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BPD and Alcoholism: What Makes Someone Struggle With Both?

One of the most insidious aspects of alcoholism is that so many people get into trouble once they start self-medicating mental health problems with alcohol which, in turn, makes those mental health problems worse. 

Unfortunately, this is an all-too-common occurrence for people struggling with Borderline Personality Disorder. 

A recent study revealed that as many as 78% of adults diagnosed with BPD also have a co-occurring substance use disorder during their lives. There is a connection between alcohol abuse and disorders like BPD. But what is the link?

What Are Alcoholism And Alcohol Use Disorder (AUD)?

Alcoholism and the term ‘alcohol use disorder’ are often used interchangeably. They both refer to a medical condition where an individual is unable to control their intake of alcohol, despite the adverse effects of drinking too much.

AUD is not just a social habit or behavior that occurs when people are having a good time. It’s considered a brain disorder because of the lasting effects on the brain by excessive alcohol intake. Like Borderline Personality Disorder (BPD), healthcare professionals can diagnose it using the DSM-5.

The Diagnostic and Statistical Manual of Mental Disorders suggests that two or three symptoms indicate mild AUD, four to five equals moderate AUD, and severe is when six or more criteria are present.

The criteria include whether, in the past twelve months, the person has:

  • Drank more – or for longer – than they intended
  • Wanted to, or tried to, cut down drinking but couldn’t
  • Spent a significant amount of time drinking, being sick from drinking, or dealing with hangovers
  • Felt consumed by the thought of having a drink (wanting to drink)
  • Found that drinking, or the after-effects of drinking, have interfered with their ability to take care of themselves, their home, or their family
  • Found that drinking – or the after-effects – has affected their job/school negatively
  • Been unable to stop drinking, even though it caused problems with friends and family
  • Chose to drink instead of other activities that used to interest you/be pleasurable
  • Gotten into situations that increased the chance of getting hurt because of drinking – for example, driving, using heavy equipment or machinery, risky sexual behavior, being in a dangerous environment
  • Continued drinking even if you felt depressed or anxious – or after blacking out from drinking
  • Had to drink more than usual to get a buzz or noticed that your usual number of drinks was having less of an effect on you
  • You experience withdrawal symptoms when you stop drinking, including insomnia, shaking/trembling, nausea, sweating, a racing heart, feeling unwell, feeling restless, uneasy, or having a seizure.

I’ve included a quiz at the end of this article to help you assess whether you’re at risk for alcohol dependence. 

A woman struggling with BPD and alcoholism holds a bottle of liquor to her forehead
Understanding BPD and Alcoholism

Borderline Personality Disorder (BPD) is a disorder where people struggle to manage their emotions, appropriately interpret situations, and maintain healthy and meaningful interpersonal relationships. The following symptoms characterize it:

  • Low self-esteem, self-harm, and self-sabotage
  • Impulsive and reckless behavior
  • Intense anger and fluctuating moods – and poor anger-management
  • Periods of depression and feelings of emptiness 
  • Intense fear of abandonment and extreme efforts to avoid ‘perceived’ abandonment
  • Sensitivity to criticism and rejection

Because of the nature of BPD and alcoholism, there is a significant overlap between the two disorders. But one can also pre-empt the other.

Co-Occurring BPD And Alcoholism

Research points to high rates of co-occurrence between BPD and alcoholism, with as much as 49% of people with BPD meeting the criteria for current AUD and 59% for long-term AUD. This is in line with the experiences of healthcare practitioners who find that about half of their patients with BPD also struggle with alcohol abuse.

One of the challenges with the comorbidity (the simultaneous presence) of BPD and AUD is that both disorders share symptoms, triggers, and potential causes. 

Why Do People With BPD Tend To Drink Heavily?

Looking at the characteristics of BPD, it’s easy to see how those struggling with their emotions, engaging in reckless behavior, and dealing with intense emotions would resort to drinking. 

What may start as a few drinks to take the edge off or help them feel less anxious can soon become heavy drinking.

Self-harming behavior is also expected in BPD – not only due to low self-esteem or a desire to feel something other than ‘numb’ – but also because BPD sufferers are often seeking attention or trying to manipulate those around them as a means of avoiding abandonment.

By drinking excessively, the person with BPD forces others to look after them when incapacitated. It also exempts them from accountability for their actions, which can often be aggressive or abusive as they struggle to deal with their emotions.

Self-sabotage in BPD is also common and serves the purpose of helping the person feel in control over a perceived rejection, to manipulate others into validating them, or simply to feel some relief.  Alcohol is a depressant, so BPD people may drink to minimize the intense emotions they feel and struggle to process.

Some studies point out how BPD and AUD share fundamental aspects, like: 

  • Dysfunctional lifestyles as a general experience, but also as a result of BPD and AUD
  • Unhealthy coping mechanisms
  • Impulsivity and inability to control their behavior
  • Codependent tendencies
A man with BPD holds a cigarette and glass of whiskey, drinking
BPD and Alcohol Abuse

Can Alcohol Abuse Cause BPD?

Experts believe that people with AUD are 3.35 times more likely to be diagnosed with BPD than those who don’t have a substance abuse issue. That being said, AUD itself doesn’t cause BPD. But it can play a role in the underlying causes that lead to BPD.

Studies suggest that BPD can be inherited via genetics or as a result of problems in the brain – in both cases, parents with AUD challenges are more likely to have children with similar issues. 

Furthermore, environmental factors like emotional, physical, or sexual abuse, exposure to extended periods of fear, distress, or neglect, and growing up in a family with mental health disorders have been linked to the root cause of BPD. 

The World Health Organization has quoted that 55% of people who engage in domestic violence do so under the influence of alcohol, and 68% of troubled children in treatment programs have witnessed such abuse. The link between alcoholism and mental health disorders is clear.

Effects Of Alcohol On People With BPD

Many people with BPD self-medicate with alcohol to deal with situations and emotions that are too big for them. As a temporary escape from reality, which can be terrifying for those expecting rejection at all times, regular alcohol use can quickly become an addiction.  

Some of the negative results of mixing alcohol with BPD are as follows:

  • Worsened feelings of depression, sadness, and emptiness: Alcohol is a central nervous system depressant that alters mood but can increase negative emotions.
  • Increased paranoia and anxiety: The effects of alcohol and the painful hangovers that follow have been seen to induce anxiety and ramp up stress, amplifying negative interactions even further. 
  • Dangerous or risky behavior is more likely, which can put the BPD person’s life at risk. For example, driving under the influence, having unprotected sex, or operating heavy machinery. In those with suicide ideation and self-harm tendencies, this can be incredibly dangerous.
  • Aggressive and violent tendencies are amplified: BPD people already struggle to manage their emotions and anger. Add alcohol, and fights (verbal or otherwise) are almost guaranteed.
  • Fear of abandonment can become a self-fulfilling prophecy: Despite the fear of rejection, BPD people who engage in heavy drinking are likely to experience challenges in interpersonal relationships. Partners can become fed up with the drinking and want to end the relationship, which is precisely what the BPD person fears. The same applies to their job.

Can BPD Lead To Alcoholism?

Because alcohol is an accessible means of dulling emotions and helping people with BPD cope in the moment, it commonly becomes habitual. Having a drink now and then to deal with difficult situations can, and often does, escalate into having a drink every day

Since BPD sufferers don’t have good coping strategies, once introduced to the relaxing effects of alcohol, it’s easy to see how it can quickly become an addiction and a dependency. The latest statistics show that more than 29.5 million people over the age of 12 in the USA have AUD. 

Looking at how easy it is for those with BPD to fall into the trap of using alcohol as a means of coping, it is even more imperative that people with BPD get professional help.

Does Alcohol Make BPD Symptoms Worse?

As we’ve briefly touched on before, alcohol is a CNS depressant which means that it leaves you feeling relaxed and at ease – at least initially. Alcohol slows down physical and psychological abilities, meaning you react slower to situations around you. 

It can also trigger feelings of euphoria or mood swings. If you have BPD, this is already something you have to deal with, so adding alcohol to the equation will magnify this emotional fluctuation. And, since alcohol impairs cognitive function, you’re even less likely to be able to process emotions in this state.

Alcohol will most certainly make BPD symptoms worse, which in turn affects the BPD person’s ability to recognize any danger they’re in. Additionally, if a person with BPD is undiagnosed, they are less likely to seek help for their BPD challenges because it can be written off as the effects of a bout of drinking.

Where To Get Help

If you’re concerned about yourself or a loved one possibly having AUD, the first step is to book an appointment with your doctor to talk about your drinking and treatment options. You can also contact American Addiction Centers or call 406-602-0637

If you are dealing with BPD and AUD simultaneously, it’s especially important to consult your healthcare practitioner about the way forward, and ensure you get the proper treatment. A support group – for you and your family – will be vital in dealing with the overlap between these two disorders. 

The most important thing is to take the first step. 

It can be really scary to admit you might have a problem with drinking. When you’re already wrestling with a challenging disorder like BPD, the two can feel insurmountable. But they’re not. 

There is help and hope on the other side of this. If you’re looking to connect with people who are in a similar boat, consider joining the Soberish private Facebook Group.

Take The AUDIT

The Alcohol Use Disorder Identification Test is used by medical professionals to assess your risk for alcohol dependency. This quiz is not a substitute for medical advice, nor is it an official medical diagnosis. It’s for informational purposes only, but I hope that you’ll take your results seriously and reach out to a medical professional if you suspect you may have a problem with drinking.

Welcome to your Alcohol Use (AUDIT) quiz

1. How often do you have a drink containing alcohol?

How many units of alcohol do you drink on a typical day when you are drinking?

A unit of alcohol is one standard drink. Examples of one standard drink include:

  • 12 oz can of beer with about 5% alcohol
  • 5 fl oz of wine (roughly 12% alcohol)
  • 1.5 fl oz shot of spirits like vodka, rum, or whiskey (about 40% alcohol)

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

How often during the last year have you found that you were not able to stop drinking once you had started?

How often during the last year have you failed to do what was normally expected from you because of drinking?

How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?

How often during the last year have you had a feeling of guilt or remorse after drinking?

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

Have you or someone else been injured as a result of your drinking?

Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

Additional Resources:

Close up image of two hands - one holding a beer glass, the other gesturing 'stop.' The title reads "BPD & Alcoholism: What you should know"
BPD and Alcoholism PIN

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