Borderline Personality Disorder and Alcohol

Borderline Personality Disorder and Alcohol

Borderline Personality Disorder (BPD) and Alcohol

Authored by Jane Squire MSc

Edited by Hugh Soames B.A.

Reviewed by Philippa Gold

Borderline Personality Disorder, also known as BPD, is a mental illness that is often misunderstood by individuals. It is a disorder that is extremely complicated and disparaged by non-sufferers. BPD is very similar to addiction in the way that others interpret and treat individuals suffering from it. Unfortunately, individuals often possess both BPD and addiction at the same time, and the two elements cause more damage to the person.


Research has found that one in 100 people possess BPD. There are multiple reasons as to why a person develops BPD with one of the most common ways being childhood trauma.1 Doctors refer to BPD as ‘borderline’ because they believe it could be in between two different mental disorders: psychosis and neurosis. Some experts have renamed BPD as Emotionally Unstable Personality Disorder (EUPD) due to the latter name clarifying the illness far better than the former.


Around half of the individuals with BDP also show signs of alcohol abuse and substance abuse disorder. The most common addiction that BPD sufferers possess is alcohol addiction.2 Compared to other psychological disorders, BPD has one of the highest percentages of sufferers also experiencing alcoholism.


Diagnosing BPD can be difficult for specialists when an individual also suffers from alcohol addiction. Alcohol abuse and BDP share symptoms making it difficult to know which disorder to treat. If left untreated, both BPD and alcoholism are dangerous. Treatment when both disorders are present in an individual is complex.


Defining Borderline Personality Disorder


BPD attacks a person’s emotions and the relationships they have with others. Individuals struggle emotionally due to the illness and it can be difficult to connect with other people. Relationships can become frayed rather easily for BPD sufferers. The addition of a substance or alcohol abuse can make struggling with emotions even more difficult.


The illness does not segregate against men and women as both genders suffer equally from the condition. However relative to the population Women have a higher level of overall diagnosis.3 According R. A., & Sansone (2011) Men are not diagnosed with BPD as often and this is typically due to them being less likely to seek out medical help. BPD is not the same for everyone. Individuals experience the illness differently and the addition of addiction can magnify the problems caused by it.


Individuals suffering from Borderline Personality Disorder may exhibit the following problems:


  • Feel isolated or abandoned by the people in their lives
  • Self-harm
  • Show signs of suicide or have suicidal thoughts
  • Stress
  • Lack stress management skills
  • Struggle to build relationships and get along with other people
  • Strong emotions that are difficult to control
  • Abuse alcohol or prescription drugs
  • Abuse illegal substances
  • Struggle to understand other people’s opinions
  • Struggle to hold down employment
  • Difficult to remain in a long-term relationship
  • Cannot maintain a home


What are the symptoms of Borderline Personality Disorder?


The illness leaves sufferers with a fear of being abandoned along with moods that change quickly. Individuals will also show signs of impulsive behavior and a low-quality of self-worth. BPD can be experienced in mild to severe form, but all cases are unique and depend on how extreme the symptoms are. BPD sufferers often show symptoms such as:


  • Strong and/or extreme emotions
  • Will co-opt the emotions or pain of others as their own
  • Reasoning is always black or white
  • Avoid abandonment by going to extreme measures
  • Attempt self-harm and/or suicide
  • Quick to anger and little to no anger-management skills
  • Paranoia or dissociation caused by stress
  • Hypersensitive to criticism and/or rejection
  • Constant feeling of emptiness or depression
  • Routinely experience unstable relationships


One of the biggest issues BPD sufferers have is they are seen as childish and attention-seeking. Due to their moods changing rapidly, others see them as unstable but do not understand that it is because of a mental illness. Unfortunately, due to relationship breakdown and other issues caused by BPD, around 10% of sufferers commit suicide. Men are more likely to commit suicide than women.


Why do BPD sufferers turn to alcohol?


The symptoms and feelings caused by BPD combine to influence individuals to turn to alcohol to self-medicate. Alcohol is not the only form of self-medication people with BPD turn to. Some seek out prescription or illegal drugs while others self-harm. Addiction is common in BPD sufferers due to them being highly impulsive people.


In terms of self-medicating, alcohol is the most common way people with BPD try to cure themselves. It is believed that alcohol can lessen the intense emotions and pain that is experienced. Meanwhile, others believe alcohol to be a social anxiety aid that makes them more entertaining and/or fun to be around.


Opioids and cocaine are two other popular drugs BPD suffers self-medicate with. Like alcohol, these drugs target the endogenous opioid system (EOS). EOS is a neglected area in people with BPD and alcohol, opioids, and cocaine stimulate the system.  Dual diagnosis (also known as simultaneous or co-occurring disorders) is a term when a mental illness and a substance use disorder occur simultaneously.


How is BPD treated?


The complexity of BPD makes it difficult to treat and some professionals choose not to work with patients. The reason doctors do not want to work with BPD patients is because patients are not easy to work with. Patients can be difficult to convince that help is needed. These individuals may also quit their treatment if sessions are difficult.


Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT) are the two most common forms of treatment. DBT is the preferred way to treat BPD patients. For the most part, DBT is just CBT, but created for patients with BPD. The treatment has been effective in reducing the possibilities of self-harm in patients. Interestingly, Equine Assisted Psychotherapy and Satori Chair sessions have been proven to relieve symptoms, in conjunction with therapeutic intervention.


Unfortunately, there is currently no specific medication give to BPD sufferers although Topiramate, sold as Topamax is often used in an off-label capacity.4 Studies have shown it safe and effective agent in the treatment of borderline personality disorder. Certain other medications can be given, however, to alleviate symptoms experienced by patients, and periods of inpatient rehab can be recommended for those displaying more severe symptoms. Inpatient treatment is often seen as the best option for patients as it provides sufferers with an intense treatment process that can help them with multiple co-morbid conditions.


References for BPD and Alcohol


1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Author; 2000. text rev. []

2. Baer RA. Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Academic Press; 2005. []

3. Burton P, Gurrin L, Sly P. Tutorial in biostatistics. Extending the simple linear regression model to account for correlated responses: An introduction to generalized estimating equations and multi-level mixed modeling. Statistics in Medicine. 1998;17:1261–1291. [PubMed] []

4. Carter BL, Tiffany ST. Meta-analysis of cue-reactivity in addiction research. Addiction. 1999;94(3):327–340. [PubMed] []

5. Drummond DC. Theories of drug craving, ancient and modern. Addiction. 2001;96(1):33–46. [PubMed] []

6. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, … Kaplan K. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Alcohol Research & Health. 2006;29:107–120. [PubMed] []

7. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry. 2007;64(7):830–842. [PubMed] []

8. Kober H. Emotion regulation in substance use disorders. In: Gross JJ, editor. Handbook of emotion regulation. 2nd edition. New York: Guilford; 2014. pp. 428–446. []

9. Rabe-Hesketh S, Skrondal A. Multilevel and Longitudinal Modeling Using Stata Vol 1: Continuous Responses. 3rd ed. 1/2. College Station, TX: Stata Press Publication, StataCorp LP; 2012a. []

10. Sax LJ. Health trends among college freshmen. Journal of American College Health. 1997;45(6):252–262. [PubMed] []

11. Tiffany ST, Wray JM. The clinical significance of drug craving. Annals of the New York Academy of Sciences. 2012;1248(1):1–17. [PubMed] []

12. World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992. []


Further Reading on BPD and Alcohol


National Education Alliance for Borderline Personality Disorder:

Borderline Personality Disorder:

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Boderline Personality Disorder and Alcohol
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Boderline Personality Disorder and Alcohol
The symptoms and feelings caused by BPD combine to influence individuals to turn to alcohol to self-medicate. Alcohol is not the only form of self-medication people with BPD turn to. Some seek out prescription or illegal drugs while others self-harm. Addiction is common in BPD sufferers due to them being highly impulsive people.
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