QUESTION:

Dear Dr. Heller,

It seems most people I know with the BPD smoke. Is there a relationship?

ANSWER:

That observation is clearly an accurate one from my perspective. I think there are many reasons...

1) The profound association with attention deficit disorder AD(H)D - studies at Duke show the nicotine in cigarettes actually "treats" AD(H)D. The sad part here is that Ritalin, which does work has as it’s long term effects a reduction in cancer, substance abuse and accidents, whereas cigarettes are one of the most poisonous substances known to mankind.

2) Nicotine is an extremely addicting substance, and individuals experience withdrawals when they try to quit. The withdrawals can often trigger dysphoria (anxiety, rage, depression and despair) - so the individual with BPD refuses to quit smoking.

3) Self-hate is extremely common, so if a person hates him/her self the consequences of smoking are not important.

4) Substance abuse is common in the BPD.

5) The family of origin commonly smokes, so it’s a learned behavior.

6) Nicotine gives some energy, and borderlines tend to have low energy.