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Dual Diagnosis: Borderline Personality Disorder

    Dual Diagnosis: Borderline Personality Disorder

    Borderline personality disorder is a condition that impacts an individual’s cognition, behaviour, and emotional stability. It tends to arise as a result of a difficult childhood which influences how an individual feels and thinks as an adult.

    While it has a variety of effects that make it a difficult condition to define, those who struggle often have distorted views of themselves, difficulty controlling their emotions, and relationship problems.

    Those with the condition are often at risk of developing an addiction, largely due to a desire to relieve their symptoms. While effective at first, substance abuse often makes things worse and exacerbates symptoms.

    What is borderline personality disorder?

    Borderline personality disorder (BPD) is a condition that greatly influences how an individual thinks, affecting their mood, their reasoning, and how they interact with others.

    It is a complex disorder, and its traits are often not very well understood by the medical world and the wider public. Its effects are varied, and they mainly include a distorted perception of the self, impulsive behaviour, and emotional instability.

    What are the signs and symptoms?

    The specific symptoms of BPD are not specifically known, as how the condition manifests itself can vary greatly from person to person. Instead, there are 4 main categories of symptoms that an individual may experience:

    • Behavioural – individuals can be impulsive and hyperactive
    • Emotional – individuals can experience ‘affective dysregulation’, involving unpredictable emotional activity and powerful emotional reactions
    • Cognitive – individuals can have distorted perceptions of themselves or others, as well as erratic thought patterns
    • Social – individuals tend to have tumultuous relationships which change very suddenly

    While these symptoms are not very specific, they can often cause individual great distress and put them in harm’s way. For example, their impulsiveness can turn into aggression, or it can cause them to act on sudden suicidal impulses.

    Their psychological symptoms can also cause them to experience emotional pain. For example, their distorted perceptions can often cause them to feel abandoned by those that they love, or provoke strong feelings of paranoia.

    While the individual will not intend for it, these symptoms can also impact those closest to them. Relationships can take on a hectic course, making a loved one feel treasured one minute and forgotten the next, and mood swings and impulses can sometimes pose the risk of violence.

    Risk factors

    Regarding why some individuals develop BPD and others don’t, there is further uncertainty. As with the condition’s symptoms, there seems to be a variety of factors.

    Primarily, an individual’s susceptibility to developing BPD lies in the quality of their relationships throughout childhood and adolescence, as the condition mainly consists of an individual struggling with relationships and emotional stability.

    The emotional and psychological basis for our future relationships and perceptions largely stem from our experiences as children, and so major disruptions during this period can have serious effects on development.

    Events that can increase the risk of BPD developing include:

    • Abandonment – if an individual is left by a parent, friend or sibling as a child, the related emotions can manifest in later life as BPD
    • Abuse – sexual, emotional, or physical abuse can cause an individual to develop the BPD symptoms of emotional instability and trouble keeping relationships
    • Disruption – the disturbance of family life – for example through a divorce, relocation, or tragedy – can affect an individual’s emotional and cognitive development
    • Nurturing – a child who is not properly nurtured and communicated with is likely to struggle to relate to and sympathise with others in later life

    Borderline personality disorder and addiction

    It is common for those with BPD to develop an addiction [1], with alcoholism being the most common type. There are several reasons why this relationship with addiction exists.

    Why does addiction occur?

    Firstly, a lot of individuals who develop BPD have unstable childhoods, in many instances due to a parent being addicted to alcohol.

    To some extent, alcoholism and general substance abuse is genetic, and the children of addicted individuals also tend to adopt their parents’ behaviours in later life. This means that those BPD may exhibit the same behaviour when they grow up.

    Another theory suggests that the use of addictive substances stems from the BPD symptoms of impulsivity. Those with the conditions often act quickly without thinking, and so becoming addicted may be a result of them consuming large or frequent quantities of a substance without thinking.

    Finally, as with other mental health conditions which have a relationship with addiction, there is the notion that BPD sufferers turn to addictive substances as a means of self-medicating.

    The symptoms related to BPD can be both discomforting and destructive, and those with the condition are therefore more likely to turn to substances like alcohol which have sedative effects. Drinking can soothe them and reduce the impact of their symptoms.

    Making things worse

    While using substances can relieve individuals of their symptoms at first, addiction ultimately makes their BPD worse.

    When an individual consistently consumes an addictive substance, their body slowly becomes used to it. As this happens, body chemistry begins adapting, eventually causing a dependency on the substance’s presence to develop.

    This causes withdrawal symptoms when use of the substance is stopped, as well as an increased tolerance. The latter means that an individual needs to consume more of it in order to achieve its initially positive effects.

    However, many substances such as alcohol have an overall negative effect on those that consume them. Known as depressants, these substances upset the brain’s chemical balance and cause an individual to experience emotional instability and cognitive complications.

    For someone with BPD, this drastically worsens their symptoms. They can become more impulsive, experience greater cognitive distortions, and cause greater harm to their relationships.

    In many cases, an individual’s response to this will be to consume more of the substance to sedate themselves again. However, the body’s new tolerance will mean that they need to consume even more of it to do this.

    Over time, this cycle repeats itself, pushing an individual further and further into their addiction.

    Treatment

    For individuals who suffer from BPD, treatment largely consists of therapies designed to help them handle difficult emotions and develop greater cognitive control. If they are also facing an addiction, it is essential that this is dealt with at the same time.

    Treating BPD

    Therapy is the preferred method of treating BPD, with medication only playing a role when there are other symptoms hindering progress. For example, if an individual has another condition impacting their treatment, such as insomnia, they may be provided medicinal support, possibly in the form of sleeping pills.

    Primarily, however, an individual will undergo therapy – often several types at one time – which looks to help them better cope with their symptoms and improve their social interactions [2].

    Examples include Dialectical Behavioural Therapy (DBT), which aims to help individuals cope with difficult emotions, and Mentalisation-Based Therapy (MBT), which teaches them to examine and understand the thought processes of themselves and others.

    Either as part of a group or as a one-on-one session with a counsellor, therapy’s goal is to allow an individual to live with their BPD in a way that does not hinder their social life, relationships, and professional prospects.

    Treating addiction

    When it comes to addiction, the primary goal of treatment is to kick the body’s dependence on the substance in question, and this is done via detoxification, where an individual discontinues their use of it.

    This process is often very uncomfortable and, in the case of alcohol, extremely dangerous. Withdrawal symptoms can cause serious harm, so it is essential that an individual only attempts detox with medical assistance.

    Within a dedicated rehab centre, an individual can detox with their health being constantly monitored. Medicinal substitutes can also be prescribed to reduce withdrawal symptoms if required.

    Alongside this weaning of the body, an individual can also benefit from therapy. Cognitive Behavioural Therapy (CBT) is a popular option, designed to help an individual recognise what situations prompt them to use a certain substance.

    This often works in tandem with therapies relating to the roots of an individual’s BPD, emphasising the importance of treating both conditions simultaneously.

    How to get more information

    If you or someone you know is struggling with borderline personality disorder, it is important to seek help and speak to a medical professional. Speak to a GP to discuss what support and treatment options are available.

    It is essential to seek help if an individual is also struggling with addiction. This can be incredibly dangerous, so speak to a GP and find out what treatments are most appropriate for the situation.

    References

    [1] https://pubmed.ncbi.nlm.nih.gov/8273769/

    [2] https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/

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