- Borderline personality disorder (BPD) affects approximately 1.6% of the U.S. adult population
- Characterized by emotional instability, intense relationships, fear of abandonment, and impulsivity
- Approximately 50-70% of individuals with BPD also have a substance use disorder
- Dialectical behavior therapy (DBT) is the most effective evidence-based treatment for BPD
- BPD is NOT a character flaw — it is a treatable condition rooted in neurobiology and experience
- Childhood trauma and invalidating environments are significant risk factors
- Recovery is possible — most people with BPD show significant improvement with treatment
- Integrated treatment for BPD and co-occurring addiction produces best outcomes
Published: February 2026 | Last Updated: February 2026 | Reading Time: 6 min
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a mental health condition characterized by pervasive patterns of instability in interpersonal relationships, self-image, emotions, and marked impulsivity. People with BPD experience emotions with extraordinary intensity and have difficulty regulating these emotional responses, leading to turbulent relationships, chronic feelings of emptiness, and impulsive behaviors that can include substance misuse.
Core Symptoms
The DSM-5-TR identifies nine diagnostic criteria for BPD. A diagnosis requires meeting at least five of: frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense relationships alternating between idealization and devaluation, identity disturbance (unstable self-image or sense of self), impulsivity in at least two areas that are potentially self-damaging, recurrent suicidal behavior, gestures, threats, or self-harm, emotional instability due to marked reactivity of mood, chronic feelings of emptiness, inappropriate intense anger or difficulty controlling anger, and transient stress-related paranoid ideation or severe dissociative symptoms.
BPD and Substance Use Disorders
The High Co-Occurrence Rate
The overlap between BPD and substance use disorders is striking. Studies consistently find that 50-70% of individuals with BPD develop a substance use disorder during their lifetime, and approximately 15-25% of individuals in substance abuse treatment meet criteria for BPD.
Why They Co-Occur
The emotional intensity and distress intolerance that characterize BPD create a powerful drive toward substance use as an emotion regulation strategy. Alcohol, opioids, and benzodiazepines may temporarily numb overwhelming emotions. Stimulants may fill the chronic emptiness. And the impulsivity inherent in BPD lowers the threshold for substance experimentation and escalation.
Treatment
Dialectical Behavior Therapy (DBT)
DBT, developed by Dr. Marsha Linehan specifically for BPD, is the most extensively researched and effective treatment. DBT teaches four core skill sets: mindfulness (present-moment awareness without judgment), distress tolerance (surviving crises without making them worse), emotion regulation (understanding and managing intense emotions), and interpersonal effectiveness (maintaining relationships while asserting needs).
DBT combines weekly individual therapy, weekly skills training groups, phone coaching for crises between sessions, and therapist consultation teams.
Other Evidence-Based Approaches
Mentalization-based therapy (MBT) helps individuals understand their own and others' mental states. Schema therapy addresses deep-rooted patterns formed in childhood. Transference-focused psychotherapy (TFP) uses the therapeutic relationship to address core issues. All have demonstrated effectiveness for BPD.
Medication
No medications are FDA-approved specifically for BPD. However, medications may target specific symptoms: mood stabilizers for emotional lability, antidepressants for co-occurring depression, low-dose antipsychotics for transient psychotic symptoms, and anxiolytics for anxiety (with caution regarding benzodiazepine addiction risk).
Frequently Asked Questions
Is BPD the same as bipolar disorder?
No. Despite some symptom overlap (mood instability), they are distinct conditions. BPD mood shifts are typically rapid (hours to days) and triggered by interpersonal events. Bipolar mood episodes last longer (days to weeks) and often occur independent of environmental triggers. The conditions can co-occur.
Can BPD be cured?
Studies show that with consistent treatment, the majority of individuals with BPD achieve significant improvement. Many no longer meet diagnostic criteria after 4-6 years of treatment. While vulnerability to emotional sensitivity may persist, the disabling symptoms can resolve substantially.
Is BPD caused by bad parenting?
BPD results from a complex interaction of genetic vulnerability, neurobiological differences, and environmental factors. While invalidating or traumatic childhood environments are significant risk factors, BPD is not simply caused by "bad parenting." Many contributing factors are beyond parental control.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
- Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
- Trull, T.J., et al. (2000). Borderline personality disorder and substance use disorders. Clinical Psychology Review.
- Zanarini, M.C., et al. (2012). Prediction of the 10-year course of BPD. American Journal of Psychiatry.
- National Institute of Mental Health. (2024). Borderline Personality Disorder.
This article was reviewed by the Valley Spring Recovery Center Editorial Team. For dual diagnosis treatment, call (201) 781-8812 or visit our admissions page.
Valley Spring Recovery Center — Evidence-based addiction treatment in Norwood, New Jersey.