Borderline Personality Disorder and Substance Use: Trauma, DBT, and the Path to Recovery
In a recent episode of the Boy Meets Therapy podcast, Dustin Oliver sits down with therapist Karley to unpack one of the most misunderstood mental health conditions, Borderline Personality Disorder (BPD). Their conversation touches on emotional intensity, trauma, substance use, and the power of Dialectical Behavior Therapy (DBT) in the healing process.
What Is Borderline Personality Disorder (BPD)?
Borderline Personality Disorder is a complex mental health condition marked by emotional dysregulation, impulsivity, unstable relationships, and a fragile sense of self. People with BPD often feel emotions more intensely and may struggle with fear of abandonment, mood swings, and self-destructive behaviors.
Karley emphasizes that BPD isn’t a character flaw, it's often a survival response rooted in unresolved trauma and early relational wounds.
The Link Between BPD and Trauma
Trauma is a central theme in the development of BPD. Many individuals with the disorder have experienced emotional neglect, invalidation, or abuse in childhood. These early experiences can make it difficult to develop secure attachments or regulate emotions, leading to patterns of intense emotional reactions and fear of rejection.
During the episode, Karley explains how therapists must approach clients with a trauma-informed lens, recognizing that behaviors often labeled as “manipulative” or “attention-seeking” are usually rooted in pain and fear.
Why DBT Works for BPD
Dialectical Behavior Therapy (DBT) is considered the gold standard treatment for BPD. Developed by Dr. Marsha Linehan, DBT combines cognitive-behavioral strategies with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills.
Karley breaks down how DBT helps clients:
Learn to regulate overwhelming emotions
Build distress tolerance without turning to self-harm or substances
Improve interpersonal skills and set boundaries
Practice radical acceptance and self-compassion
Co-Occurring Substance Use Disorders
A significant portion of individuals with BPD also struggle with substance use disorders. In many cases, substances are used to cope with emotional pain, numb feelings, or manage chaotic interpersonal dynamics.
Karley shares her experience working with clients who face both BPD and addiction. She emphasizes the importance of integrated care that addresses both the emotional dysregulation of BPD and the behavioral patterns associated with substance use.
Active Passivity and the Therapeutic Relationship
One concept discussed in the episode is active passivity, a pattern where clients seek help from others without attempting to help themselves. This dynamic can be frustrating for therapists, which is why therapist self-care and supervision are so important.
Karley stresses the need for boundaries and modeling healthy, secure relationships in therapy. Recovery is possible, but it requires trust, consistency, and a therapist who can hold both accountability and compassion.
Key Takeaways from the Episode
BPD is treatable, especially with DBT and trauma-informed therapy.
Substance use and BPD often go hand in hand, and both need to be addressed in treatment.
Compassion matters. Clients with BPD often have complex trauma histories and benefit from nonjudgmental support.
Therapists must practice self-care to avoid burnout and maintain empathy.
Final Thoughts
Borderline Personality Disorder is one of the most stigmatized mental health diagnoses, but conversations like this one with Karley help change that narrative. With the right support, individuals with BPD can build meaningful relationships, regulate their emotions, and recover from co-occurring challenges like addiction.
If you’re a therapist, student, or someone navigating BPD or substance use in your own life, this episode is a reminder: healing is possible, and you don’t have to do it alone.
