Date of Conferral

8-2-2025

Degree

Doctor of Psychology (Psy.D.)

School

Psychology

Advisor

Brent Robbins

Abstract

This study explored the lived experience of Borderline Personality Disorder (BPD) and substance use as a maladaptive coping mechanism during recovery, raising the question of whether recovery itself fosters comorbidity. The study was grounded on several theories, including Linehan’s biosocial model, the Cox and Klinger alcohol motivation model, the affect regulation model, and the self-medication hypothesis. These theories argue that substance use arises from emotional vulnerability, invalidating environment, and affect regulation efforts. The study employed a phenomenological qualitative approach to guide data collection and analysis. Interviews from 20 BPD patients and mental health care providers were completed. The thematic analysis identified six fundamental themes: (1) emotional rollercoaster and addiction as a coping mechanism, (2) addiction cycles through treatment, (3) self-injury and impulsivity, (4) fear of abandonment, (5) comorbidity of BPD and addiction, and (6) obstacles to effective treatment. Participants described how conventional therapeutic models inevitably triggered emotional instability and consequently self-medication. This behavior was not a consequence of insubordination but systemic gaps in trauma-informed care, rigid treatment protocols, and stigma. Providers concurred that, in combination, less-intrusive, patient-focused treatments directed at emotional dysregulation and drug use were preferred. The study points out the necessity of trauma-informed, attachment-sensitive care while treating BPD. It encourages the incorporation of Dialectical Behavior Therapy (DBT) together with addiction-focused treatments, focusing more on emotional regulation, tolerance of distress, and interpersonal skills.

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