Borderline personality disorder is a personality disorder that is characterized by unusual and significant instability in mood, which is severe enough to undermine relationships. A person suffering from borderline personality disorder will often switch between idealizing and demonizing others, a symptom known as splitting. Individuals will often be very sensitive to the way they are treated and react strongly if they perceive criticism or harm. Many will abuse drugs and alcohol in a dangerous and impulsive way.
Borderline personality disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV as:
> A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
* Frantic efforts to avoid real or imagined abandonment which does not include suicidal or self-harm behaviors.
* A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
* Identity disturbance, which is the markedly and persistently unstable self-image or sense of self.
* Impulsivity in at least two areas that are potentially self-damaging such as eating disorders, binge substance abuse and reckless driving.
* Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself.
*Affective instability due to a marked reactivity of mood such as irritability or anxiety that lasts a few hours and only rarely more than a few days.
* Chronic feelings of emptiness
* Inappropriate anger or difficulty controlling anger such as frequent displays of temper, constant anger and recurrent physical fights.
* Transient stress-related paranoid ideation, delusions or severe dissociative symptoms
Borderline personality disorder must also meet a set of general personality disorder criteria for it to be clinically diagnosed.
Many of those diagnosed with a borderline personality disorder also abuse alcohol and drugs. They use drugs to dull the fears, anger and delusions that they experience. This self-medication is incredibly dangerous. In many cases, the person will not even realize that they are taking drugs or drinking to deal with their personality disorder. What a person does realize is that they can hide their feelings when they are intoxicated or under the influence, and they feel better.
Self medication may provide short-term relief to a life-long issue but it also places a person at risk of developing an addiction to drugs or alcohol. If an addiction sets in, the quality of life will be reduced and a person will face devastating changes including relationship breakdowns, loss of job and health problems. Sadly, those with borderline personality disorder have a tendency to ignore the reality of their problems and become aggressive and violent towards those who may be trying to help them. They will accuse others of conspiring against them or of a lack of trust and compassion. Then will seek out loving emotional support from the same people. For friends and family, this can be an incredibly confusing and difficult and requires others to put in a lot of effort and be strong.
Research suggests that up to 50 percent of those who suffer from a borderline personality disorder abuse alcohol and drugs, with many of these facing addiction and dependency. When a person has a co-occurring disorder, it can be difficult to treat either condition. Psychiatrists and other medical professionals will face the difficult task of determining which has caused the other and treating both appropriately.
Co-occurring disorders are especially difficult to treat, as it is often the case where one condition is the consequence of the other. For example, an alcoholic may consume excessive amounts of alcohol that reduces the levels of serotonin in the body. This makes a person behave in an irrational, impulsive and self-destructive manner. In many cases, each disorder maintains the other. Chronic drug use makes the symptoms of borderline personality disorder more severe, introducing the need for more drugs to self-medicate. This, in turn, makes the symptoms more severe. Tolerance and dependence then establish themselves, and a person faces addiction.
Because of the impulsive and irrational nature of borderline personality disorder, people suffering from the condition often abuse drugs and alcohol in an incredibly harmful way. They may binge on drugs or alcohol or engage in high-risk activities such as promiscuous sex, sharing needles or driving when under the influence. These dangerous situations can cause significant harm to the user and those around them. Sharing needles is a known risk factor for contracting infectious diseases such as hepatitis and HIV. Driving when drunk or high increases the risk of accident-related injury or death. Promiscuous sex can lead to unwanted pregnancies, rapes and sexual assault. Any of these consequences can have a dire effect on the future for a person.
Some research suggests that those suffering from borderline personality disorder may seek out alcohol and other drugs like methamphetamine because of the increased impulsivity, loss of inhibitions and increased risk-taking properties derived from the drugs. Additionally, the impulsivity of the condition may influence a person’s initial decision to use a substance, leading them to continue to take the substance or use it in excess.
Treating Borderline Personality Disorder
Unfortunately, there is no set treatment for borderline personality disorder yet. The symptoms of paranoia, depression and anxiety can be treated with effective medications that will provide some relief. Some individuals respond well to cognitive behavior therapy and psychotherapy to delve into some of the issues surrounding the disorder. Those who benefit from these therapies have found that opening up to the inner fears of abandonment, hurt and anger relieves the build-up of these emotions and reduces outward aggression. Skill development can also be beneficial for some people and helps to identify risk situations and triggers. These are also good for a person who has both a substance abuse problem and borderline personality disorder.
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