What Causes BPD?

Borderline Personality Disorder & Addiction

You might have heard about the condition called, “Borderline Personality Disorder” or “BPD” for short.

And you might even have a vague idea of what it means if someone is “borderline.” Since there are a lot of misconceptions and uncertainties about this condition, we will break down the facts of BPD and its unfortunately strong connection to drug and alcohol abuse.

People diagnosed with BPD have difficulty controlling their rather intense and extreme emotions. They also experience intense mood swings and have trouble returning to a more neutral state of mind. As the National Institute of Mental Health says, “These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.”

Signs & Symptoms

Someone with BPD can display mood swings over short periods of time that are brought about for no apparent reason.

The way they see themselves in the world can also fluctuate on a daily basis, which can lead to unusual changes in behavior and even ethics.

The opinions they have, especially of other people, change rapidly. One day, someone will be their favorite person in the world, and the next day, that same person will be banished from their social orbit. This often leads to personal and work relationships that are unstable at best, and disastrous at worst.

Additionally, when encountering someone with BPD, it can be very difficult to know what exactly will trigger the person. Sometimes, the most mundane, ordinary event can set someone with BPD off, and it won’t matter whether that person is a loved one, close friend, work colleague or even complete stranger.

There’s a wide variety of other symptoms as well, but not everyone with BPD will have all of them. Since every person is different, the mix of signs and symptoms in someone with BPD will also vary. Here are a few other symptoms to look out for:


  • Makes efforts to avoid feeling abandoned, whether real or imagined
  • A history of unstable relationships
  • Unstable self-image
  • Lack of sense of self
  • Impulsive, dangerous, and self-harming behavior
  • Suicidal ideation, threats, and attempts
  • Extreme and rapidly shifting moods
  • Apathy, feeling empty inside
  • Inappropriate and extremely intense anger
  • Trust issues
  • Feelings of bodily dissociation and a sense that life isn’t real

In addition to physical cravings, someone with an addiction issue will also spend a tremendous amount of time thinking about their drug of choice. These thoughts become a compulsion and impossible to control, which leads to drug-seeking behavior that can sometimes be criminal.

Feelings of depression, sadness, anxiety, despair, and the like are often at the root of substance abuse. The substance might temporarily mask these feelings, but they return once the high wears off, creating a vicious circle of drug abuse.

Taking a substance will temporarily stop the cravings and compulsion for it, but soon the same feelings return. In time, it takes more and more of the same substance to achieve the same effect it once had.

People addicted to drugs and alcohol may feel like they have no control over their drug use. Refraining from using or stopping seems to be an impossibility for them. The substance controls them, rather than the other way around.

Someone addicted to drugs or alcohol will continue to seek them out even if their addiction has made them lose friends, family, spouses, and jobs. Drug-seeking behavior can even lead to diseases such as hepatitis and HIV/AIDS.

What Causes BPD?

What causes BPD isn’t currently fully understood. However, research does indicate that there are several risk factors involved in developing this condition.

Over the last decades, research has shown how addiction is much closer to a disease that has physical causes than to a simple lapse of judgment or willpower. While all the causes of addiction remain the subject of ongoing research, we do know that continued abuse of drugs and alcohol causes physical changes to the brain that leads to overwhelming cravings (research has also shown that similar changes can be created in the brain by things like gambling, sex, and other risky activities).

The fact is, people become addicted to drugs and alcohol in many different ways. Contemporary research looks at things like “risk factors” and “protective factors.” Risk factors increase a person’s tendency to become addicted to drugs or alcohol. Protective factors are types of interventions that can help nullify the risk factor. A table put together by the National Institute on Drug Abuse summarizes these risk and protective factors like this:


BPD tends to run in families. Someone with BPD may discover that a close family member suffers from the condition as well. Whether this is a genetic trait or something passed on through behavior is unclear.


The brains of people with BPD have differences in the areas that control emotion and impulse. However, it’s not known whether these changes cause BPD or occur because of BPD.


People who grew up in traumatic, unstable environments seem to be more prone to developing BPD. The Mayo Clinic notes, “Many people with the disorder report being sexually or physically abused or neglected during childhood.” Being separated from a caregiver at a young age, or having a caregiver display BPD traits are also thought to be a cause.

Statistics on BPD

The National Institute of Mental Health reports that:

  • 1.4% of the adult U.S. population experiences borderline personality disorder
  • Nearly 75% of people diagnosed with BPD are women
  • Men may be equally affected but are misdiagnosed with PTSD or depression

This means that over four million people in the United States currently have BPD. However, it’s likely that the number is much higher due to the condition being misdiagnosed as bipolar disorder, PTSD, or major depressive disorder.

If you are considering treatment for yourself or a loved one, call us today.

BPD’s Connection to Substance Abuse

As the NCBI states, “For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person.”

Another study also published by the NCBI suggests that “About 78% of adults with BPD also develop a substance-related disorder or addiction at some time in their lives.”

Why is the combination of BPD and addiction so prevalent?

Many people with BPD come from traumatized backgrounds. Unable to deal with their emotions in a healthy way, they turn to drugs or alcohol to help them cope or to mask feelings they would rather not address in a more productive manner.

Symptoms of someone with substance use disorder are also similar to many other symptoms of BPD, which means that someone with BPD can easily fall into a pattern of drug abuse. Things like impulse control, mood swings, unstable relationships, and deceitful behavior can easily lead someone with BPD to seek out drugs or alcohol to help them deal with the condition. Other symptoms overlap as well, such as depression, anxiety, and suicidal thoughts.

All of this makes treatment for someone with a “dual diagnosis” of BPD and a drug addiction rather complicated but possible. It’s unlikely that the person will get better on his or her own, and treatment for BPD has been shown to be effective, contrary to what was once thought.

Treatment Options

People with a dual diagnosis of both BPD and addiction often require a special program to get well. Usually, detox is the first stage in a comprehensive therapy regime. This is then followed by things like Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT).

Cognitive Behavioral Therapy (CBT)

CBT for BPD involves finding practical solutions to a person’s problem. Situations, thoughts, and triggers that cause problems to arise are first identified. These thoughts are then analyzed with the help of a therapist. Lastly, specific strategies are developed and then implemented that help overcome the feelings and thoughts that arise from any given trigger or event.

Dialectical Behavioral Therapy (DBT)

This type of therapy was first developed by Dr. Marsha Linehan, a psychologist at the University of Washington, to treat people with BPD; since then, it’s been used for other forms of mental health disorders as well. This form of therapy helps people learn to deal with their emotions in a much healthier way.

As part of a total program, CBT and/or DBT are often complemented by:

  • Motivational Enhancement Therapy
  • Multidimensional Family Therapy
  • Psychodynamic Therapy
  • Motivational Interviewing
  • Gestalt Therapy
  • Eye Movement Desensitization and
  • Reprocessing (EMDR)
  • Rational Emotive Behavior Therapy (REBT)
  • Art Therapy
  • Surf Therapy
  • Music Therapy
  • Yoga
  • Meditation and Mindfulness

Are Natural Remedies Available?

While prescription drugs like antidepressants are sometimes prescribed to help people with BPD, there is no single FDA-approved medication to treat the whole condition.

SSRIs and other antidepressants may treat some of the symptoms, such as depression and anxiety, but they fail to address the total issue.These days, people sometimes look for alternative or natural remedies for different conditions, including BPD. A few studies have shown some promise. In fact, in 2008 the NCBI published a study indicating that the Chinese herbal medicine yi-gan san (YGS, yokukan-san in Japanese) may be useful in treating BPD.

Other natural remedies someone might consider are things that are believed to treat depression and anxiety. These include:

  • Eating an anti-inflammatory diet
  • Daily exercise
  • Avoiding alcohol and caffeine
  • Taking vitamin D, magnesium, and omega-3 fatty acid supplements
  • St. John’s Wort and valerian root for anxiety

While these sorts of natural remedies may be worth a try, they will almost undoubtedly be more effective in combination with traditional therapies like CBT or DBT, especially when a dual-diagnoses is involved. If you or a loved one has a dual diagnosis of BPD and a concurrent addiction issue, it’s crucial to seek out help. Remember, you are not alone. Reach out to Nexus today to take the first step on your recovery journey.

If you or a loved one are suffering from addiction and/or dual diagnosis, we’re here to help. Contact us today and speak with one of our trusted recovery advisors.

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