Personality is what makes each of us unique. It is a set of characteristics that helps to define our thoughts, attitudes, feelings, behaviors, and how we interact with the rest of the world. A sound and healthy personality allows us to function successfully in everyday life. It allows us to maintain good relationships, carry out tasks, pursue our interests, and overcome challenges during times of stress.
When an individual has a personality disorder (PD), these day-to-day tasks become more difficult. People with personality disorder often struggle to keep up with life’s demands, cope with stress, and even form relationships with others. These struggles can lead to great distress, depression, isolation. In many cases, it can also lead those suffering to drug and alcohol abuse.
Almost one in four (23 percent) people with a personality disorder also battle a substance use disorder simultaneously. 38 percent of people with Borderline Personality Disorder (BPD) – a type of personality disorder – also suffer from substance addiction.
When substance addiction and personality disorder co-exist, they are called co-occurring disorders, or sometimes “dual diagnosis.” If your loved one is suffering from these co-occurring conditions, you may be wondering, “Why them?” You may be wondering what to expect or where to go for help. Already, you feel like you’ve lost someone close to you, as personality disorder and addiction can make loved ones feel like complete strangers at times.
To understand the connection between substance addiction and personality disorders, and how to address them properly, it’s important to first understand the nature of each condition.
What are Personality Disorders?
A personality disorder (PD) is a mental health condition that affects an individual’s perception of, and response to, the world around them. It is characterized by a chronic pattern of unusual, unhealthy, or dangerous thoughts and behaviors. And it impairs a person’s functioning significantly.
According to the fifth (and most recent) Diagnostic and Statistical Manual for Mental Disorders, a personality disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture." Personality disorders are “pervasive and inflexible,” “stable over time” and lead to “distress or impairment.” Personality disorders, as cited by the DSM, also surface in adolescence or early adulthood.
In order to have a personality disorder diagnosis, the following criteria must be met:
- The person experiences significant impairments in self-identity or self-direction, as well as interpersonal functioning
- They must possess one or more pathological personality trait domains or trait facets
- The impairments must be stable over time, and across a variety of situations
- The impairments must not be understood as a normal part of development
- The symptoms must not be caused by a person’s environment, medical condition, or substance abuse
The DSM-5 defines 10 personality disorders, divided into three different categories depending on the types of symptoms they produce. Cluster A is characterized by odd, eccentric behavior, including:
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Cluster B is associated with dramatic, erratic, and overly emotional thoughts and behaviors:
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Finally, Cluster C includes any personality disorders defined by anxiety and fear, such as:
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-Compulsive personality disorder
Each personality disorder produces different symptoms. However, as noted above, most will affect a person’s ability to manage stress, handle responsibilities, and build meaningful relationships. They can also prevent someone from achieving life goals. As a result, it can be difficult to cope.
The Link Between Personality Disorder and Addiction
When an individual is suffering from a personality disorder, and does not know how to cope effectively, they may turn to drugs or alcohol. This is called self-medication, and can look like this:
- A person with avoidant personality disorder may use drugs to hide feelings of social incapacity
- A person with paranoid personality disorder may use drugs to escape negative thoughts
- A person with borderline personality disorder may use drugs to feel better about themselves
When a person self-medicates for an extended period of time, it can lead to drug addiction (formally known as a substance use disorder). And once a substance use disorder develops, the severity of a personality disorder usually increases, as well. The side effects of the disorder also worsen.
Co-occurring substance use and personality disorders affect the overlapping parts of the brain—those responsible for reward, impulse, and regulating emotions. Someone with a personality disorder is already prone to emotional instability, erratic behaviors, and anxieties. (This compulsion also leads many people with personality disorders to use drugs in the first place.) When drugs and alcohol are introduced, the person’s ability to control impulse, make sound decisions, and manage emotions becomes even more impaired and irregular. It becomes even harder to get them into a treatment program, and the treatment becomes much more complex.
Treating Comorbid Personality Disorders and Addiction
Personality disorders on their own can be difficult to treat, as many of those affected will not accept they have a problem. They may be aggressive or hostile when treatment is mentioned, or intervention is introduced. Recovery from personality disorders, as a result, requires deep psychotherapy sessions. Behavioral therapies can be used to help a person develop healthier thought patterns, attitudes, and routines – replacing the negative and destructive ones.
Behavioral therapies – such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) – are also very effective in treating co-occurring substance addiction and personality disorders. Combined with a comprehensive dual diagnosis treatment plan, an individual is likely to have a successful recovery. However, the key to this treatment plan is that it works to address both disorders at once, in an integrated fashion.
Integrated treatment is necessary for anyone struggling with personality disorders and addiction. This means that both disorders are considered, and addressed, simultaneously—in the same place and with the same clinical team. The treatment must also be individualized for your loved one’s needs, taking into considering their physical, mental, social, emotional, and even legal needs. It should incorporate:
- Behavioral therapy sessions
- One-on-one counseling
- Group therapy
- Family focused therapy
- Relapse prevention
- Support groups and 12-step meetings
- Consistent aftercare support
If you suspect or are concerned that your loved one is suffering from a personality disorder and an addiction to drugs or alcohol, please do not hesitate to reach out. Turnbridge is a dual diagnosis treatment center with individualized programs for young men and women. We are here for you.