A person who has a dual diagnosis (also referred to as co-occurring disorders) has two separate illnesses, which need to be treated simultaneously.
“Tonight, you’re mine… But will you love me tomorrow?” We’ve heard this song of love, hope, and fear hundreds of times. We might even sing along when it’s playing in the car.
But what if this song isn’t really about love. What if it’s a description of something much more damaging?
People with borderline personality disorder (BPD) can fall in love. Often, they feel passionate about others, and they would do almost anything to keep their relationships intact.
But BPD is characterized by a deep fear of abandonment, combined with rapid cycling between love and hate.
If you or someone you love has BPD, love songs take on a new meaning. Treatment is one of the most loving steps you can take to repair the damage and heal your relationship.
What You Should Know About BPD
Personality is typically defined as a combination of thoughts, feelings, and behaviors. Our experiences can shape our personalities, but ultimately, our personalities tend to be relatively stable. People with BPD have unusual thought patterns, and they often manifest as damaging behaviors and quickly shifting feelings.
The National Alliance on Mental Illness suggests that about 6 percent of the population could have BPD, although many people haven’t been diagnosed yet. The illness can masquerade as depression, post-traumatic stress disorder, or schizophrenia. Some people don’t talk about their symptoms at all, so they’re never diagnosed.
People with BPD develop symptoms such as:
- Impulsivity. They may spend too much money, drive recklessly, or engage in unsafe sex. They may also participate in self-harm.
- Mood swings. They may feel intensely depressed or anxious. A few hours later, they may feel the opposite.
- Isolation. They may attempt to avoid separations from those they love, and those actions can lead to physical or emotional abandonment. They may also shift between idealization and devaluation of the same person.
- Distortion. They may have an unusual or unstable self-image, which leads to changes in their moods, goals, and values.
- Disassociation. They may have episodes in which they feel they’re floating or standing outside of their bodies.
As the National Institute of Mental Health points out, some people with BPD have all of these symptoms, and others have just a few. But those with BPD can show these symptoms in response to a trigger others consider minor.
For example, someone with BPD may become angry or even frantic when a loved one will not answer the phone. This is a very minor issue that happens to people around the world every day. But for people with BPD, that slight separation could be enough to trigger an episode of anger or mania that lasts for hours or even days.
What Causes BPD?
Researchers haven’t determined the exact cause of BPD, but they have theories about contributing factors. Some you can control, while others you cannot.
BPD does seem to have a genetic component, as parents with the disorder tend to have children with the same issue. But childhood experiences can also play a role.
The U.S. National Library of Medicine says BPD risk factors include:
- Poor communication, including frequent fights or long silences.
- Abandonment, whether it is real or imagined.
- Disruption, including divorce or some other issue that breaks the family apart.
- Abuse, including physical, sexual, or emotional trauma.
These risk factors are most powerful during childhood when personality traits are set. Adults with BPD may demonstrate their malformed ways of thinking and behaving for years before they realize there is a problem. And the steps they can take as a result of the disorder can be incredibly dangerous.
The Role of Substance Abuse
Avoiding drugs and alcohol is hard. Everywhere we go, there’s a substance inviting us to take part. We’re told to take a pill or knock back a hit to make our problems go away. For someone with BPD, the checks and balances that keep substance abuse at bay are missing, and that can lead to severe problems.
We use our higher brain to keep our impulses in check. It’s this part of the mind that keeps us from yelling at our bosses during tough meetings or ramming our cars into other vehicles in crowded parking lots. People with BPD struggle with this form of impulse control, and that can lead them into drug experimentation and addiction.
During a manic episode, drugs seem to calm and soothe the overactive mind. During depression, other drugs seem to give a sudden boost of energy and activity. For someone with BPD, drugs can seem helpful, and no inner voice counsels against the use of substances.
German researchers say that about 80 percent of people with BPD develop a substance abuse problem. Those who do differ from people with BPD and no addiction in that they:
- Show symptoms earlier in life.
- Have more trouble with healthy relationships.
- Drop out of treatment more frequently.
- Have stronger BPD symptoms.
Addictions can also make impulsivity even worse. A sedated brain can’t do complicated calculations of cost and benefit. Any idea seems like a good one.
Harvard Medical School reports that 69 to 80 percent of people with BPD attempt suicide or take other life-threatening steps, and up to 9 percent succeed and die due to suicide.
For people with addictions and BPD, drugs can become the suicide method of choice. And some drugs make losing life remarkably easy. Crushing pills and inhaling the powder, rather than swallowing them, brings all of the power to the forefront at once. Loading up a needle with a more significant dose of heroin does the same. When emotions run high and suicide seems wise, drugs make that decision easy to follow through on.
How BPD Treatment Works
Several decades ago, says Mental Health America, we considered BPD untreatable. People with the disorder were doomed to live out their lives in an unusual way, and since they couldn’t change, they would often be shunned.
We’ve learned a lot about the disorder, and now, we know it can be treated effectively.
Dialectical behavior therapy (DBT) is the treatment of choice for BPD. The treatment helps people to:
- Accept. Strong emotions are a part of life, and they don’t always need a shift. Therapy aims to help people accept their feelings as they are without engaging in drug use or other destructive behaviors to soothe them.
- Control. Unusual thoughts aren’t always accurate. Therapists help clients to explore their beliefs and choose how to react to them positively.
- Regulate. Strong emotions don’t need to control your life. Clients learn to identify negative impulses and choose to behave differently.
- Discuss. Bottled-up feelings tend to grow stronger. Clients learn how to articulate their feelings and needs so others can understand them.
As a therapist explains, the ultimate goal of therapy is to help people learn to handle situations appropriately, especially when negative emotions bubble up. Skill-building allows people to take charge of their lives and control their relationships, so they’ll feel more comfortable every day.
For people with addictions, therapists will illuminate the connection between impulsivity and drug use. They’ll help clients to explore different self-soothing techniques so they won’t lean on addictive substances.
What to Look For in a Treatment Program
When you have BPD, your life is at risk. Treatment is critical, and you’ll need to find a program that’s right for you and your lifestyle.
DBT relies on a close connection between you and your therapist, and as someone with BPD, it’s tough for you to trust other people. When you feel pushed or pressured, you can lash out and break ties with people you’ve trusted before.
A dash of trust makes any therapy program more effective. But it’s critical for people with BPD. Before you sign up for treatment, make sure you’re allowed to meet your doctor. If you feel suspicious or uneasy about that person, keep searching.
Your family can help you search, but they may also need a therapist’s help. Your family will work as a sounding board as you recover. They can help you spot unhealthy habits and unusual thoughts, and they might confront you when you’re about to make a mistake.
Chances are, you’ll fight. You will have a therapist to help you work through it, and your family should too. An outsider can help to process trauma, so you don’t harm one another even more.
If you have BPD, start your search for care now. It’s a dangerous disease, and it can take your life. Look for a program that helps you recover.