Understanding Borderline Personality Disorder & Addiction
Borderline personality disorder (BPD) is a complex mental health condition characterized by pervasive instability in interpersonal relationships, self-image, emotions, and behavior. Individuals with BPD experience intense and rapidly shifting emotions, chronic feelings of emptiness, a deep fear of abandonment, and frequent interpersonal conflicts. Impulsivity is a core feature of the disorder, manifesting as reckless spending, unsafe sexual behavior, self-harm, and -- critically -- substance abuse.
The co-occurrence of BPD and substance use disorders is extraordinarily high. Research indicates that approximately 50% to 70% of individuals with BPD will develop a substance use disorder at some point in their lives, making it one of the most common co-occurring pairs in psychiatric practice. Substances serve multiple functions for individuals with BPD: they blunt the intensity of overwhelming emotions, fill the chronic sense of emptiness, provide temporary relief from identity disturbance, and offer an escape from the interpersonal pain that is a hallmark of the condition.
The treatment of co-occurring BPD and addiction has historically been considered one of the most challenging clinical scenarios, as the emotional instability, self-destructive behaviors, and interpersonal difficulties associated with BPD can complicate engagement in traditional addiction treatment. However, the development of Dialectical Behavior Therapy (DBT) -- originally created specifically for BPD -- has transformed outcomes for this population. At Trust SoCal, DBT forms the foundation of our treatment approach for clients with co-occurring BPD and addiction, teaching essential skills in emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness that address the core vulnerabilities driving both conditions.