What Is Borderline Personality Disorder?
According to the DSM-5, borderline personality disorder (BPD) is defined by a consistent pattern of very intense and unstable interpersonal relationships, chronic feelings of emptiness, unstable or shifting self-image, significant levels of impulsivity, and extreme emotional reactions that are not proportional to the stressor.[1]
Approximately 1.6% to 5.9% of the general population suffers from BPD, and the frequency of BPD increases significantly amongst people seeking treatment for mental health and addiction issues.[2] BPD is a clinically recognized psychiatric disorder with scientifically proven and effective interventions available to treat it, not a character defect or something a person chooses.
Signs and Symptoms of BPD
BPD presents differently for each person that has it, but the following are common signs:
- Intense fear of being abandoned, real or imagined, to the point of engaging in frantic efforts to prevent abandonment from happening.
- Frequent patterns of unstable, intense interpersonal relationships that alternate between extreme idealization and devaluation.
- An unstable or shifting sense of self.
- Impulsive behavior, such as spending large amounts of money, abusing drugs and alcohol, reckless driving, or binge eating.
- Frequent self-harm or suicidal thoughts.
- Mood swings that can change by the hour.
- Chronic feelings of emptiness.
- Extreme outbursts of anger that the person may have difficulty controlling.
- Dissociation or feeling detached from themselves during periods of extreme distress.
Building Healthier Relationships and Emotional Patterns
Building healthy relationships and managing emotions is one of the biggest struggles faced by individuals with borderline personality disorder (BPD). Intense emotions, fear of abandonment, and difficulty with trusting people can create patterns that feel unmanageable and/or overwhelming. When substance use is factored in with these patterns, they can become increasingly complex.
Treatment provides support for developing stronger interpersonal skills such as setting boundaries, better communication, and managing conflict in more constructive ways. By learning how to pause before acting and respond to situations more thoughtfully, people with BPD can significantly increase the stability of their relationships.
Over time, individuals also begin to build a stronger sense of identity and self-understanding. Instead of relying on external validation (or substances) to cope emotionally, they identify and rely on their internal resources that will support ongoing emotional stability. The result of these changes will not only create a better quality of life for the individual, but will help cultivate greater support and stability within the person’s social circle.
OCD and Substance Abuse
There is a well-established relationship between obsessive-compulsive disorder (OCD) and co-occurring substance use disorders (SUDs). A large study published in 2022 in JAMA Network Open indicates a 3.7-times increased risk of substance abuse among OCD patients versus the general population.[4]
One of the major reasons for this association is that people with OCD use substances to self-medicate.[5] Alcohol, cannabis, and opioids can temporarily reduce anxiety and obsessive thinking. Eventually, however, substance use has a negative effect on the underlying OCD condition, increasing impulsive behavior and creating a new cycle of craving and withdrawal that adds to their distress.
The relationship between OCD and substance abuse is bidirectional and complicated. Using substances will reduce obsessive-compulsive symptoms for a short period of time, but in the long term, it continues to reinforce substance abuse, interferes with the serotonin system (which is thought to be involved in the development of OCD), increases the degree of impulsivity that makes resisting compulsions and cravings more difficult, and worsens anxiety and intrusive thoughts during withdrawal.[6]
Because of this, treating OCD and addiction as separate disorders typically does not work.
OCD and Alcohol Abuse
Alcohol is the most commonly used substance abused by people with OCD.[7] Alcohol is often used to self-medicate for chronic anxiety and intrusive thoughts because it produces calming effects, which interrupt obsessive thoughts and reduce the need to perform compulsive behaviors.
However, the effects of alcohol are short-lived. Alcohol interferes with sleep, which reduces the cognitive control required to handle obsessive thoughts, and produces very high levels of anxiety when a person stops drinking, which can greatly exacerbate obsessive-compulsive symptoms.[8] For people with both OCD and alcohol abuse, dual diagnosis treatment that addresses both the neurobiological and psychological aspects of OCD and SUD is critical for continued recovery.
Compulsive Behavior vs. Addiction
Both OCD and addiction involve repetitive behaviors that are hard to control. As a result of this similarity, some people wonder whether they are experiencing one condition, the other, or both. It is important to understand the difference because it affects treatment.
A person with OCD has compulsive behaviors because of anxiety, and they engage in the behaviors to prevent some type of threatened consequence. They do not enjoy the compulsive behaviors that they perform, but the anxiety they experience when thinking about not performing the behaviors is so overwhelming that they cannot stop performing them.
In contrast, a person with addiction initially engages in substance use for the rewards and pleasures associated with it. They want to experience the high, the energy, or the calming effects produced by the drug, or may be consuming them to avoid withdrawal symptoms. Many people with OCD also have a substance use disorder because they were using substances to self-medicate, and, over time, they become physiologically and psychologically dependent on them.
When a person is suffering from both conditions, both conditions require attention from a qualified mental health professional. If only one condition is treated, the other can make recovery more difficult and increase the risk that symptoms will continue or return over time.
