Borderline Personality Disorder

Borderline Personality Disorder is a common disorder that occurs alongside addiction. On its own, it is a painful experience for all involved. Coupled with addiction, it can be devastating. BDP is characterised by dysregulation of behaviours and unstable self-image, relationships and emotions. You’re likely to become angry quickly and lose your temper with little provocation.

Mental health issues such as these push you to self-medicate negative emotions or take impulsive actions. Addiction and Borderline Personality Disorder is one of the hardest co-occurring disorders to treat. You’re more likely to leave rehab against medical advice, despite evidence showing that staying longer in treatment reaps positive results.

What is Borderline Personality Disorder?

Borderline Personality Disorder is a mental health issue affecting emotions, mood and your ability to sustain relationships. The term was coined by psychoanalyst Adolph Stern in 1938 to describe patients on the borderline between psychosis and neurosis.

It’s a problem that goes undiagnosed, misdiagnosed or untreated in millions of people around the world.  BPD makes it difficult for you to hold down a job or sustain a relationship. In despair or loneliness, you might be tempted to look for comfort in alcohol and illicit substances.

Researchers believe Borderline Personality Disorder is caused by altered brain chemistry, whereby specific areas of the brain are underdeveloped (or more active in some). Most medications for BPD work by suppressing others and stimulating certain areas of the brain to restore balance and treat specific facets of the disorder.

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Signs and Symptoms of Borderline Personality Disorder

In many cases, symptoms of BPD are confused with addiction, because they share similar characteristics, making it harder to diagnose. Thankfully, therapists and neuroscientists have made giant strides in recent years to understand BPD. Common symptoms include:

Extreme episodes of anxiety or depression

  • Paranoia
  • Feeling empty inside
  • Eating disorders, such as bulimia or anorexia
  • Intense emotional swings
  • Manipulative behaviour
  • Impulsive behaviour
  • Extreme changes in perceptions of others
  • Extreme fear of being alone

Spotting Addiction and Borderline Personality Disorder

As a BDP patient, emotions are more extreme. In a moment of rage, you could destroy everything in your path and when you calm down, feel sorry for the chaos you’ve caused. You see the world differently from others, because your cognitive and emotional filters are faulty. Add substance abuse to the mix and you’re more likely to be impulsive, suicidal or harm yourself. Other symptoms include:

Manipulative deceitful actions

Mood swings, such as manic intense energy one minute and severe depression the next

Engaging in risky behaviour to the detriment of your personal safety

Some Statistics on Borderline Personality Disorder

In the UK, seven in every thousand people have Borderline Personality Disorder.

70% of individuals with Borderline Personality Disorder will attempt suicide, with 8%-10% success.

1.6% of Americans are diagnosed with BPD, but the figures are higher when you consider undiagnosed or misdiagnosed BPD.

20% of individuals with BPD have Bipolar Disorders.

Almost half the people diagnosed for BPD who seek treatment won’t meet the criteria in two years.

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Origins of Bipolar Disorder

The terms for bipolar extremes, mania and melancholy have their origins in ancient Greek -particularly to Aretaeus of Cappadocia, a philosopher and physician during the time of Vespasian or Nero in the first century AD. He suggested that both behavioural patterns result from the same disorder, but the theory didn’t gain popularity until the modern era, when Jean Pierre Falret and Jules Baillarger presented separate descriptions on Bipolar Disorder to the Academie de Medicine in Paris.

Falret’s findings (which translates to “circular insanity”) was published in 1851 and details individuals switching between manic excitement and severe depression. His work was considered as the first official document on Bipolar Disorder.  History changed with Emil Kraepelin, who recognised biological causes of mental illness and detailed the difference between praecox and manic-depressive (schizophrenia) in 1921.

The term ‘Bipolar Disorder’ first appeared in the American Psychiatric Association DSM in 1980, with a revision that avoided calling patients ‘maniacs’. The document is the leading guide for mental health professionals and includes detailed diagnostics and treatment guidelines to help doctors treat Bipolar Disorder in today’s patients.

Who is at risk of Bipolar Disorder?

Like other mental health issues, there is no single risk factor for developing Bipolar Disorder. Researchers believe it’s a combination of multiple factors that triggers the illness. Risk factors include:

Genetics: Genetics is a known risk factor for mental health related illnesses. If your parents had mental health issues, there’s a chance you might have Bipolar Disorder. Symptoms manifest in teenage years or early adulthood, with the average onset at 25 years. A study of identical twins shows that both twins might not have Bipolar Disorder, as other factors decrease or increase the risk.

Environment: A major life change or living in a stressful environment might trigger Bipolar Disorder. Childhood factors such as neglect, death of a loved one, or physical or sexual abuse increase the risk of developing Bipolar Disorder.

Substance Use Disorder: If you abuse drugs and alcohol, you’re at risk of Bipolar Disorder. Although this doesn’t cause Bipolar Disorder, it worsens or speeds up the onset of symptoms.

Gender: While both sexes are equally affected, women are three times more likely to experience rapid cycling of mood episodes and mixed episodes, compared to men.

Brain structure: Some research findings on brain scans are associated with Bipolar Disorder, although more research is needed to determine how Positron Emission Technology (PET) and Functional Magnetic Resonance Imaging (FMRI) impact Bipolar Disorder.

The Relationship between Borderline Personality Disorder and Addiction

The relationship between addiction is fostered by difficulties you might experience with emotional regulation and attachment to others. Researchers indicate that most people with a BPD diagnosis also have a substance use disorder. Drugs and alcohol are substitutions that allow you to create a false perception that by abusing these substances, you can control self-image, emotions and relationships.

Although addiction with mental health disorders is serious, the combination is more lethal with BPD, as drugs and alcohol bring out the worst of symptoms such as depression, rage and suicidal ideation. In fact, the risk of suicide is 400 times higher if you have BPD than the national suicide rate. It’s hard to distinguish between addiction and BPD, but simultaneous treatment is important to overcome barriers such as paranoia, hostility and impossible demands.

Borderline Personality Disorder makes it extremely difficult to manage relationships with friends, family or cope with pressures at work. If your loved one shows any of these symptoms, please seek professional help.

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How to Be a Friend to Someone Who Has Borderline Personality Disorder

Given the symptoms of Borderline Personality Disorder, it’s clear to see that maintaining a friendship or relationship with someone who has BPD won’t be easy. Sometimes, their helplessness and emotions make you feel helpless in turn. Here are a few tips to help you be a good friend to someone with BPD.

Validate their feelings: sometimes, all you can do is sit and listen. You don’t have to share the same views they express or accept justification for actions, but you can let them know you understand the emotional difficulties they’re facing. Receiving validation from people they care about is a huge relief to someone with BPD, because they will often think that no one cares about their feelings.

Learn all you can: The first step to helping anyone with mental health issues is to learn about the disease in question. It will help you understand that their hurtful and destructive behaviour are reactions to deep emotional pain. You also need to familiarise yourself with the symptoms of BPD. Small things might trigger a reaction, as they’re extremely sensitive.

Stay in touch, don’t isolate: It’s hard to be around someone with BPD. You may feel like you have to tiptoe around their feelings to avoid an outburst and censor every statement you make, so it won’t be misconstrued. In spite of the difficulties, stay in touch with them. They’re more likely to turn to drugs if they feel alone than when they’re supported by loved ones like you.

Join a support group: There are support groups for friends and family of individuals with BPD. Interacting with others who understand what you’re going through makes it easier.

Take threats of self-harm seriously: A major symptom of BDP is the threat of suicide. Some make multiple threats, leading family members and friends not to take these seriously. People with BPD are at high risk of committing suicide, with 10% actually going through with it. If you think there’s a risk they might commit suicide, call the emergency services, so that professionals who are better qualified can then access the risk of self-harm.

Take care of yourself: In many friendships and relationships with people who have BPD, you give more of yourself than you get. It’s okay if this happens sometimes, but as a regular occurrence, it strains the relationship.

It leads to mental health issues such as depression, anxiety, hostility and distrust. You’ll burn out easily and feel resentment towards the person with BPD. Therefore, it’s extremely important that you take breaks when needed to care for yourself. Create boundaries in the relationship; this way, you can have your needs fulfilled when needed.

The Cost of Having Borderline Personality Disorder

When talking about the cost of Borderline Personality Disorder, it’s not limited to the physical cost suffered as a result of mental illness. BPD is a chronic, highly prevalent condition. Its problematic nature is associated with significant societal costs that haven’t been properly assessed in the past. Costs include medication, healthcare, productivity losses, informal care and out-of-pocket expenses.

The inability to hold down a regular job means you’ll be living month to month through your income. Your impulsive nature spurs you to splurge on items you don’t need, nor can afford. It feels like buying these items can make you happy, but in reality, it doesn’t. There’s also the cost of maintaining drugs, food and alcohol addiction. When you decide to get treatment, state funding might not be available, and you’ll need private treatment to properly address other co-occurring disorders associated with BPD.

The NHS can’t keep up with the demand for treatment, nor does it cover one-on-one therapy – an essential part of psychotherapy for BPD. Because of anxiety, many can’t use public transport or stay in tight spaces. Taxis to and from therapy appointments cost money, which can prove expensive – especially for those on low incomes.

However, above all else, the biggest cost is that of the risk of suicide. One in 10 people with BPD die from taking their own lives, so listen when they ask for help.

Borderline Personality Disorder Myths

Commonly held myths about Borderline Personality Disorder include:

BDP is not treatable: BDP is treatable, even with the presence of co-occurring disorders. A diagnosis of BPD doesn’t mean you can’t get better. Psychotherapy is very effective in reducing the symptoms of BPD.

BPD is a personality flaw: Every individual has a unique set of characteristics and flaws that make them human. BDP is not a personality flaw, it simply means your view of the world is different from that of others.

Only women suffer from BPD: it’s a widely held myth that women are the only ones who suffer from BDP. While more patients are women, statistics shows that 25% of diagnoses are men.

All individuals with BPD are victims of abuse: Most people assume that BDP is brought on by traumatic experiences you went through as a child. There is no known cause of BPD and it’s seen as a combination of several risk factors, rather than a single cause.

Only adults have BPD:  the fifth edition of the Diagnostic Statistical Manual states that caution must be used when diagnosing any mental health issues, especially for disorders that mimic adolescent behaviour. While personality is still forming during adolescence, early diagnosis ensures your pre-teen gets the psychological help they need for recovery.

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Dual Diagnosis Treatment for Borderline Personality Disorder and Addiction

DBT: one the most effective treatments for addiction and BPD is Dialectical Behaviour Therapy (DBT) – a therapy approach designed to treat borderline disorder, using skills-based techniques to teach you to tolerate distress, manage emotions and improve relationships. Treatment includes skills training, individual therapy sessions and phone coaching, where needed.

Mentalization Based Therapy (MBT): This approach combines individual and group therapy to help you gain a better understanding of yourself and become more aware of your thoughts and the thoughts in the minds of others.

Cognitive Behavioural Therapy (CBT): CBT is a therapy model that targets the thinking-related and action-related parts of mental health. The goal of CBT is to reduce symptoms of BPD by helping you understand past behaviours that led to negative thoughts; changing the way you think; interpreting situations; and helping you exhibit positive action in your daily life.

Medication: while studies on the effectiveness of pharmacology in treating BPD have provided mixed results, some medications are useful in treating specific symptoms. Medications include Selective Serotonin Reuptake Inhibitors (SSRIs), antipsychotics, antidepressants and mood stabilisers.

The Challenges of Treating Addicts with Borderline Personality Disorder

Challenges faced during treatment include:

Treatment compliance: You are likely to be treatment resistant and demanding. Having one disorder is a notorious issue; together, this complicates treatment. A study of BDP patients in detox shows they’re more likely to discharge themselves early than others without BPD.

Relationship with therapist: A symptom of BPD is difficulty establishing or maintaining relations with others. This carries over into treatment, where you’ll likely find it harder to establish trust with your therapist, who you might feel has taken you away from the only stable relationship you’ve experienced; that being with drugs. You might become passive-aggressive, miss sessions and view your therapist as the enemy when they criticise or disapprove of your actions.


What is Borderline Personality Disorder?

BPD is a mental illness, characterised by impulsiveness, distorted self-image, intense, unstable relationships and extreme emotions. You might suffer from depression, anxiety and eating disorders, alongside BPD.

What Causes Borderline Personality Disorder?

Researchers have found factors that contribute to Borderline Personality Disorder include genetics from family members who suffered from BPD; low levels of dopamine, serotonin and noradrenaline neurotransmitters in the brain; environmental factors; and neurobiology, where some parts of the brain are more active or smaller in those with BPD.

How Do BPD and Addiction Overlap?

It is a common occurrence for addiction and BPD to occur concurrently, as two-thirds of people suffering BDP have abused drugs at least once in their lives. You might take BPD to self-medicate symptoms and feel better about yourself. Both addiction and BPD share similar characteristics such as deceitful actions, self-destructive behaviour and unstable careers and relationships.

How is BPD Treated?

Talk therapy is often the first approach used in the treatment of BDP. There are two weekly sessions involving therapy approaches, such as Dialectical Behavioural Therapy, Transference-Focused Therapy, Mentalization-Based Therapy (MBT) and Good Psychiatric Management. Medication is provided to help with symptoms such as impulsivity, depression and anxiety.

What medications are used to treat Borderline Personality Disorder?

Although there are no FDA-approved medications specifically for treating BPD, certain medications help with co-occurring disorders and specific symptoms. Medications include: antipsychotics, SSRIs, antidepressants, Omega-3 fatty acids, anti-anxiety, mood stabilisers and sedatives. Names of medications include Xanax, Klonopin, Seroquel, Buspar, Tegretol, Ativan and Valium.

Where can I find help, treatment and support for Borderline Personality Disorder?

Start by seeing your primary care doctor, who can refer you to a psychiatrist or psychologist. You might need intense treatment in a clinic or hospital to manage suicidal thoughts and prevent self-harm. If you’re having suicidal thoughts, call your local emergency number, therapist, doctor or a loved one.

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