BPD and Alcoholism

QUESTION:

I would like to share a recent observation regarding BPD with you.

I had developed a rather "healthy" drinking problem over the last two months. Something to numb the pain... When I realized I was getting into trouble with substance abuse, I reached out for help and joined AA. It is remarkable how much overlap there is between the emotional makeup of an alcoholic and a borderline.

Alcohol abuse is merely a symptom of a much larger underlying problem in alcoholics: the alcoholic mind.

Alcoholics are controlling, manipulative, insecure, depressive and perfectionist. They fear abandonment, they have low self-esteem and are arrested in their emotional development. They have difficulty forming healthy relationships because they never deal with their emotions in a normal adult manner. The terrible emotional pain and suppression they inflict on themselves (and those around them) often results in a virtual loss of identity.

I have found the similarities astounding. I am not yet convinced that my problem is nothing more than garden variety alcoholism (like my father and his father before him), but it is certainly within the realm of possibility.

I know that the two illnesses (alcoholism and BPD) often co-exist, but what do you think of the similarities between the two?

DR. HELLER'S ANSWER:

They're very different. Borderlines do whatever they have to in order to stop the pain of dysphoria - and substance abuse is one thing that's commonly used. The BPD is due to instability in the brain's limbic system - basically the same area responsible for responding to a severe threat. The inappropriate mood swings, chronic anger, emptiness, boredom and dysphoria - anxiety, rage, depression, despair, and dissociate symptoms are the key. These symptoms are present in borderlines with or without alcoholism. Perfectionism is not a symptom of the BPD.

The symptoms you described can be caused by many things, they don't relate directly to the biological basis of the BPD. Many alcoholics do indeed show the symptoms you described, however. Responding to talks I've given about the BPD, leaders of AA groups have told me the borderlines "are the ones who consistently fail in AA."

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