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Alcohol Use Disorder and BPD: What You Should Know

Alcohol Use Disorder and BPD: What You Should Know

Alcohol use disorder (AUD) and borderline personality disorder (BPD) are common co-occurring disorders that can trigger or aggravate one another.

Mental health conditions are some of the most common underlying contributors to alcohol use disorder (AUD). Co-occurring disorders, like borderline personality disorder (BPD), affect how you think and feel, making you more vulnerable to self-medication if you do not get the proper treatment. Unfortunately, combining alcohol with mental health disorders is a recipe for disaster.

If you are struggling with borderline personality disorder and AUD, Confidant Health’s virtual medication-assisted treatment for alcohol use can help you get back in control. Our online depression treatment and alcohol rehab allow you to receive the support, therapy, and medication you need to manage these conditions right from the comfort and privacy of your home. Download our app today to find out more.

What Is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental health condition in which a person struggles to regulate their emotions. They may have distorted perceptions of themselves and others, act impulsively, and exhibit disproportionate anger, making it challenging to maintain healthy relationships. 

According to a 2018 article in Nature Reviews Disease Primers, approximately 1.7% of the general population has borderline personality disorder. Among those who seek professional help for their mental health, it is estimated that 15% to 28% struggle with BPD.

What Causes BPD?

There are several factors that can contribute to a person's risk of developing borderline personality disorder. Some potential causes of BPD are:

Brain Imbalances 

Inadequate levels of certain brain neurotransmitters are believed to increase one's risk of BPD. Serotonin, one of the feel-good hormones, is considered to play an especially important role. Researchers have also discovered that people with BPD had differences in size and activity of three areas of the brain: the amygdala, hippocampus, and orbitofrontal cortex. 


A family history of borderline personality disorder can make you more likely to develop this mental health condition. It is usually correlated with BPD in a close family member such as a parent or sibling. Having parents who struggle with substance use disorder or mental health issues can also increase one's risk of developing BPD.


A person can develop borderline personality disorder as a result of their upbringing. A supportive home environment that exposes children to loving relationships can decrease the chances of a person learning unhealthy relationship behaviors, such as reacting with anger and impulsivity when conflicts arise. On the other hand, children who witness turbulent relationships fraught with harsh words and actions may pick up those behaviors and infuse them into their own relationships. Childhood trauma, such as neglect, sexual or physical abuse, or witnessing violence, can make people more susceptible to developing BPD later in life.

How Does BPD Impact an Individual’s Behavior and Perception?

Borderline personality disorder affects how a person thinks and feels about themself and others. Poor self-image is one of the core symptoms of BPD, causing a person to struggle with insecurity, feelings of emptiness or worthlessness, and fear of rejection or abandonment. Since they may view themselves as inadequate or undeserving, they may also feel that others are judging them negatively. One woman with BPD explained that basic social interactions, such as paying for items at her local grocery store, were overwhelming and anxiety-inducing. 

Emotions can run high due to difficulty with emotional regulation, leading to feelings that swing on a pendulum from intense love to deep hate. This can make for turbulent relationships since a person with BPD struggles with emotional balance but also fear losing their partner and go to extreme lengths to keep them. One person with BPD described feeling as though their “mind is a rollercoaster of emotions.”

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Symptoms of BPD

Borderline personality disorder is a frequently misdiagnosed mental health condition. Consider the following symptoms of BPD to see if the emotional difficulties you've been experiencing may be part of this condition. If you think you may have borderline personality disorder, scheduling an assessment with your provider can help you get a proper diagnosis and appropriate treatment.

Difficulty Regulating Emotions

A person with BPD struggles to feel emotionally balanced. Their feelings can range from low, depressive moods to periods of intense irritability, anxiety, and anger. One telltale sign of borderline personality disorder is frequently reacting with disproportionate anger to minor situations. 


BPD may lead to impulsive behaviors that can endanger a person's well-being. They might feel powerful urges to misuse substances, gamble, have unprotected sex, drive recklessly, or go on shopping sprees. 

Fear of Abandonment

People with borderline personality disorder can be consumed with fear of abandonment, often worrying that their partner or other loved one will leave them. They may go to extremes to try to prevent a breakup or any other type of rejection.

Unstable Relationships 

Since a lack of emotional regulation is one of the primary concerns with BPD, a person's relationships can suffer. Their feelings about others can fluctuate between extremes such as love and hate.

Poor Self-Image

Since BPD affects how a person thinks and feels about themselves and others, they often have a distorted self-image. A low sense of self-worth can also contribute to insecurity in relationships, suicidal thoughts, and self-harming behavior. People with BPD have a higher risk of suicide than others.

What Is Alcohol Use Disorder (AUD)?

Alcohol use disorder is a chronic condition in which a person feels compelled to drink alcohol despite its consequences on their health, finances, and relationships. According to the 2019 National Survey on Drug Use and Health, approximately 14.5 million people in the United States aged 12 and up struggle with alcohol use disorder. Of those, 414,000 are between the ages of 12 and 17.

AUD develops when the brain starts to depend on alcohol to activate neurotransmitters responsible for positive mood and relaxation. When a person with alcohol use disorder stops drinking, they will feel physical and mental discomforts, such as low mood, anxiety, nausea, and tremors.

Symptoms of AUD

People do not always recognize alcohol use disorder in themselves, especially if drinking is a regular part of their social circle. The following symptoms of AUD can help let you know when you may need to rethink your alcohol consumption.

Difficulty Moderating Alcohol Consumption 

If you start the evening planning to have just one or two drinks, which often turns into four, five, or more drinks, you might be dealing with alcohol use disorder. An inability to limit yourself to a specified number of drinks repeatedly demonstrates that your consumption may be outside your control.

Life Revolves Around Alcohol 

When AUD sets in, you may spend much of your time thinking about your next drink, consuming alcohol, and recovering from the effects of alcohol through hangovers and withdrawal symptoms. If you look at how you spend your free time and see that it is full of alcohol-related activities, you could be on the road to AUD if you have not already developed it.

Requiring Alcohol to Fend Off Withdrawal Symptoms 

Needing a drink first thing in the morning to stave off tremors, anxiety, depression, or nausea is a sure sign of alcohol use disorder. And if you find yourself drinking at inappropriate times, such as while working or driving, you may have a severe, potentially dangerous case of AUD.

Isolation from Activities and Loved Ones

AUD can take over your life and drain your interest in things you once loved. You may stop spending time with friends and family members, especially if they do not drink or disapprove of your drinking behaviors. And you may give up hobbies and interests that once brought you joy. This is AUD creating more space in your life for alcohol by getting rid of anything that does not support your consumption.

Understanding the Link Between Alcohol Use Disorder and BPD

Alcohol use disorder frequently occurs alongside borderline personality disorder. Approximately 46% to 49% of people diagnosed with BPD also have AUD. There are several explanations for the higher incidence of AUD and co-occurring BPD:

Poor emotional regulation and impulsivity make a person more likely to engage in alcohol misuse.

Someone with BPD may be less likely to think through the consequences of problematic drinking behaviors like binge or heavy drinking. Without weighing the risks of alcohol misuse, such as addiction, injuries, health problems, or hangovers, a person may not hesitate to drink excessively.

AUD can lead to impulsivity and emotional dysregulation.

Alcohol use disorder can cause changes in brain neurotransmitters that make a person more likely to act impulsively and struggle to regulate emotions, two symptoms of borderline personality disorder.

AUD and BPD trigger or exacerbate one another.

Regardless of which condition manifests first, the co-occurring condition can be triggered or worsened by the first. The impulsivity and neuroticism of BPD can make a person more likely to engage in alcohol misuse. And AUD can increase the chances of developing BPD or the severity of existing BPD symptoms. 

Does Alcohol Use Disorder Intensify BPD?

The preferred treatment for borderline personality disorder is therapy. No medications are FDA-approved to treat BPD, and some people may be treatment resistant. This can lead to increasing frustration, making a person more likely to self-medicate with alcohol or other substances to manage their symptoms. However, instead of relieving symptoms, alcohol misuse can intensify BPD symptoms. Binge or heavy drinking can worsen mood swings, impulsivity, neuroticism, depression, and suicidal thoughts, especially once a person with BPD has developed AUD.

Risks and Dangers of Alcohol Use Disorder in BPD

Managing co-occurring alcohol use disorder and borderline personality disorder can be incredibly challenging. Without effective treatment, people with these conditions are susceptible to the following risks and dangers:

  • Low retention in treatment programs
  • Increased impulsivity
  • Heightened emotional dysregulation
  • Engaging in risky or addictive behaviors like reckless driving and gambling
  • Suicidal thoughts

These risks are much more common in people with AUD who have co-occurring BPD. Alcohol use disorder intensifies the symptoms of borderline personality disorder, making this challenging condition even more difficult to manage.

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Diagnosis of AUD and BPD

Many people with borderline personality disorder are misdiagnosed and go without the proper treatment because this condition has symptoms that can mimic those of other mental health conditions like bipolar disorder and attention-deficit/hyperactivity disorder (ADHD). People with BPD may also be resistant to treatment due to the nature of the condition. Adding alcohol use disorder to the mix can make things even more complicated. AUD and BPD have similar symptoms, so the latter can go undetected in those seeking treatment for the former.

The methods used to diagnose alcohol use disorder and borderline personality disorder have some overlap. To determine whether you have one or both of these conditions, your provider may:

  • Perform a physical exam
  • Conduct a psychological evaluation 
  • Record your personal and family medical history
  • Discuss your signs and symptoms

If your provider believes you have alcohol use disorder, they may also order lab tests and imaging tests to get a better picture of your physical health. AUD can lead to organ damage, elevated liver enzymes, and other medical conditions that must be factored into your treatment plan.

Treatment for Borderline Personality Disorder

There are several challenges when treating borderline personality disorder. First, the neuroticism and emotional dysregulation common in people with BPD can make them opposed to getting treatment. Getting past this resistance and beginning a therapy program using specific therapeutic modalities, like dialectical behavior therapy (DBT), can help someone with this condition find more peace and calm. This form of therapy teaches mindfulness, distress tolerance, and emotional regulation, which are crucial for supporting emotional balance in people with BPD.

The second challenge for treating BPD is that no prescription medications are FDA-approved to treat the symptoms of borderline personality disorder. A provider generally needs to prescribe medications off-label to address specific symptoms. This can be a combination of antidepressants to tackle low mood and suicidal thoughts and mood stabilizers to manage mood swings and neuroticism. 

Rehab for Alcohol Use Disorder and Borderline Personality Disorder

The most effective treatment for alcohol use disorder and co-occurring borderline personality disorder is dual diagnosis treatment. Both conditions should be treated simultaneously for the best outcome. However, in cases of severe AUD, a provider may suggest detoxing from alcohol before addressing BPD symptoms. Once alcohol is out of your system and withdrawal symptoms have dissipated, it will be easier to assess your mental health accurately.

Dual diagnosis treatment for AUD and BPD usually consists of:


Medications are usually introduced early in treatment to minimize alcohol withdrawal symptoms and cravings. People with BPD may struggle with depression, low mood, and suicidal thoughts, so antidepressants may also be added to the treatment protocol. 


Therapy is the cornerstone of treatment for borderline personality disorder and alcohol use disorder. Dialectical behavior therapy (DBT) was developed specifically for BPD since the condition was notoriously difficult to treat. The most commonly used therapeutic modality, cognitive-behavioral therapy (CBT), did not provide the desired results. DBT emphasizes mindfulness, non-judgment, and acceptance, making it the modality of choice to help clients manage the challenges of AUD and BPD. 

Find Online Treatment for AUD and BPD at Confidant Health

Overcoming AUD and BPD can be challenging but not impossible. When you choose online depression treatment and alcohol rehab with Confidant Health, you'll get the support you need to manage the unique issues that arise with these co-occurring conditions. Download our app today and schedule a virtual assessment to get started with medication-assisted treatment for alcohol use disorder and borderline personality disorder.

This article has been medically reviewed by
Erin Hillers
Erin Hillers
Erin Hillers
Nurse Practitioner

Erin is a Nurse Practitioner with 8 years of experience in midwifery and women's health. She has spent the past 5 years specializing in the treatment of opioid and alcohol use disorders.

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