Impulsivity is a common characteristic in both borderline personality disorder (BPD) and substance use disorder (SUD), and the presence of one condition can have a direct impact on the severity of the other. Abusing substances such as alcohol and drugs can aggravate the symptoms of BPD including suicide ideation and risk of self-harm. Conversely, the symptoms and behaviors associated with addiction to substances can be worsened due to BPD.
Since impulsive behavior is inherent to both the disorders, people who have co-occurring BPD and SUDs are expected to display significantly higher levels of impulsivity. To establish this hypothesis, a team of Hungarian researchers undertook a study to explore the incidence of impulsive behavior in different situations which included co-occurrence of BPD with SUDs, alcohol use disorders (AUDs) and drug use disorders (DUDs). Findings of the study were published in the journal Drug and Alcohol Dependence in June 2016.
The researchers evaluated the medical conditions of 345 patients by referencing the criteria laid down by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Participants were recruited from eight different mental health treatment facilities and divided into six groups: a) healthy (those without either BPD or SUDs), b) with BPD but no SUDs, c) with DUDs but no BPD, d) with AUDs but no BPD, e) with BPD and AUDs, and f) with BPD and DUDs.
Researchers measured two facets of impulsivity: a) delay discounting and b) self-reporting. For the study, delay discounting reflected participants’ preferences for lesser and instantaneous rewards instead of bigger and deferred rewards. Previous studies have shown an association between BPD and higher measures of self-reported impulsivity – this prompted the researchers to evaluate distinct categories of impulsivity. It was found that self-reported measures of impulsivity were the highest in case of patients with BPD, either with or without SUDs.
Impulsivity highest among people with co-occurring BPD and DUDs
The researchers found that patients who had both DUDs and BPD scored highest in terms of overall impulsivity. BPD was found to have a direct impact on delay discounting; however, no such impact was observed due to SUDs. The findings led to the conclusion that self-reported impulsivity is frequently over-estimated. The behavioral measure of impulsivity is more subjective and is influenced by psychiatric symptoms and depression among individuals suffering from BPD or SUDs.
According to the National Institute for Mental Health (NIMH), BPD is characterized by persistent variability in mood, relationships, self-perception and behavior. It affects nearly 1.6 percent of adult Americans. As per the results from the 2014 National Epidemiological Survey on Alcohol and Related Conditions (NESARC), 2.7 percent of the adult U.S. population satisfies the criteria for BPD. It also reported that around 78 percent of adults with BPD suffer from co-occurring SUDs or addiction. Other research has previously found that a lifetime diagnosis of BPD is associated with a 50.7 percent lifetime prevalence rate of substance abuse.
Dual diagnosis treatment
Individuals with BPD who also suffer from SUDs are at an elevated risk of relapse. During the treatment for relapse prevention, it must be emphasized to patients that they need to give up substances completely. It must also be ensured that patients are insulated from the risk of self-harm and other precarious behavior. If someone with BPD shows symptoms of addiction to drugs or alcohol, it becomes absolutely essential to assess the individual for a co-occurring SUD.
The assessment and treatment of co-occurring BPD and SUDs necessitates interventions under the guidance and supervision of professionals who specialize in the treatment of dual diagnosis. The group of specialists may comprise individual and group counselors, substance abuse therapists, mental health experts and primary care providers. Psychotherapy is the main treatment for people diagnosed with BPD, but it must be personalized to take into account related issues such as SUDs.
If you or someone you know is suffering from a mental illness as well as an addiction to any substance, contact the Dual Diagnosis Helpline to know more about various dual diagnosis programs. Call our 24/7 helpline number 855-981-6047 or chat online with our experts to seek assistance regarding dual diagnosis rehab centers in your vicinity.