Borderline personality disorder (BPD) is a mental health condition that affects a person’s ability to manage their emotions. BPD can also increase a person’s risk of developing substance use disorder (SUD).

BPD can cause a person to experience intense emotions and may cause them to have a negative self-image.

A person with BPD may also experience constantly changing feelings, which can contribute to instability in their relationships with other people.

Studies suggest that people with BPD may also be at a higher risk of developing SUD.

SUD is a mental health condition that causes a person to lose the ability to manage their use of substances. This can lead to unmanaged use of:

  • legal or illegal drugs
  • alcohol
  • medications

This article outlines the connection between BPD and SUD. It also discusses the risk factors for both conditions and explains how to recognize their signs.

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Mental health and healthcare professionals often diagnose BPD and SUD in the same person. There may be a number of reasons for this.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) is a manual that provides mental health professionals with specific diagnostic criteria for mental health conditions.

The DSM-5-TR lists substance misuse among the possible diagnostic criteria for BPD.

People with BPD may display impulsive behaviors that can be dangerous, such as misuse of certain substances. Regularly misusing substances can increase a person’s risk of SUD.

People with mental health conditions such as BPD may also misuse substances as a form of self-medication.

Some drugs may improve symptoms of some mental health conditions for a short period. However, they often make symptoms worse over time.

Regular substance misuse may also cause changes in a person’s brain, which can lead to the development of SUD.

Factors that can increase a person’s risk of developing BPD include:

  • environmental factors
  • genetics
  • changes to the brain

However, having these risk factors does not always mean that a person will develop BPD.

Environmental factors

Research shows that environmental factors may play a large role in the development of BPD. According to certain studies, around 70% of people with BPD have experienced childhood mistreatment such as:

According to the National Institute of Mental Health (NIMH), experiencing unstable or invalidating relationships and conflicts may increase a person’s risk of developing BPD.


People who have a a parent or sibling with BPD may have a higher risk of developing the condition themselves.

Learn about BPD and genetics.

Changes in the brain

According to the NIMH, people with BPD may have certain changes in brain structure and function.

These changes are often present in areas of the brain that control a person’s impulses and emotions.

According to neuroimaging studies, people with BPD may have differences in the:

  • amygdala
  • hippocampus
  • medial temporal lobes

Medical professionals are unsure whether these changes cause BPD to develop or whether BPD causes the changes.

Learn more about BPD.

The likelihood of developing SUD varies from person to person. However, certain factors may increase a person’s risk of developing it.

These factors include:

  • lacking the ability to refuse peers
  • experimenting with drugs
  • lacking parental supervision
  • exhibiting aggressive behavior in childhood
  • having easy access to drugs at school
  • having a low socioeconomic status

Learn more about SUD.

There are certain signs of both BPD and SUD that people can be aware of. Recognizing these signs can help people seek help for themselves or encourage others to seek help.

Signs of BPD

People with BPD may experience the following common symptoms:

  • intense mood swings
  • feelings toward others that can change quickly or swing from extreme closeness to extreme dislike
  • a tendency to view things in extremes, such as all good or all bad
  • an uncertain feeling about their self-image
  • changes in interests and values
  • a tendency to act impulsively or recklessly, which may involve:
    • sexual activity that could have harmful effects
    • substance misuse
    • reckless driving
    • spending sprees

Other possible signs that a person has BPD include:

  • self-harm
  • a chronic feeling of emptiness
  • frequent efforts to avoid real or perceived abandonment
  • problems controlling anger
  • intense and unstable relationships
  • thoughts of suicidal behaviors

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Not all people with BPD will experience the same symptoms. The severity and frequency of symptoms will also vary from person to person.

Signs of SUD

A person with SUD may be unable to stop using substances even if they are aware that they have a problem.

SUD can cause both physical and mental difficulties that may affect a person’s relationships with family and friends.

According to the American Psychiatric Association (APA), medical professionals often group the symptoms of SUD into the following four categories:

  • The inability to control actions: A person may have a strong urge to use specific substances and may not be able to reduce their use.
  • Substance use that may be harmful: A person may use substances in unsafe settings, such as when driving. They may also use large amounts of substances.
  • Substance effects: SUD can increase a person’s tolerance for substances. This means they may have to use more of a substance to get the same effects. SUD can also cause people to develop withdrawal symptoms if they stop using a substance.
  • Social problems: A person may have difficulty completing tasks in their daily life, which can affect their social functioning.

Learn more about the effects of drug misuse.

Both BPD and SUD are treatable conditions. Treatment for BPD may not cure the condition, but it can help people manage their symptoms.

Treating BPD

Treatment can help improve symptoms of BPD. It can also help improve a person’s daily functioning and quality of life.

Psychotherapy is the main treatment option for BPD.

The two main types of psychotherapy for BPD are dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT).

According to the APA, DBT is a treatment that helps people with BPD accept the reality of their lives and behaviors. It also helps them learn how to change their lives and change any dysfunctional behaviors.

The main emphasis of DBT is to help people learn how to tolerate and regulate their emotions.

CBT is a type of psychotherapy that helps a person learn to recognize distortions in their thinking.

CBT can also help a person with BPD learn new ways to behave and develop a greater sense of self-confidence. A person can use these new behaviors to help reduce anxiety symptoms and severe mood changes.

Learn more about therapies for BPD.

Treating SUD

The most common treatment option for people with SUD is a combination of medication and therapy.

Medical professionals will often tailor a person’s treatment plan to their specific situation.

A person can use certain medications that can help:

  • relieve withdrawal symptoms
  • control cravings for substances
  • prevent relapses

A person may also undergo psychotherapy to help them understand their behavior, learn about their motivations, and improve their self-esteem.

Psychotherapy can also help a person with SUD cope with stressful situations.

Learn how to help someone with SUD.

The following are answers to some questions people frequently ask about BPD and SUD.

What is the life expectancy of a person with borderline personality disorder?

Some research suggests that BPD may reduce life expectancy by around 20 years.

This is mostly due to cardiovascular issues that people with BPD may develop. Factors that can increase the risk of developing these issues include:

What drugs should people with BPD avoid?

People with BPD should avoid using any drugs that have a risk of overdose.

They should also avoid using multiple drugs at once.

Healthcare professionals should prescribe medications to people with BPD only alongside psychotherapy.

BPD is a mental health condition that affects a person’s ability to manage their emotions. A person with BPD will experience intense emotions and may have a negative self-image.

BPD can also increase the risk of developing SUD, a mental health condition that causes a person to lose the ability to manage their use of substances such as alcohol, medications, and other drugs.

Treatment for BPD involves psychotherapy. The two main types of psychotherapy for BPD are DBT and CBT. Treatment for SUD includes a combination of medications and therapy.