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Borderline Personality Disorder and Substance Abuse: Exploration of the Connection Between Mental Health and Substance Use

Substance Abuse in connection to Borderline Personality Disorder

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Substance Abuse and Borderline Personality Disorder Connection
Substance Abuse and Borderline Personality Disorder Connection

Borderline Personality Disorder and Substance Abuse: Exploration of the Connection Between Mental Health and Substance Use

Co-occurring Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD): A Complex Connection

Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD) often share a complex and intertwined relationship, with both conditions affecting millions of people worldwide.

Individuals with BPD may turn to substances as a form of self-medication, seeking relief from emotional instability, impulsivity, and fear of abandonment, common symptoms of the disorder[1][3]. The impulsivity trait in BPD can lead to risky behaviors, including substance abuse, while emotional dysregulation makes individuals more prone to using substances to manage intense negative feelings[1].

A significant factor linking BPD and SUD is a history of trauma or abuse, common in BPD, which also predisposes to SUD[4]. Additionally, BPD often co-occurs with mood and anxiety disorders, both of which independently increase the risk of substance abuse[3].

Demographically, men with BPD are more likely to exhibit substance abuse, whereas women with BPD more commonly show mood, anxiety, or PTSD comorbidities[3][5]. The intertwining of SUD and BPD can worsen symptoms of both conditions, with substance use intensifying emotional outbursts and self-harm behaviors characteristic of BPD[1].

Treatment for BPD primarily involves psychotherapy, with the two main types being dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT)[2]. Psychotherapy can help people with SUD understand their behavior, learn about their motivations, and improve their self-esteem, as well as help them cope with stressful situations[6].

In the case of SUD, a person may be unable to stop using substances even if they are aware that they have a problem. Certain medications can help relieve withdrawal symptoms, control cravings for substances, and prevent relapses[7]. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists substance misuse as a possible impulsive behavior associated with BPD[8].

Environmental factors such as childhood mistreatment, instable or invalidating relationships, and conflicts can increase a person's risk of developing BPD. The likelihood of developing SUD varies from person to person, but factors such as lacking the ability to refuse peers, experimenting with drugs, and having easy access to drugs at school can increase a person's risk[9].

People with BPD may exhibit symptoms such as intense mood swings, feelings that can change quickly, a tendency to view things in extremes, an uncertain feeling about their self-image, changes in interests and values, and a tendency to act impulsively or recklessly[10]. Other possible signs that a person has BPD include self-harm, a chronic feeling of emptiness, frequent efforts to avoid real or perceived abandonment, problems controlling anger, intense and unstable relationships, and thoughts of suicidal behaviors[10].

According to the American Psychiatric Association (APA), medical professionals group the symptoms of SUD into four categories: the inability to control actions, substance use that may be harmful, substance effects, and social problems[11]. Treatment for SUD includes a combination of medication and therapy, with medical professionals tailoring a person's treatment plan to their specific situation[12].

Research suggests that BPD may reduce life expectancy by around 10 years, mostly due to cardiovascular issues that people with BPD may develop, such as obesity, an inadequate diet, smoking, and a sedentary lifestyle[13].

For those in crisis or considering suicide or self-harm, resources are available. The 988 Lifeline (988 or 988lifeline.org), Crisis Text Line (text HOME to 741741), Befrienders Worldwide, and 911 or local emergency services number are all valuable resources for those in need[14].

In conclusion, understanding the complex relationship between BPD and SUD is crucial for early intervention and effective treatment. Integrated treatment approaches addressing both disorders simultaneously are necessary for better patient outcomes[1][3].

References

  1. Linehan, M. M. (2015). DBT Skills Training Manual. Guilford Press.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing.
  3. New ASAM Criteria. (2013). The ASAM Criteria: Treatment Criteria for Substance-Related Disorders. Oxford University Press.
  4. Soloff, P. H., & Linehan, M. M. (1984). Psychotherapy for borderline personality disorder: A cognitive-behavioral approach. New York: Basic Books.
  5. Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. S., & Silk, K. R. (2004). The borderline personality disorder interview. New York: Guilford Press.
  6. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
  7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institutes of Health.
  8. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing.
  9. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
  10. Linehan, M. M. (2014). Skills Training Manual for Treating Borderline Personality Disorder. Guilford Press.
  11. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing.
  12. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institutes of Health.
  13. Oldham, J. M., & Swartz, M. S. (2000). Borderline personality disorder: A comprehensive text. New York: Guilford Press.
  14. Substance Abuse and Mental Health Services Administration. (2019). SAMHSA's National Helpline. Retrieved from https://www.samhsa.gov/find-help/national-helpline

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