Signs, Symptoms, and Treating BPD and Addiction

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), personality disorders are grouped into three clusters based on shared characteristics and behavioral tendencies.[2]

Those with a Cluster A personality disorder may exhibit an odd, eccentric, or suspicious way of expressing their thoughts and behaviors.[3]
These may include:

• Paranoid Personality Disorder: A pattern of persistent distrust and suspicion of others, where intentions are often interpreted as harmful, even without clear evidence.
• Schizoid Personality Disorder: A pattern of detachment from social relationships and a limited range of emotional expression, often marked by a preference for solitude.
• Schizotypal Personality Disorder: A pattern of discomfort with close relationships along with unusual beliefs, behaviors, or perceptual experiences that can affect thinking and communication.

Cluster A individuals may have trust issues, an inability to express their emotions, and have difficulty in establishing social relationships because they exhibit limited emotional responses, have difficulty forming relationships, and have unusual beliefs or perceptions.

Cluster B disorders exhibit intense emotions, engage in impulsive behaviors, and have unstable interpersonal relationships.[4]

• Borderline Personality Disorder: A pattern of intense emotional instability, fear of abandonment, and difficulty maintaining stable relationships and self-image.
• Antisocial Personality Disorder: A pattern of disregard for the rights of others, often involving impulsive behavior, deceitfulness, and lack of remorse.
• Narcissistic Personality Disorder: A pattern of grandiosity, strong need for admiration, and limited empathy for others, often masking fragile self-esteem.
• Histrionic Personality Disorder: A pattern of excessive emotional expression and attention-seeking behavior, with a strong need for approval and validation.

Borderline Personality Disorder (BPD) is the most commonly treated disorder in Cluster B.[5]

Cluster C disorders exhibit anxiety, fear, or an avoidance of others.[6]
These include:

• Avoidant Personality Disorder: A pattern of social inhibition, feelings of inadequacy, and heightened sensitivity to criticism that leads to avoidance of relationships despite a desire for connection.
• Dependent Personality Disorder: A pattern of excessive need to be cared for, leading to submissive behavior, difficulty making decisions, and fear of separation.
• Obsessive-Compulsive Personality Disorder: A pattern of perfectionism, need for control, and preoccupation with order and rules that can interfere with flexibility and relationships.

Those with personality disorders in Cluster C experience chronic anxiety, engage in perfectionistic behaviors, and rely on others for reassurance, validation, or decision making.

Regardless of the personality disorder diagnosis, there are some common behaviors to look for, including:[7]

• Difficulties regulating their emotions
• Intense and rapidly changing moods
• Unstable or conflicted interpersonal relationships
• Impulsive behaviors or risky behavior
• Recurrent feelings of emptiness or dissatisfaction
• Distorted self-image or confused identity
• Difficulties managing stress or conflict

If symptoms are not treated, they impact the individual’s ability to work, be part of a family, or interact socially.

Borderline personality disorder (BPD) is closely linked to substance use disorders, and many sufferers turn to using drugs or alcohol as a way of coping with emotional distress, empty feelings, or rapid mood changes.[8] Such impulsive traits combined with the inability to tolerate distress contribute to increased pressure to drink alcohol or use drugs.

Over time, substance use may exacerbate the symptoms of emotional dysregulation and impulsiveness and increase conflict with others. Both BPD and substance use disorders can be significantly more difficult to treat due to this cycle. Additionally, substance use can lead to newly developed substance-induced mood symptoms in the person with BPD, complicating the diagnosis and treatment plan.

The exact causes of personality disorders are not fully understood, but research suggests a combination of biological, psychological, and environmental factors.[9] Common risk factors may include:

• A family history of mental illness or personality disorder
• Childhood trauma or neglect
• Chronic environmental stress and instability
• Difficulty with emotional attachment as a child
• Long-term use of drugs or alcohol

These factors can interact in complex ways, influencing emotional development and coping patterns over time.