Co-ordinating Action on Drug Issues
Borderline Personality
Disorder
And Substance Abuse
Jane Freeman
HOP Training
2nd March 2005 – Edinburgh
3rd March 2005 – Glasgow
8th March 2005 – Aberdeen
10th March 2005 – Dundee
Co-ordinating Action on Drug Issues
Overview
 How does Personality Disorder differ from mental
illness?
 What is Borderline Personality Disorder?
 Why are substances so frequently used in people with
BPD?
 Treatment issues & priorities – which comes first?
Co-ordinating Action on Drug Issues
Personality Disorder
 Personality disorder and mental illness are two related,
but different concepts
 Mental illness implies discrete periods
 Personality disorder implies stable, inflexible
maladaptive coping strategies
 Treatment implications
Co-ordinating Action on Drug Issues
DSM-IV Definition
A Personality Disorder is an enduring pattern
of inner experience and behaviour that deviates
markedly
individual’s
from
the
culture,
expectation
is
of
pervasive
the
and
inflexible, has an onset in adolescence or early
adulthood, is stable over time, and leads to
distress or impairment
Co-ordinating Action on Drug Issues
Borderline Personality
Disorder
Pervasive
pattern
of
instability
of
interpersonal relationships, self-image and
affect, and marked impulsivity
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Characteristics of BPD
 Efforts to avoid real or imagined abandonment
 Pattern of unstable and intense interpersonal
relationships which alternate between extremes of
idealisation and devaluation
 Identity disturbance
 Impulsivity
 Recurrent suicidal and/or self-harm behaviour
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Characteristics continued…
 Mood instability/reactivity
 Chronic feelings of emptiness
 Inappropriate, intense anger
 Transient stress-related paranoia
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Case Study
“Being someone with BPD feels like eternal hell.
Nothing less.
Pain, anger, confusion, hurt,
never knowing how I’m going to feel from one
minute to the next.
Hurting because I hurt
those I love. Feeling misunderstood. Analyzing
everything. Nothing gives me pleasure. Once in
a great while I will get “too happy” and then
anxious because of that.
with alcohol.
Then I self-medicate
Then I physically hurt myself.
Then I feel guilty because of that.
Shame.
Wanting to die but not being able to kill myself
because I’d feel too much guilt for those I’d
hurt, and then feeling angry about that so I cut
myself of OD to make all the feelings go away.
Stress!”
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BPD
 80% are victims of childhood abuse
 Prevalence: 2% of general population
 Primarily diagnosed in females (75%)
 54% have co-morbid substance abuse
 Recent research indicates that prolonged mental
health intervention has significant positive effect
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Emotional Dysregulation
 Learning to regulate emotion part of normal
development.
 Expect this to occur by late adolescence/early
adulthood
 Requires receptive environment and individual
 Inability to tolerate negative emotion, and marked
reactivity to perceived interpersonal stress – leads to
maladapative coping strategies
Co-ordinating Action on Drug Issues
Why substance abuse?
 To cope with effects of trauma
 To avoid intense negative emotion (caused by
emotional dysregulation)
 As general coping strategy (belief that “I cannot cope
on my own”)
 As self-punishment (belief that “I don’t deserve a
better lifestyle than this”)
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Treatment/Support Issues
 What to work on first? Anorexia analogy
 Need alternative coping strategies
 Emotional dysregulation needs mental health
professional input
 Complex, multiple needs. Call for multi-disciplinary
team
 Increased risk for suicide attempts – constant risk
assessment
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Worker Issues
 High resource demand cases
 Limit cases
 High rate of worker burnout or apathy
 Close supervision needed
 Worker safety – contract if necessary.
 Professional clear boundaries essential
 Good documentation important for ‘splitting behaviour’
Co-ordinating Action on Drug Issues
Useful Resources on BPD
‘Stop Walking on Eggshells.’ By P. Mason & R. Kreger
‘Lost in the Mirror: An Inside Look at Borderline
Personality Disorder.’ By R. Moskovitz
www.psycom.net/depression.central.borderline
(links to academic articles, support sites, information
sheets for families, etc)
www.bpdcentral.com