Where Addiction Meets Your Brain

The Neurobiology of Addiction

Borderline Personality Disorder and Addiction

Chaos for those suffering from BPD and Addiction

Borderline Personality Disorder (BPD) is a commonly co-occurring disorder with addiction. BPD is an emotionally painful disorder for everyone involved. Couple that with addiction and it is devastating.

BPD by definition is a disorder characterized by dysregulation of emotions, interpersonal relationships, behaviors, thinking processes and unstable self-image. Without getting too complicated, people with borderline personality disorder or borderline features tend to lose their temper easily and may rage without much provocation, relationships are tenuous and fragile, threats of suicide or self-damaging behavior is common, feelings of emptiness and low self-worth are seen and people with BPD tend to have cognitive disturbances and tend to “take things personally” when nothing accusatory is intended.

So what we see in the lives of people with BPD is, in a word, chaos. These people are demanding, hard on themselves and others, constant life crises. The chaos leads to shame and lack of self-worth even though the person may be very intelligent or accomplished. They engage in a lot of helplessness, frequently asking for help but not carrying through with moving to a conclusion.

On a practical note, BPD patients tend to be like an angry tornado destroying things along their path, but they feel terrible about themselves when they look back on the destruction. They tend to look at the world through green glasses when everyone else is looking through red glasses. They are puzzled by the fact that they are not understood and that they do not understand others. Their emotional and cognitive filters are faulty and misinterpretation and distortion of words and intent are part of everyday life.

So how does this fit with addiction? Well, people with BPD make up about 1 % of the population, but they are overrepresented when it comes to the number of people with BPD who have addiction. So if someone is an addict, there is a much likelier chance than 1% that they have BPD. Addiction plus BPD can be lethal as BPD patients are more likely to be suicidal and impulsive to begin with. Add alcohol or drugs and the ability to prevent self-harm goes out the window.

I am blogging about this because there are many addicted people who either have BPD or have a spouse or relative with BPD who have no idea why things are so chaotic. If this sounds like someone you know, it is a serious problem. But it is treatable. First, if there is addiction, the drug and alcohol use must be arrested. But beyond not drinking or drugging, there is psychological and psychiatric help for people with BPD. Treatment such as Cognitive Behavioral Therapy and Dialectical Behavioral Therapy can be extremely beneficial and even life-saving. Sometimes BPD patients are so deregulated that medication is needed for someone suffering this way.  Better to get help than suffer unnecessarily.

Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.
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