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Borderline personality disorder (BPD) is a complex, misunderstood, and highly-misunderstood mental illness, just like alcoholism. Either of the conditions can make life difficult to live for anyone, and having them together leads to an even bigger problem. Unfortunately, the rate of comorbidity between BPD and alcohol addiction is very high. Statistics suggest that up to 50 percent of people diagnosed with BPD also meet the criteria for substance use disorder. Hence, people diagnosed with this psychiatric illness must educate themselves about the association, how it affects them, and what to do about it before it significantly affects their life.

An Overview of Borderline Personality Disorder

Also known as an emotionally unstable personality disorder (EUPD), borderline personality is a mental illness characterized by rapidly changing moods, fear of abandonment, poor sense of self-identity, and impulsive behaviors. The term “borderline” suggests that this mental illness’s symptoms border on neurotic and psychotic behaviors.

Estimates suggest that there is currently 1.6 percent of diagnosed cases of BPD in the United States. However, because the condition is very difficult to pinpoint and label, the real prevalence could be as high as 5.9%. BPD can have various spectrums, depending on the intensity of its symptoms, which may include:

Intense emotions
Unstable relationships
Long-term feelings of depression or emptiness
Stress-induced dissociation or paranoia
Black-and-white thinking
Acts, attempts, or idealization of suicide or self-harm
High sensitivity to rejection or criticism
Poor anger management
Weak temper
Going to extreme efforts to prevent abandonment

The intense emotions that a person with BPD feels are not only their own. For example, if they see someone in pain, they may replicate their emotions as if the pain is their own. While this makes it easy for the patient to connect with others, it may get them attached to others too quickly, often in an unhealthy way.

Unfortunately, most people with BPD are deemed manipulative, attention-seeking, and childish because of how they act. The rapidly changing moods they experience can also make others feel as if they have different personalities. Due to this reason, many people find it challenging to live with, get into a relationship with, or do business with someone with BPD. Ironically, this feeds their fear of abandonment, which only worsens things. Hopeless, such people often resort to other means of coping with these difficulties, one of which is alcohol use.

Borderline Personality Disorder and Alcohol Addiction

Alcoholism and mental health disorders often go hand-in-hand, and an increasing number of experts are now researching the complex interplay be t ween the two. As the awareness regarding the relationship of alcohol with more prevalent psychiatric issues like depression and anxiety continues to expand, most experts leave other disorders like BPD out of the picture.

Between 50 to 7- percent of individuals with BPD simultaneously suffer from a substance use disorder, and alcohol tops the list. The reason for this extremely high rate of concurrence is in the multidimensional symotomatologies of borderline personality disorder itself, according to experts. The lives of such people are full of chaos due to interpersonal difficulties, a lack of emotional regulation, extreme vulnerability to distress, minimal healthy coping skills, and an unstable sense of self. All of these issues force them to make alcohol a pleasant escape from the world of constant turmoil in which these people are residing.

While these psychosocial issues can just as easily lead to alcoholism as a part of other mental health disorders, BPD has two features that dampen the self-protecting instincts in individuals and make it more prevalent. These two features include self-harm and impulsivity, which can easily temper alcohol use and force patients to act on self-destructive impulses, sometimes even deliberately. These impulsive thoughts disrupt their ability to limit their alcohol use and may even remove the desire to do so in the first place. The incidence of BPD and alcohol blackouts can also be justified by these impulsive thoughts where an individual may be aiming to drink as a way of attempting suicide or self-harm.

BPD and Alcoholism: Is Drinking a Substitution for Attachment?

Another unique component that may propel individuals with BPD to use and abuse alcohol is a lack of secure attachments. Many experts are of the viewpoint that a disturbance in secure attachments, especially in early childhood, can easily make one vulnerable to developing alcohol dependence. If this ongoing attachment insecurity remains even in adulthood, the risk of formation and articulation of BPD becomes significantly higher. Many behaviors included as a part of BPD are maladaptive attempts that take place subconsciously to access secure attachments.

A growing body of evidence related to neurobiological research now proposes that substance use in some individuals also serves as a substitute for unmet needs for attachment. For instance, studies suggest that people who were weaned early from breastfeeding were more likely to develop alcoholism in adulthood. Experts now speculate that the satisfaction of unmet attachment needs may make alcohol and other substances attractive to people with BPD.

As such, alcoholism in most people with BPD has been thought of as merely an escape from painful symptoms. However, it may be much more than that in reality. The reason behind the concept of a BPD alcoholic can be deeply rooted in their attempts to fulfill their primal psychological needs. These findings also explain why a lot of people suffering from this disorder experience an earlier onset of drinking, heavier use of alcohol, and more relapses even after seeking alcohol addiction treatment.

Symptoms of Alcoholism in People with BPD

If you compare the signs of alcohol addiction with the symptoms of borderline personality disorder, a lot of similarities may become noticeable. These similarities are why it may be difficult to diagnose if a person has either one or both illnesses. Some common aspects that both these issues share include the following:

Unhealthy Coping

People with BPD and alcohol use disorder rely on alcohol as a coping mechanism. Be it day-to-day problems, stress, or other emotions, both are likely to use alcohol in excessive amounts, which ultimately leads to dependence and tolerance.

Unstable Behaviour

Long-term or chronic use of alcohol alters brain function, leading to angry outbursts and mood swings that are often seen with BPD as well. Alcohol may also affect concentration and memory, which are common in people with BPD, especially in stressful situations. Most borderlines are already at a high risk of self-harming behavior, and using alcohol makes them lose their inhibitions, further increasing the risk of suicide.

Dysfunctional Lifestyle

Alcoholism can easily lead to neglect in self-care, work, finances, and relationships, which people with BPD also face on a routine basis. Both types of individuals constantly miss out on responsibility, either because of their drinking habits or fear of socialization. To cover up these faults, both types of individuals may lie.

Codependent Relationships

Most people with BPD easily get attached to others and may have difficulty letting go of the relationship, even if it turns violent. Such people may also end up with someone with obvious harmful narcissistic traits as they display the characteristics that individuals with BPD crave. A narcissistic person appears as caring but is controlling or abusive in reality, and despite acknowledging these traits, it may get complicated for a BPD patient to leave them because of a fear of abandonment. Likewise, many alcoholics, particularly women, end up in codependent relationships. This is particularly true if their partner also abuses alcohol.

A Traumatic Past

The exact cause behind BPD remains unclear, but experts are of the opinion that a mix of genetic predisposition with environmental factors can play a role in it. Factors like how an individual was raised, their community, and their history of childhood trauma are essential to consider in this regard. With alcoholism, the same factors also play a role.

BPD and Alcohol: Seek Concurrent Treatment For True Relief

The unique relationship that alcoholism and BPD share is one of the reasons why the conventional treatments addressing these issues have low success rates. Research pinpoints that people with BPD, along with co-occurring alcohol abuse, are less likely to re-experience their borderline symptoms but are at a higher risk of restarting their alcohol use. Hence, it is essential to acknowledge the mutually reinforcing and reciprocal nature of BPD and alcohol use to make people more aware of their issues and offer them more meaningful options for treatment.

If you or a dear one has been exhibiting signs of both issues simultaneously, it is best to look for a professional rehabilitation center to kickstart the treatment journey as soon as possible. A good treatment center employs a highly-skilled team of psychiatrists, therapists, and psychologists with adequate training and experience to provide evidence-based treatment. Through a personalized program that uses integrative therapies, these experts address the full scope of patient needs with understanding, compassion, and care.

The curriculum of these programs includes the most effective and science-backed therapeutic modalities, such as:

Dialectical Behavior Therapy ((DBT)

DBT is the gold-standard treatment for helping people with BPD move toward recovery.

Trauma-Focused Therapies

Many people fighting borderline personality disorder and alcoholism simultaneously have a history of sexual abuse, childhood neglect, or physical violence. Trauma-focused therapies help individuals break through the traumatic events that may be holding them back.

Throughout the therapeutic experience, experts will constantly support you in exploring your unhealthy relationship with alcohol. Moreover, they will encourage you to reframe this relationship to achieve true, lasting sobriety. In this way, a good, professionally-led treatment plan can equip everyone with BPD and alcoholism with the stability, insight, and skills they need to flourish.

FAQs

Does alcohol mask the symptoms of BPD?

Yes, it can get difficult to recognize specific symptoms of borderline personality disorder due to the obvious effects of alcohol use. Problems like boredom, feelings of emptiness, intense moods, difficulty controlling anger, and unstable relationships depict that you may be suffering from BPD but cannot see it because your compulsive drinking habit has masked it. The best thing to do in this case is to visit a mental healthcare professional and request an assessment. Once a diagnosis is made, the symptoms of both conditions can be managed through appropriate treatment.

How can I know that my occasional drinking habit has turned into dependence?

If you have been diagnosed with BPD and have been drinking for a long time, you naturally tend to develop alcohol tolerance and dependence. To catch the problem and nip it in the bud, ask yourself the following questions:

Do I hide my drinking from my loved ones?
Am I in my healthiest form when I am drinking?
Does alcohol help me reach my goals
Do I feel shameful or guilty after drinking?
Does alcohol interfere with my ability to regulate emotions?
Have other people raised concerns about my alcohol use?

If you answer yes to most of the questions, you may have developed alcohol dependence.

References

1 Gamlin, C., Varney, A., & Agius, M. (2019). Emotionally Unstable Personality Disorder in Primary Care: A Thematic Review and Novel Toolkit. Psychiatria Danubina, 31(Suppl 3), 282–289.

2 Helle, A. C., Watts, A. L., Trull, T. J., & Sher, K. J. (2019). Alcohol Use Disorder and Antisocial and Borderline Personality Disorders. Alcohol research : current reviews, 40(1), arcr.v40.1.05. https://doi.org/10.35946/arcr.v40.1.05

BPD and Alcohol