Borderline Personality Disorder and Addiction

Tackling addiction is tough enough on its own, but when coupled with Borderline Personality Disorder (BPD), the challenge of overcoming addiction becomes even more complex. What’s more, a staggering 78% of people with BPD will struggle with a substance-related disorder or addiction at some point in their lives, highlighting the importance of understanding how the two interact with each other and how to get the best treatment possible.

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a complex mental health condition and is considered to be part of Cluster B personality disorders. This cluster is characterised by dramatic, overly emotional or unpredictable thinking or behaviour.

Those who have BPD often find themselves showing symptoms of rapid and intense mood swings. They might also struggle with a deep sense of uncertainty about their self-identity. It’s common for their feelings towards others to shift dramatically quickly, oscillating between feeling very close and suddenly very distant or disapproving. This whirlwind of emotions often results in relationships that are full of emotional distress.

Their interests, values, and even sense of self can change abruptly, leading to spontaneous or risky behaviours that might seem out of character.

How is a person diagnosed with Borderline Personality Disorder?

According to the DSM-5, to receive a diagnosis of BPD, an individual must exhibit a pervasive pattern of instability in interpersonal relationships, self-image and emotions, as well as significant impulsivity. This begins by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following nine criteria:

  • Frantic efforts to avoid real or imagined abandonment.


  • Chronic feelings of emptiness.


  • Recurrent suicidal behaviour, gestures or threats or self-mutilating behaviour.


  • Transient, stress-related paranoid ideation or severe dissociative symptoms.


  • A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.


  • Identity disturbance: markedly and persistently unstable self-image or sense of self.


  • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).


  • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).


  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).


Disclaimer: This information is intended for educational purposes only and should not be used as a tool for self-diagnosis. Although medical professionals utilise these criteria as part of the diagnostic process for Borderline Personality Disorder (BPD), they do so with extensive training and licensing that equip them to interpret these signs within the broader context of an individual’s mental health and life history. Attempting to self-assess using these criteria is not advised.

If you are concerned about your mental health or believe you might meet these criteria, it is crucial to seek evaluation and support from a licensed mental health professional.

What causes Borderline Personality Disorder?

Trying to pinpoint one specific cause of BPD isn’t recommended due to the numerous and diverse pathways through which it can develop. Each person’s experience is unique, and applying a one-size-fits-all approach to understanding the origins of BPD could prove inefficient and potentially harmful. Recognising the complexity and variability in the development of BPD, we highlight below some of the main areas from which it can emerge.

Issues with brain development
People with Borderline Personality Disorder (BPD) may have differences in how their brains are structured and function, especially in areas responsible for controlling emotions and making decisions. For example, the amygdala, which helps process emotions and the prefrontal cortex, which is key for planning and managing impulses, might differ in size or activity. These changes could result from issues during important stages of brain development, possibly due to genetics or early life stress. As a result, individuals might find it hard to handle their emotions and stress, which are common signs of BPD.
Issues with brain chemistry
The balance of certain neurotransmitters, like serotonin, dopamine and noradrenaline, which all play a part in mood regulation, can be off. This imbalance can lead to problems with controlling impulses and emotions, making the symptoms of BPD more pronounced. Some research indicates that people with BPD could have differences in how their brain uses these neurotransmitters, leading to affective instability.
Environmental and genetic factors
The development of BPD could arise from the interaction between genetic predispositions and specific environmental factors. Impulsivity and heightened emotional sensitivity become problematic when combined with particular family environments: chaotic families lacking support, ‘perfect’ families intolerant of negative emotions and typical families that clash with the needs of a sensitive child. These dynamics could lead children to develop dysfunctional coping mechanisms in response to their surroundings.

Adding another layer of complexity, children inherit not just their parents’ genes but often their environments too, blurring the lines between genetic predisposition and environmental exposure.

Can Borderline Personality disorder co-occur with addiction?

It’s not uncommon for BPD to appear alongside addiction as people with BPD are more likely to struggle with substance use disorders than those without BPD. The interplay between Borderline Personality Disorder and addiction is intricate, with each one possibly making the other’s symptoms more severe.

Self medication

For those dealing with BPD, deep emotional pain, instability and a sense of emptiness are all too familiar. These intense feelings are tough to handle and can cause a lot of suffering. In an attempt to cope or find a temporary escape from these overwhelming emotions, individuals might lean on alcohol, drugs or prescription meds. This approach to self-medication seeks to dull or flee from the severe emotional distress tied to BPD. Yet, while using substances may offer a momentary sigh of relief, it tends to make BPD symptoms worse in the long run, creating a harmful loop of growing substance reliance and deteriorating mental health.

Trauma and negative past experiences

While this is another form of self-medication, the frequent co-occurrence of BPD and addiction extends beyond managing the intense emotions characteristic of BPD alone. This co-occurrence often serves as a mask for previous negative experiences, especially trauma and adverse childhood events. Their substance use can be seen as an attempt to dull the pain and memories of their earlier traumas, suggesting a deeper layer of psychological distress.

Addiction and BPD both share traits of impulsivity

Impulsivity stands out as a hallmark of BPD, characterised by rash decisions and actions without thought for the aftermath. This impulsiveness can lead to various damaging behaviours, such as unsafe driving, overeating, engaging in risky sexual activities and notably, substance use. The instant satisfaction or respite substances provide can be particularly tempting for those with BPD, heightening their risk of falling into addictive habits.

Treatment for Borderline Personality Disorder and addiction

At Sanctuary Lodge, our primary mission is to support individuals in overcoming addiction. Recognising the intricate relationship between addiction and mental health, particularly with conditions like BPD, we extend our expertise and care to those facing these co-occurring challenges.

Although our facility is not specifically designated for BPD treatment, the therapeutic approaches we implement are beneficial for those with BPD, especially when it co-occurs with addiction. Below are some of the therapeutic options we provide:

Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) is a crucial part of our therapy services, especially beneficial for individuals with Borderline Personality Disorder (BPD) and addiction. Originally designed for BPD, DBT has proven highly effective in improving emotional regulation and interpersonal skills. It equips individuals with valuable tools to manage the challenges of BPD and addiction simultaneously.
Group therapy
Group therapy is essential in Sanctuary Lodge’s programme for Borderline Personality Disorder and addiction. It fosters a supportive environment for sharing experiences and gaining insights from peers, fostering community. Particularly beneficial for those with BPD, it offers a safe space to work on interpersonal dynamics while addressing addiction recovery.
One-to-one therapy
Our one-to-one therapy sessions offer a private space for in-depth exploration of your journey through addiction and, when present, its interplay with BPD. Tailored to the unique needs of each person, this personalised approach allows for a focused exploration of both conditions, facilitating the development of targeted coping strategies and deeper personal insights.
Holistic therapies
Sanctuary Lodge adopts a holistic approach to recovery, incorporating art, yoga, and mindfulness alongside traditional therapies in our BPD and addiction treatment programmes. These practices complement each other, addressing recovery’s mental, emotional, and physical aspects. For individuals with BPD, they promote mindfulness, self-awareness, and emotional balance, which are essential for managing symptoms alongside addiction recovery.

What are the next steps?

It’s incredibly brave to recognise when you need help, especially when battling both Borderline Personality Disorder and addiction. Sanctuary Lodge offers a compassionate, understanding environment tailored to address these challenges. Here, you’ll find professional support that respects your individual journey, providing the tools and care necessary for healing and recovery. Reaching out might feel daunting, but it’s a step towards regaining control and finding peace. You’re not alone, and Sanctuary Lodge is ready to walk with you every step of the way.

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