Category: Comorbidity - Substance Use and Other
Despite the well documented association between borderline personality disorder (BPD) and alcohol abuse during adulthood (Trull, Sher, Minks-Brown, Durbin, & Burr, 2000), scant research has explored this link during adolescence. Teens who have BPD symptoms and use alcohol may be at heightened risk for negative outcomes (e.g., suicide, risky behaviors), thus it is critical to understand this association. The purpose of the present study is to explore two factors that may heighten risk for alcohol use among youth with BPD symptoms: drinking motives and poor emotion regulation (ER) skills. Drinking motives, such as to self-medicate and to increase rebelliousness, are associated with adolescent drinking. These motives may apply equally well to adolescents with BPD symptoms, many of whom show mood swings and impulsive risky behavior. ER deficits, common to BPD, may also increase the likelihood of alcohol use as a maladaptive coping behavior. We hypothesized (1) BPD symptoms and alcohol misuse would be positively related; and (2) drinking motives (self-medication, rebelliousness) and perceived ER skills would moderate the association between BPD symptoms and alcohol misuse.
Participants included 181 psychiatrically hospitalized adolescents (Mage 15.02 years, SD=1.33 years; 72.1% female, 83.1% White). Empirically validated measures were used to assess BPD symptoms, drinking motives, ER skills, and alcohol misuse (problems and frequency). Linear regression analyses were conducted using PROCESS (Hayes, 2013) in SPSS. Number of BPD symptoms and alcohol misuse were positively related. Greater drinking to self-medicate and to rebel motives were also positively associated with alcohol misuse. Self-medication moderated the relation between BPD symptoms and alcohol problems, but not frequency of use. Simple slope tests showed that BPD symptoms were positively related to alcohol problems (B=0.30, p=.01) at low levels of self-medication, but not moderate or high levels. Rebelliousness was not a significant moderator. While ER skills were not associated with alcohol misuse, they moderated the relations between BPD and alcohol misuse. Simple slopes tests revealed BPD symptoms were related to alcohol problems at moderate (B=0.49, p < .001) and high (B=0.77, p < .001) levels of ER; the same was true for frequency of use (moderate: B=0.74, p < .01; high: B=1.39, p < .001).
Consistent with adults, BPD symptoms and alcohol misuse co-occur among adolescents. Self-medication and rebelliousness motives appear to be risky regardless of BPD symptoms. Contrary to expectations, low self-medication motives and higher perceived ER skills strengthened the relation between BPD and alcohol misuse. Apparent competence (i.e., present as “in control” but lack sufficient skills) may be at play.