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Borderline Personality Disorder, Obsessive-Compulsive Disorder, Addiction

 

What Is The Connection?

When Jack Bingham was 14, he couldn’t leave his house because he thought the indoor air was contaminated at head level. So he crouch-walked all the way to the bathroom. Worse, he couldn’t urinate without showering. Buoyed by his worry about contaminated air, he sometimes held off urinating for 24 hours until he could safely get to the bathroom, where he would shower for eight hours straight.

Another time, he felt contaminants coming in through electronics, so he didn’t watch TV. He stood under the ceiling fan to shake and cough away the contamination. When he wasn’t afraid to attend school, he used Lysol wipes to repeatedly clean his seat on the bus before he could sit. He lost a lot of sleep and wasted time because of his compulsions. If he tried to resist them, all that did was make them last 10 times longer when he finally gave in.

Bingham suffered from extreme obsessive-compulsive disorder (OCD), a psychiatric condition characterized by uncontrollable obsessions (recurring obtrusive thoughts), resulting in anxiety and compulsions (repetitive behaviours used to alleviate anxiety caused by the obsessions) [1]. The prevalence of OCD is estimated at 1%, or approximately 3.1 million people in the USA [2].

He also suffered from substance use disorder (SUD) and borderline personality disorder (BPD)—aka emotionally unstable personality disorder (EUPD)—characterized by self-image issues, difficulty managing emotions and behaviour, and a pattern of unstable relationships.

Bingham explains the obsessive aspect: “OCD causes a lot of anxiety, panic, and fear to the point where you’ll act on compulsive behaviour even though you know it’s irrational just to get relief. It’s like using (drugs) just to not be dope sick. You’re not getting high when you’re doing your compulsion; you’re just not in hell. But eventually, that whole pattern becomes hell.”

He turned to drugs to escape. But when addiction set in, the drugs no longer helped. So he turned to stereotype addictive behaviours (like stealing) while also managing compulsions. It all came to a head when he attempted suicide.

Numerous doctors told him, “There’s nothing we can do. We can try different therapies but you’re always going to have a certain degree of OCD.” Salvation came through his mom’s therapist friend, with whom he shared a secret that may have been the cause of his OCD—sexual trauma at eight years old. She was able to bring him to a moment of clarity with a single sentence: “All of this insanity and fear is a lie created by the mind of a child.”

It took six months of not giving in to compulsions before he got better. “The obsession doesn’t go right away just like getting sober. But as time goes on and you fight that obsession, it does leave you,” assures Bingham, who has written a book about his multiple disorders [3].

Why Borderline Personality Disorder and Obsessive-Compulsive Disorder Sufferers are Susceptible to Addiction

They are more prone because of emotional sensitivity and hyper-vigilance to issues like abhorrence to germs, abandonment, loneliness, and emptiness. Substance use is a means to create a dissociative sensation, so patients are separated from whatever they loathe, including themselves.

Environmental and social factors, such as stress, peer pressure, and negative interactions, are the usual triggers to substance use. This continued indulgence typically ends up in addiction, which encourages maladaptive behaviour and functioning.

Personality disorder psychologist Dr Daniel Fox says that approximately 78% of those with BPD also have an SUD [4]. This doesn’t mean that everyone with BPD abuses substances and that everybody who has SUD has BPD. Alcohol/drug use is a short-term reward because after the high, patients experience symptoms again, making them want to reuse, reinforcing a vicious cycle. When BPD, OCD, and SUD overlap, therapy is more challenging, but all are treatable.

Borderline Personality Disorder Characteristics

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), criteria for Borderline Personality Disorder include:

  • identity disturbance—influences patients to adopt many identities, often leading to a misdiagnosis of dissociative identity disorder (DID), formerly multiple personality disorder.
  • impairment in interpersonal functioning with either empathy (obliviousness to others’ feelings) or intimacy (intense, unstable, and conflicted relationships)

BPD patients also have these pathological personality traits:

  • Negative affectivity—fear of rejection, anxiety, frequent mood changes, feeling down, suicidal thoughts and behaviour
  • Disinhibition—impulsivity and risk-taking
  • Antagonism—inappropriate, intense display of anger

Comorbidity* statistics

Apart from mental health disorders, obsessive-compulsive disorder also commonly occurs with physiological diseases like fibromyalgia and irritable bowel syndrome. According to a 2013 article by Biskind and Paris, the average for comorbidity with borderline personality disorder is four mental health disorders and two personality disorders. Comorbidity is the reason BPD is often perceived as treatment-resistant. So careful diagnosis and precise treatment planning is of utmost importance.

Disorders that co-occur with Borderline Personality Disorder

88% anxiety

75% depression

50% PTSD

40% panic disorders

55-60% SUDs

15% eating disorders

25% ADHD

What causes Obsessive-Compulsive Disorder and Borderline Personality Disorder?

Factors blamed for causing these conditions include both genetics and the environment. No research, however, has shown that stress or negative parental interaction during childhood causes OCD. The most common BPD triggers are relationship torment or interpersonal distress.

Treatment options

Integrated treatment

Cohesive mental care and addiction therapy for two or more mental health conditions or SUDs. This is more effective than treating each diagnosis separately. Clinical psychologist Dr. Ramani Durvasula of California State University recommends treating co-occurring mental illnesses simultaneously, while Fox is adamant about treating addictions first to break the cycle.

Medications

According to the Mayo Clinic, psychiatric medications used to treat OCD control compulsions and obsessive thoughts by increasing serotonin levels in the brain (low in OCD patients). Serotonin is a ‘happy hormone’ that regulates anxiety, happiness, and mood. The most commonly used mood stabilizers effective for BPD are antiepileptic drugs. Lithium is effective in treating BPD anger and irritation. These drugs are habit-forming, so doctors’ guidelines should be strictly followed.

Natural supplements

Natural supplements recommended for OCD include milk thistle, said to have similar effects to that of the antidepressant Prozac. Magnesium and zinc also boost levels of serotonin. Foods to avoid include caffeine, energy drinks, alcohol, anything processed, and trans/saturated fats.

Glutamate

This amino acid in protein-rich foods has been found to cause psychological distress. Also produced by the body, it’s vital for metabolism and brain function. A 2016 study by Holton and Kotter found that lowering glutamate from the diet alleviates OCD symptoms [5].

Exercise

Working out promotes the release of endorphins, “feel good” neurochemicals that zap stress.

Behavioural therapy

  • Cognitive Behaviour Therapy—modifies harmful beliefs and maladaptive behaviours. Effective for SUDs, anxiety, and mood disorders.
  • Dialectical Behaviour Therapy—reduces self-harm behaviours. Most effective for BPD.
  • Contingency Management (aka Motivational Incentives)—reward-based treatments.
  • Assertive Community Treatment—for severe mental illnesses like schizophrenia and co-occurring SUDs.
  • Eye Movement Desensitization and Reprocessing—patients relive traumatic experiences while therapists direct eye movements.
  • Rational Emotive Behaviour Therapy—helps patients change thoughts and beliefs on addiction.
  • Exposure therapy—repeated exposure to a feared situation, object, traumatic event, or memory.

Diagnosing Borderline Personality Disorder and Obsessive-Compulsive Disorder

Online tests for determining BPD or OCD

BPD: http://www.bpddemystified.com/resources/online-test/

OCD: https://www.psycom.net/do-i-have-ocd-test

Don’t go solo

It’s critical that people with simultaneously occurring BPD, OCD, and addiction consult mental health professionals to receive appropriate diagnosis and treatment. Those on a budget may contact their local health centre for free or subsidized support.

* The simultaneous presence of two chronic diseases or conditions in a patient.

Sources

[1] Mcleod et al. “Diagnostic and Behavioral Assessment in Children and Adolescents: A Clinical Guide”. The Guilford Press, USA. 2013.
[2] Kessler et al. “Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication”. Archives of General Psychiatry, 62(6), 617-627. 2005.
[3] Bingham, Jack. “Obsessive-Compulsive Dramatic: My Fight Against OCD, Borderline Personality Disorder, and Addiction”. 2018.
[4] Fox, Daniel. “The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD”. 2019.
[5] Holton and Cotter. “Could dietary glutamate be contributing to the symptoms of obsessive-compulsive disorder?”. Future Science. 2018.