s important to address both issues together to find the path to recovery.

Experiencing both BPD and addiction can be incredibly tough, making everyday life and personal growth much harder.

For example, research shows that specifically, alcohol-dependent patients with personality disorders differ significantly from those without such disorders. They tend to exhibit a higher general psychopathological burden, experience an earlier onset of dependence and face more severe symptoms. Additionally, these patients often have a lower level of social functioning and are more likely to use other drugs. Suicidal behaviour is also more common among them and they generally have shorter periods of abstinence along with more frequent relapses.

Worryingly, BPD has also been found to have links to behavioural addictions, such as:

Borderline personality disorder and gambling addiction: A recent meta-analysis found that nearly half of pathological gamblers meet the criteria for a personality disorder. Most of these cases are Cluster B disorders, including borderline, histrionic and narcissistic personality disorders.
Borderline personality disorder and internet addiction: Cross-sectional studies have shown that the affective instability and impulsivity associated with borderline personality disorder (BPD) are linked to internet addiction (IA).
Borderline personality disorder and food addiction: The results of one study suggested that individuals with BPD might be more sensitive to rejection. This heightened fear of rejection can lead to increased emotional dysregulation, which in turn may result in dysregulated eating behaviours.

The results of the studies are concerning, underscoring the urgency of addressing the co-occurrence of addiction and Borderline Personality Disorder in a swift and comprehensive manner.

How is borderline personality disorder and addiction treated?

Treating addiction alongside BPD is challenging but with the right approach, it’s possible. People with BPD face unique hurdles in rehab, such as difficulties in forming relationships or feeling abandoned. At Linwood House, our experienced team understands these challenges and provides a supportive, compassionate environment tailored to individual needs.

Our recovery programmes address addiction while helping manage BPD symptoms. Many therapies used for addiction also benefit BPD, including:

Cognitive-behavioural therapy (CBT): CBT helps identify and change negative thought patterns and behaviours. It develops coping skills to manage emotions, reduce impulsivity and prevent relapse.
Dialectical behaviour therapy (DBT): Developed specifically for BPD, DBT teaches skills to manage intense emotions and improve relationships. It effectively reduces self-harm behaviours and enhances emotional regulation.
Group therapy: This supportive environment allows sharing experiences and learning from others. For those with BPD and addiction, it fosters connection and social skills, which are crucial for preventing relapse.
One-to-one therapy: Individual sessions provide a confidential space to explore thoughts, feelings and behaviours. They are particularly beneficial for addressing the unique challenges of managing both conditions.
Aftercare: Long-term support is essential for maintaining recovery. At Linwood House, we offer weekly group therapy sessions for a year after treatment, providing ongoing support and connection, crucial for those with BPD who often struggle with feelings of abandonment and maintaining relationships.

BPD therapy session

What are the next steps?

If you or a loved one is struggling with both BPD and addiction, Linwood House is here to help. Our comprehensive treatment programmes are designed to address both conditions with care and expertise. Reach out to us today and start your journey towards healing and recovery. We understand the complexities you face and are committed to providing the support you need every step of the way.

(Click here to see works cited)

“Personality Disorders.” GOV.UK Ethnicity Facts and Figures, NHS Digital, 4 Mar. 2021, www.ethnicity-facts-figures.service.gov.uk/health/mental-health/prevalence-of-personality-disorder-in-adults/latest/.
Chapman J, Jamil RT, Fleisher C, et al. Borderline Personality Disorder. [Updated 2024 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/
Nenadić I, Voss A, Besteher B, Langbein K, Gaser C. Brain structure and symptom dimensions in borderline personality disorder. Eur Psychiatry. 2020 Feb 7;63(1):e9. doi: 10.1192/j.eurpsy.2019.16. PMID: 32093800; PMCID: PMC8057374.
Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S. The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective. Front Psychiatry. 2021 Sep 23;12:721361. doi: 10.3389/fpsyt.2021.721361. PMID: 34630181; PMCID: PMC8495240.
Beeney JE, Hallquist MN, Clifton AD, Lazarus SA, Pilkonis PA. Social disadvantage and borderline personality disorder: A study of social networks. Personal Disord. 2018 Jan;9(1):62-72. doi: 10.1037/per0000234. Epub 2016 Dec 12. PMID: 27936840; PMCID: PMC5468502.
Kienast T, Stoffers J, Bermpohl F, Lieb K. Borderline personality disorder and comorbid addiction: epidemiology and treatment. Dtsch Arztebl Int. 2014 Apr 18;111(16):280-6. doi: 10.3238/arztebl.2014.0280. PMID: 24791755; PMCID: PMC4010862.
Moreira D, Azeredo A, Dias P. Risk Factors for Gambling Disorder: A Systematic Review. J Gambl Stud. 2023 Jun;39(2):483-511. doi: 10.1007/s10899-023-10195-1. Epub 2023 Mar 8. PMID: 36884150; PMCID: PMC9994414.
Internet Use Expectancy for Tension Reduction and Disinhibition Mediates the Relationship between Borderline Personality Disorder Features and Internet Addiction among College Students – One-Year Follow-Up.” Computers in Human Behavior, Pergamon, 13 Nov. 2015, www.sciencedirect.com/science/article/abs/pii/S0747563215301771.
Selby EA, Ward AC, Joiner TE Jr. Dysregulated eating behaviors in borderline personality disorder: are rejection sensitivity and emotion dysregulation linking mechanisms? Int J Eat Disord. 2010 Nov 1;43(7):667-70. doi: 10.1002/eat.20761. PMID: 19806606; PMCID: PMC4243037.