What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a condition that massively increases your risk of addiction. One study estimates that about 78% of people with BPD will develop a substance use disorder at some point in their lives, compared to only about 8% of the general population. However, BPD is a fairly obscure disorder. Major depression and anxiety disorders, for example, are far more common and although there are many misconceptions related to those conditions, people generally understand what they’re about and probably know at least one person who has struggled with them. On the other hand, a condition like schizophrenia is far less common but the sometimes extraordinary symptoms attract a lot of attention. BPD, by contrast, is less well-known and the name doesn’t offer much insight either. Insofar as people know about it at all, they often assume it’s similar to bipolar disorder, which isn’t really accurate. The following is a brief look at BPD, what it is, how it affects your life, and how it’s treated.
Who Does BPD Affect?
Roughly 2.7% of adults have BPD. Although it is often associated with women--perhaps because of stereotypes involving hyperemotionality--BPD affects men and women about equally. The perception that BPD mainly affects women has likely led to it being under-diagnosed in men so it’s important to be aware that men have about equal risk. Symptoms also appear to be more severe in younger adults and often get milder with age.
BPD is currently not well understood but it appears that many of the risk factors that are relevant for other mental health issues are relevant for BPD as well. For example, there appears to be a genetic component, so if a close family member such as a parent or sibling has BPD, you are more likely to develop it at some point. Childhood environment appears to be another major risk factor as well, particularly any history of abuse or neglect. One central characteristic of BPD is an intense fear of abandonment, so any childhood trauma related to abandonment or neglect--either physical or emotional--may be particularly relevant.
The symptoms of BPD are mainly characterized by two factors: the intensity of emotions and all-or-nothing thinking. In other words, people with BPD tend to feel overwhelmed by their emotions, both positive and negative, and they have trouble coping with the complex gradations that characterize much of our emotional lives. This affects how they relate to themselves and others.
Unstable Sense of Identity
First, the difficulty dealing with emotional complexity, as discussed above, along with other factors make it hard for someone with BPD to form a stable and coherent sense of identity. Much of our identity comes from our relationships to others and if these associations are always fluctuating wildly, it’s hard to know where you stand. Your judgments of yourself are also subject to these kinds of fluctuations. And finally, if your emotional reactions to people, values, and ideas are always drastically changing, it’s hard to form a coherent sense of yourself and this can sometimes be extremely disorienting.
Fear of Abandonment
As noted above, BPD is typically characterized by an extreme fear of abandonment. They may go to great lengths to avoid abandonment, either real or imagined. For example, they may escalate a relationship quickly or completely cut off contact suddenly if they are afraid they might be pushed away. However, like most people, those with BPD want to have stable, intimate, and meaningful relationships. The desire for close relationships and the fear of abandonment can create a lot of emotional stress.
As discussed above, BPD is characterized both by very intense emotions and by all-or-nothing thinking. Therefore, to someone with BPD, someone or something may be either amazing or terrible, with little in between and these judgments may change from one day to the next. They often experience intense anger that they have trouble controlling. They may experience moods that are both intense and changeable and these moods may last hours or days. This is one reason BPD is sometimes mistaken for bipolar disorder, although bipolar episodes typically last something more on the order of weeks.
Predictably, emotional volatility, intense anger, fear of abandonment, and an unstable sense of self often lead to relationship problems. Because people with BPD typically fear abandonment, they may adore someone one day and despise them the next for no apparent reason. Obviously, this can be confusing and stressful for the people in their lives. It also tends to confirm the worst fears of the person with BPD when the people they care about start to distance themselves because of this behavior.
Impulsiveness and risky behavior is another common characteristic of BPD, and it is especially common in those with a co-occurring substance use disorder. This might include excessive drug and alcohol use, unsafe sex, reckless driving, or spending sprees. This is another behavior that sometimes leads to BPD being confused with bipolar disorder since reckless behavior is also a common feature of manic episodes. Clearly, the mix of substance use with frequent feelings of intense anger and alienation puts someone at high risk for developing a substance use disorder.
Treating BPD can be difficult. Not only is the condition poorly understood, but successful psychotherapy depends on a good therapeutic relationship, which is one of the central problems of BPD. However, dialectical behavioral therapy, or DBT, has been shown to be pretty successful in treating BPD. DBT is based on the more common cognitive behavioral therapy (CBT), but it’s more intensive and places more emphasis on accepting and regulating challenging emotions as well as developing interpersonal skills to improve relationships. To those ends, DBT has both individual and group therapy components, as well as more frequent contact with the therapist between sessions.
BPD is one of the less well-understood mental health issues and it affects a relatively small percentage of people. However, for those it does affect, it is practically the perfect storm for creating a substance use disorder. It undermines relationships and causes a deep sense of alienation, it causes intense and rapidly changing emotions, including anger, and it often leads to impulsive behavior. If you or someone you love shows symptoms of borderline personality disorder, it’s crucial to seek help as soon as possible, whether or not substance use is also a problem.
At Foundry, we know that substance use is usually only the most visible part of a bigger problem. Most people who struggle with addiction have a co-occurring mental health issue and BPD is one of the most challenging. We offer DBT as well as a range of other therapeutic options as part of our comprehensive approach to treating addiction. To learn more, call us today at (844) 955-1066.