Borderline personality disorder and addiction

Last Updated:

March 24th, 2025

Living with borderline personality disorder (BPD) is a journey fraught with emotional turbulence, intense relationships and a pervasive sense of uncertainty about your identity. It’s a mental health condition that is often misunderstood, which only adds to the challenge for those experiencing it. When addiction enters this already disorientating labyrinth, the complexity only deepens further. It is a dual diagnosis that is overwhelming, casting a shadow of hopelessness over your entire life. However, it is crucial to understand that there is genuine hope if you are ready to reach out. If you are struggling with both borderline personality disorder and addiction, professional support and comprehensive treatment can guide you out of this seemingly inescapable maze to a new life of happiness and opportunity.

What is borderline personality disorder?

Borderline personality disorder is a complex mental health disorder that creates a profound and often painful way of experiencing the world. BPD is characterised by emotional instability, impulsive behaviour and intense fear of abandonment or judgement. People with BPD often struggle with their self-image, which can fluctuate wildly from one moment to the next. Relationships are typically stormy, marked by a constant push-pull dynamic that can be confusing and distressing.

The term “Borderline Personality” originated in the early 20th century, reflecting the belief that the disorder sat on the “borderline” between neurosis and psychosis. Today, we understand that this is a misnomer, as BPD is neither of these but a unique condition in its own right.

Borderline personality disorder types

Crucially, borderline personality disorder is not a one-size-fits-all diagnosis; it manifests in various forms, each with unique characteristics. For example, histrionic borderline personality is characterised by intense, unstable emotions and a distorted self-image. Individuals with histrionic borderline personality disorder may engage in attention-seeking behaviours and exhibit a heightened sensitivity to rejection or criticism. Their emotional expression can be overly dramatic and they may struggle with a deep-seated fear of being ignored or unloved.

Common borderline personality disorder symptoms and signs

Borderline personality disorder symptoms are diverse and affect virtually every aspect of life. As noted above, symptoms and signs of borderline personality disorder can vary from person to person and between different borderline personality types. However, general borderline personality disorder symptoms include:

  • Intense fear of abandonment: This fear can lead to desperate efforts to avoid real or imagined abandonment, resulting in a pattern of unstable relationships.
  • Unstable relationships: People with BPD often have relationships that are intense and short-lived. They may idealise someone one moment and then suddenly believe the person doesn’t care enough or is cruel.
  • Unclear or shifting self-image: A persistently unstable self-image or sense of self often leads to frequent changes in jobs, friends, lovers, religion, values, goals and self-identification.
  • Impulsive, self-destructive behaviours: These can include substance abuse, eating disorders, reckless driving, unaffordable spending sprees, self-harming and suicidal thoughts and actions.
  • Extreme emotional swings: Intense mood swings can last from a few hours to a few days and can include intense happiness, irritability, shame or acute anxiety.
  • Chronic feelings of emptiness: People with BPD often describe feeling empty, as if there is a void inside them that cannot be filled.
  • Explosive anger: This can involve intense, inappropriate anger or difficulty controlling temper.
  • Feeling suspicious or out of touch with reality: Paranoia and dissociative feelings often occur under stress.

Dual diagnosis: Borderline personality disorder and addiction development

The development of a dual diagnosis of borderline personality disorder and addiction can often be traced to the core symptoms of BPD itself. The intense emotional pain, fear of abandonment and unstable relationships that characterise BPD create a fertile ground for substance abuse and addiction. This is often compounded by a history of trauma (common in individuals with BPD), which can profoundly impact emotional regulation and coping mechanisms, making substance use an appealing escape.

However, as the individual with BPD turns to alcohol, drugs or other substances to numb their emotional pain, the temporary relief can lead to repeated use. Over time, this repeated use can escalate into addiction, creating a new set of problems while exacerbating existing borderline personality disorder symptoms.

Co-occurring addiction and borderline personality disorder can present as:

Borderline personality disorder and alcohol addiction

Alcohol is a common substance of abuse as its initial calming effect can provide temporary relief from the intense emotional turmoil characteristic of BPD. However, as the body develops tolerance, more alcohol is required to achieve the same effect, leading to a cycle of increased consumption and dependency. Alcohol can also exacerbate the mood swings, impulsivity and emotional instability of BPD, ultimately leading to a worsening of borderline personality disorder symptoms.

Borderline personality disorder and drug addiction

Drug addiction, whether involving prescription medications, opioids or illegal drugs, presents a similar pattern. Drugs may offer a temporary escape from the emotional distress and instability of BPD, but over time, they contribute to a decline in mental health and exacerbate borderline personality disorder symptoms. This cycle can be particularly hard to break due to the addictive nature of many drugs and the deep-rooted emotional issues associated with BPD.

How are borderline personality disorder and addiction treated?

The presence of BPD in individuals struggling with addiction presents unique challenges in addiction treatment. Individuals may potentially react more intensely to perceived criticism or rejection in therapy, while detox alone will not address the underlying emotional and psychological issues driving the addiction.

UKAT recognises that treating the dual diagnosis of BPD and addiction requires a holistic, integrative approach. Our rehab centres address the psychological, physical and behavioural components of addiction, all of which can have a positive knock-on effect on borderline personality disorder symptoms. UKAT London Clinic can offer even more comprehensive care, treating both addiction and borderline personality disorder at the same time.

This approach is highly effective because addressing only one condition often leads to limited success, as each condition can exacerbate the other. Our rehab treatment programmes typically involve:

One-to-one therapy
In one-to-one therapy, your therapists will work closely with you to unravel the complex web of emotions, thoughts and behaviours that characterise borderline personality disorder and addiction. This personalised attention allows for deep exploration of your personal issues, trauma and the specific challenges of living with BPD.
Cognitive behavioural therapy (CBT)
CBT is a key part of all effective treatment for both addiction and borderline personality disorder. It can identify and challenge negative thought patterns and behaviours and can help you stabilise emotions and impulsivity. These are key symptoms of BPD and also driving forces of addiction, so stabilisation can be a huge step forward on the path to recovery.
Dialectical behaviour therapy (DBT)
DBT was initially created for people with BPD and is particularly effective for those with a dual diagnosis. This therapy combines standard cognitive-behavioural techniques with mindfulness practices and focuses on accepting uncomfortable thoughts, feelings and behaviours rather than struggling with them. These skills are crucial for managing your intense emotions and relationship difficulties and can also aid in overcoming addiction.
Group therapy
In group therapy, you will find a supportive environment where you can share experiences and learn from others facing similar challenges. It offers a sense of community and belonging, which can be particularly valuable for someone with BPD who may feel isolated. In the context of addiction treatment, group therapy helps you understand the common patterns and triggers of addictive behaviour and develop strategies to maintain sobriety.
Meditation and mindfulness
Meditation and mindfulness practices will help you centre yourself, become more aware of your thoughts and feelings, and learn to respond healthier. These practices can reduce the BPD-fuelled impulsivity and emotional intensity that often lead to substance use.
Trauma-based therapy
If you have a history of trauma, trauma-based therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) can be instrumental in your healing process. These therapies can help you process and heal from traumatic experiences, thereby reducing one of the root causes of both BPD and addiction.
Yoga therapy
Yoga therapy combines physical postures, breathing exercises and meditation to improve mental and physical health. For someone with borderline personality disorder and addiction, yoga can offer a way to develop greater body awareness, emotional regulation and stress relief.
Aftercare
Aftercare is a critical component of your treatment for dual diagnosis. Weekly group therapy sessions for a year will provide ongoing support and help you stay committed to your recovery journey. These sessions offer a safe space to discuss challenges, celebrate successes and receive encouragement from peers and therapists.

Start your new life today

Embarking on the journey of recovery from BPD and addiction is undoubtedly challenging, but it is also a path filled with hope and opportunity for transformation. UKAT provides the comprehensive, compassionate care needed to address the complexities of co-occurring BPD and addiction and create a more stable, fulfilling life. With the right support and treatment, a life of stability, health and happiness is not just a possibility; it is within your reach. Contact UKAT to start your journey towards recovery today.

FAQ’s

Is borderline personality disorder a type of OCD?
No, BPD is not a type of obsessive-compulsive disorder (OCD). While both are mental health disorders, they are distinct in their characteristics and symptoms. BPD is primarily characterised by intense and unstable relationships, self-image and emotions, along with impulsivity. OCD, on the other hand, is defined by unwanted and repetitive thoughts (obsessions) and behaviours (compulsions) that the individual feels driven to perform. Although some symptoms may overlap, the underlying causes and treatment approaches for BPD and OCD are different.
Is borderline personality disorder the same as bipolar disorder?
BPD and bipolar disorder are separate mental health conditions, each with its unique set of symptoms and treatment approaches. BPD involves instability in behaviour, personal relationships, self-image and emotions. Bipolar disorder, in contrast, involves distinct periods of depression and mania which are changes in mood, energy and activity levels. While both disorders can involve mood swings, the nature, duration and triggers for these mood changes differ significantly.