Dual Diagnosis Treatment for Borderline Personality Disorder

Living in a constant state of instability is common for people with borderline personality disorder (BPD), a chronic mental illness characterized by intense mood swings, impulsive behavior, and ongoing struggles with self-image, relationships, and more. Per a report from Verywell Mind, data from one report shows that 1.6% of U.S. adults have BPD, which translates to more than 4 million people in the country who have the disorder.

As the National Institute of Mental Health (NIMH) notes, people with BPD may have intense episodes of anger, depression, and anxiety that can last anywhere from a few hours to a few days. Because their self-image shifts rapidly, how they see themselves and their place in the world can prompt them to change their interests, values, behaviors, and more, often without warning. 

All of this and more can lead to unfulfilling, strained relationships and cause a person with BPD to isolate themselves from everyone they know. In the past, treating the illness was viewed as difficult, but according to NIMH, evidence-based treatment can help people suffer fewer symptoms or symptoms that are less severe. Before a person with BPD can get help for the disorder, it is important for them and their loved ones to understand what it is.

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a mental health condition characterized by intense and unstable emotions, difficulty maintaining relationships, and a distorted sense of self. People with BPD often experience rapid mood swings, fear of abandonment, and patterns of impulsive behavior, such as risky spending, substance use, or self-harm.

These symptoms can make it challenging to maintain stable relationships, hold a job, or manage daily life. BPD typically emerges in late adolescence or early adulthood and affects approximately 1–2% of the general population.

The exact cause of BPD is not fully understood, but research suggests it results from a combination of genetic, environmental, and neurological factors. Trauma, such as childhood abuse or neglect, can increase the risk of developing BPD, as can certain brain differences affecting emotional regulation and impulse control.

Treatment for BPD often includes therapy, with Dialectical Behavior Therapy (DBT) being the gold standard, alongside medication and support for co-occurring conditions like depression, anxiety, or substance use disorders. With proper care, individuals with BPD can learn to manage symptoms, improve relationships, and lead fulfilling lives.

Symptoms of Borderline Personality Disorder

If you or someone you know suspects that concerning behavior could mean a person has borderline personality disorder but aren’t sure, there are several symptoms that can help you decide that you should seek some answers. Borderline personality is officially recognized as a personality disorder. It can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Because it is a personality disorder, BPD can affect how you think about yourself, how you think about other people, how you relate to others, and how you conduct yourself. BPD is characterized by nearly a dozen symptoms. People who have BPD may have any of the following:

Fear of Abandonment

Per Mayo Clinic, the fear of being left alone is intense. A person with BPD could go to extreme lengths to avoid being rejected or separated from someone else.

Unstable Ties to Other People

A pattern of unstable relationships is characteristic of BPD. A person with the disorder could think someone cares deeply for them and then switch out, thinking the person does not care for them at all. Instability in relationships could also involve being in an abusive relationship.

Quickly Changing up One’s Identity

Fast changes in self-identity could mean a person may view themselves as a bad person or not view themselves at all. A person with BPD may also switch out their values or goals.

Extreme Paranoia

BPD can make a person paranoid due to extreme stress, making them lose touch with reality for a certain amount of time. This could last a few minutes or a few hours.

Extreme Mood Swings

A person with BPD can have emotional highs and lows that can cause them to experience happiness, shame, anxiety, or irritability. These shifts in mood can last a few hours to a few days, depending on the person. 

Engagement in Reckless Behavior

A lack of self-control is also an issue with BPD. This includes any activity that presents a danger to a person. It could be risky drug use, sex, binge eating, shopping sprees, or gambling. Mayo Clinic notes that a person with BPD could also sabotage themselves by quitting a job suddenly or ending a positive relationship.

All of these examples suggest a lack of self-control. Acting first without thinking about what they are doing or the kinds of problems it could bring is problematic for people with BPD.

Borderline personality disorder can cause a person to detach from themselves and feel empty on an ongoing basis. They can also struggle with bouts of intense anger that do not fit the context of the situation. Inappropriate outbursts of anger, biting sarcasm, and picking physical fights are some things that can happen when a person has BPD.

Not everyone will experience all of these symptoms. It is also important to note, however, that any event could trigger any of these symptoms. According to NIMH, the severity and frequency of any symptoms experienced depend on the person and their illness.

Factors that Could Cause BPD 

As with other mental illnesses, the factors that cause borderline personality disorder are not understood entirely. Each person with the illness is different, so the factors that come into play for each person varies. 

BPD Could Run in the Family

According to Mayo Clinic, some research suggests that BPD could be inherited from other family members. Per NIMH, people who have a parent or sibling with BPD may be at a higher risk of developing the illness.

Functioning in the Brain

Brain abnormalities, particularly in the areas of the brain that control emotional regulation, aggression, and impulsivity, could cause it. An imbalance of brain chemicals that help regulate mood could also be a reason BPD happens. 

Factors that Shape Experience

According to NIMH, some people with BPD are victims of traumatic experiences, particularly those involving abandonment, abuse, or other kinds of hardships. Environmental influences can also bring on the illness. Examples of this include a person who has a history of being abused or neglected during their childhood. 

Who is at Risk of Developing BPD?

Per Verywell Mind, women are more likely to be diagnosed with the disorder than men since about 75% of diagnoses issued are for women. According to the site, researchers do not know why more women than men are diagnosed with BPD, but it says that women are more likely to seek treatment since they are prone to it. 

Verywell Mind also says there could be gender biases as men tend to be diagnosed with post-traumatic stress disorder (PTSD) or major depressive disorder (MDD) instead of BPD.

Borderline Personality Disorder and Addiction

Borderline personality disorder (BPD) and addiction often occur together, creating a complex and challenging set of struggles for those affected. BPD is characterized by intense mood swings, unstable relationships, impulsive behavior, and difficulties with self-image.

These overwhelming emotional experiences can lead individuals to seek relief through drugs or alcohol, using substances as a way to cope with feelings of emptiness, anxiety, or anger. Unfortunately, substance use can make symptoms of BPD more severe, increasing impulsivity, heightening emotional instability, and intensifying conflict in relationships.

Self-Destructive Cycles

The connection between BPD and substance abuse can become a self-destructive cycle. For example, someone may drink or use drugs to numb painful emotions, only to experience worsened depression, anxiety, or reckless behavior as a result.

This, in turn, can deepen feelings of shame and guilt, driving further substance use as a means of escape. Over time, addiction not only masks the underlying mental health condition but also creates new challenges, such as health risks, strained relationships, and increased difficulty in managing BPD symptoms.

Recognizing the link between borderline personality disorder and addiction is crucial for effective treatment. Both conditions need to be addressed together in a comprehensive way that supports emotional healing while also breaking the cycle of substance abuse.

By understanding how closely tied these challenges are, individuals and their loved ones can take the first step toward seeking the right help and beginning the path to recovery.

Dual Diagnosis Treatment for Borderline Personality Disorder

Dual diagnosis treatment for borderline personality disorder (BPD) and addiction addresses the unique challenges of managing both conditions together. Individuals with BPD often struggle with intense emotions, unstable relationships, impulsive behaviors, and difficulties with self-image. These struggles can increase the risk of turning to drugs or alcohol as a way to cope with emotional pain or stress. Over time, however, substance use only intensifies the challenges of BPD, creating a cycle that can feel impossible to break without professional help.

Therapy

An integrated dual diagnosis program provides a coordinated approach that treats both conditions at the same time. Evidence-based therapies such as Dialectical Behavior Therapy (DBT) are particularly effective for individuals with BPD, as they teach emotional regulation, distress tolerance, and healthier ways to manage interpersonal relationships. When combined with substance use treatment—including detox, relapse prevention strategies, and group support—this approach helps individuals build a stronger foundation for recovery.

Support

Support in dual diagnosis treatment also extends beyond therapy. Holistic methods like mindfulness practices, stress management, and structured daily routines can help reduce impulsivity and encourage emotional stability. Family therapy and peer support groups are also essential, as they provide encouragement and help loved ones better understand the challenges of living with both BPD and addiction. With compassionate, comprehensive care, individuals can learn to manage symptoms more effectively, reduce the risk of relapse, and move toward long-term healing and stability.

Our team at Serenity at Summit is here to guide you through every step of your recovery journey, offering hope, healing, and long-term success.