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January 2011



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Simone Hoermann, Ph.D. Updated: Nov 10th 2009

In a previous blog, I wrote about some aspects of substance abuse and its relationship to Personality Disorders. A common problem for people with Borderline Personality Disorder is a tendency to get very overwhelmed by intense emotions. Sometimes, this leads to self-destructive behaviors, such as cutting, bingeing and purging, shopping, spending, or gambling.


My colleague Dr. Karen Frieder, who specializes in treating people with substance abuse issues and also with problems related to a dual diagnosis of substance use  and Personality Disorders, explained to me that in the past, substance use was seen as a different set of problems: “There was so much stigma attached to substance abuse issues, even more than other difficulties, but thankfully that has changed more recently. Nowadays, in people with Borderline Personality Disorder, we tend to see substance abuse as part of the issues with emotion regulation, similar to cutting, spending, or bingeing and purging. Therefore, one way of conceptualizing substance use in people with Borderline Personality Disorder is that substance use can be added to this list of self-destructive, impulsive behaviors.”


Frequently, people with Borderline Personality Disorder feel overwhelmed with intense emotions and use substances in order to avoid or cope with these painful or tense internal states.  Sometimes, the opposite is the case: Some people with Borderline Personality Disorder are very detached from their feelings and feel empty inside.  Using a substance, for instance, using alcohol, can serve as a means to feel things more intensely.  “We call this the self-medication hypothesis”, says Dr. Frieder, “If you’re feeling up, you use the substance to come down, and if you’re down, you use the substance to come back up. The idea is that there is an underlying cause for the substance use.  The person engages in these behaviors in an attempt to find short-term solutions, but they are not very effective.”


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