Borderline Personality Disorder and Addiction – How To Understand Yourself and Accept Treatment

Borderline personality disorder (BPD) is a condition that most often occurs in people who have experienced trauma early in life. It is characterized by anger, instability, mood swings, and impulsiveness. People who suffer from BPD often hold very strong opinions about others, are suspicious of their motivations, and have difficulty finding and maintaining stable, trusting relationships. The borderline personality is prone to substance abuse for a number of reasons – the most obvious being the pre-existence of trauma, and the development of impulsive personality traits. Studies have found that 50-70% of persons with BPD also have another co-occurring substance use disorder. BPD sufferers also tend to very willful – a characteristic that can increase the difficulty of treatment. If you have been diagnosed with borderline personality disorder and are also suffering from addiction, it is worthwhile to understand the challenges that treatment professionals fac – and what you can do to make treatment easier on yourself, as well as others who are trying to help you.

Complying with Treatment

Keeping the BPD patient in addiction treatment can be a daunting task. Studies show that the longer the borderline personality stays in treatment, the better the outcome. However, perhaps due to willfulness and a general mistrust of others, BPD sufferers tend to be resistant to treatment. For example, one study found that BPD patients in a detox program were much more likely to have an “unplanned discharge” than others. At the same time, however, patients can be very demanding of treatment, and insist that others go out of their way to care for them. In general, BPD personalities tend to look for quick fixes and exhibit a lack of patience – impulsivity may also drive a desire to move on quickly during periods of frustration or boredom. As a patient, the borderline personality can assist themselves and others by recognizing their resistance to change and attempt to understand why this is so (often due to trust issues.) Also, there is a tremendous need to fully understand and accept that the treatment process is often time-consuming, difficult, and will probably require an extended duration.

Therapist-Patient Relationships

Again, often due to trust issues and impulsiveness, many patients drop out of therapy because of difficulties engaging in relationships. Also, due to strong convictions about others, the borderline personality tends to flip-flop regarding feelings about another’s motivations. For example, in a breakthrough moment, the borderline personality may perceive a therapist as a needed support source – someone who is very helpful and understanding, almost to the point of being a savior. But if the patient perceives any sign of criticism or rejection, the therapist may instantly become an enemy who is not deserving of trust. At this point, the patient may become resistant or drop out of therapy entirely. As a patient, the borderline personality can help facilitate therapy by attempting to put aside feelings of distrust. Keep in mind, these feelings are very normal for someone with BPD – but also understand that these feelings do not have to overtake every personal interaction. It is true that not all therapists are not created equal, and some may be more judgmental or less effective and understanding than others. That said, if you are a patient and find you are bonding well with a therapist, it may behoove you to set aside suspicious feelings when they arise – or at least, try not to overreact to what you perceive as criticism. Moreover, no one is saying that your feelings are not valid. But you have to realize that they are still your own subjective perceptions, and often do not accurately reflect the motivations and intentions of the therapist.

Understanding the Risk of Relapse

BPD patients with a substance use disorder are at a high risk for relapse. Underlying issues, such as trauma, are often driving addiction and behavioral patterns. Keep in mind, relapse is a significant risk faced by most substance abusers. For the borderline personality, however, the risk may be increased due to trauma, impulsiveness, and straight up stubbornness. Again, knowing the inherent characteristics of your personality can help you avoid relapse. The key is to understand why you do what you do, and the feelings and dynamics involved with your particular condition. Relapse is common and normal among all addictions – it is not necessarily a sign that your therapist or treatment is failing you. Indeed, the very fact that you relapse is an indication that you have quit, at least for some time, and are seeking recovery. Simply put, relapse is probably going to happen, and you need to understand it’s not just you.

Understanding Dysfunction in Relationships

Sufferers from BPD often crave attention and affection. However, due to severe, continual trust issues, relationships tend to be very volatile and may result in rejection. When this occurs, it is often more or less due to the self-fulfilling idea that one’s self is not good enough to be loved by another. It is this negative self-image, coupled with suspicions about others that sabotages relationships, particularly among family and friends, or anyone who tends to get too close. Everyone must determine those who are worthy of trust and those who are not. If you have borderline personality disorder, your distrust of others and low self-esteem is probably contributing to your inability to maintain stable, healthy relationships. Again, working on trust issues and understanding that your suspicions are often unfounded can help you regain your ability to let others get close to you. You are no more inherently flawed than anyone else – moreover, it is your perception of yourself (and others) that makes it feel that way.

Conclusion

Unfortunately, borderline personality disorder can be a very debilitating and often unhappy condition to live with. And a sufferer is, by nature, prone to substance abuse, as a means to self-medicate away negative thoughts and feelings. Fortunately, however, BPD is treatable, and so is addiction. I encourage you to educate yourself on the characteristics of BPD, and more than anything, to open yourself up to trusting someone else – and entertain the idea that another person may be honest in their desire to help you. ~ G. Nathalee Serrels, M.A., Psychology