Chemical Dependency & the Borderline Personality Disorder

DSM IV - There are Three Clusters of Personality Disorders, the Borderline Personality Disorder falls into Cluster B and includes the following symptoms:

• Cluster B
  Dramatic, Emotional, Erratic, Angry, Unhappiness, Alienation, Conflict with Authority and Family, Control Issues, Dissociation

Borderline Personality Disorders (BPD's) are AT A HIGH RISK FOR DEVELOPING CHEMICAL DEPENDENCY!

Borderline Personality Disorder will usually have five or more of the following:

• Efforts to avoid real or imagined abandonment
• Unstable, intense personal relationships
• Identity disturbance
• Recurrent suicidal behavior – self-mutilation
• Marked reactivity of mood
• Feelings of emptiness
• Intense, inappropriate anger
• Paranoid ideation
• They will assume that all people are either totally good or totally bad

• Genetic tendency toward interpersonal sensitivity
• The Dysfunctional Family
  -Physical Abuse
  -Sexual Abuse
  -Neglect
  -Hostile Conflict
  -Early parental loss or separation

Borderine Personality Disorder occurs in about 2% of the population

The prevalence of BPD’s with Substance Use disorders ranges from 39% to 84% or roughly 2/3 of Borderline Personality Disorder’s. Relating Borderline Personality Disorder and Substance Use can be very difficult due to the fact that Borderline Personality Disorder symptoms can be very similar to those of substance use. Some signs include:

• Impulsivity, which is a core feature of BPD’s.
• Dissociation vs. Intoxication
  -Signs may be very similar.
• Substance use can increase symptoms in a BPD. 

Abstinence, Abstinence, Abstinence! Substance use interferes with learning new skills and working through the trauma.

PATIENT

The BPD patients seek the love and nurturing they never received as a child, but also fear they will be abused and abandoned. Often family members used chemicals extensively. BPD’s seek relief from their psychic pain by using chemicals. BPD’s should initially require residential or inpatient treatment with a dual diagnosis approach.

COUNSELOR

The counselor may experience intense negative responses by the client. The counselor gets “enmeshed in the defenses” of a borderline. BPD can “mimic” other disorders. Find the patient a same-sex sponsor. Stay in the “present” and be highly aware of boundary issues.

Daley, D. & Moss, H. (2002). Dual Disorders: counseling clients with chemical dependency and mental illness (3rd ed.)

Hazelden. (pp. 137-160) Evans, K. & Sullivan, J.M. (2001).

Dual Diagnosis: Counseling mentally ill substance abusers (2nded.) New York: Guilford (pp. 122-145) APA (2001).

DSM-IV-TR: Diagnostic and statistical manual of mental disorders (Rev. ed.) Washington DC: APA.

Ojehagen, I. (2001). Journal of Psychiatry Epidemiology . Severely mentally ill substance abusers: an 18-month follow-up study. (pp. 70-78)

Bosch, L., Verheul, R. & Brink, W. (2001). Journal of Personality Disorders. Substance abuse in borderline personality disorder: Clinical and etiological correlates. (pp. 416-425)