Personality Disorders and Substance Use Disorder

Personality disorders are a group of mental health disorders. They affect a person’s perception and response to the world around them. Unfortunately, personality disorders and substance abuse often co-occur. 

Understanding the different personality disorder clusters, how it changes a person, and the risks of substance misuse can encourage Recovery for Life. 

What are Personality Disorders?

According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are 10 diagnosable conditions within the personality disorder clusters. Each personality disorder is defined by its unhealthy pattern of thoughts, feelings, and behaviors. 

  • Cluster A personality disorders – known as the odd or eccentric cluster, include paranoid personality disorder and schizoid personality disorder.
  • Cluster B personality disorders – known as the dramatic and erratic cluster, include antisocial personality disorder and borderline personality disorder.
  • Cluster C personality disorders – based on fear and anxiety, includes avoidant personality disorder and obsessive-compulsive personality disorder.

For those struggling with personality disorders, getting along with others and coping with daily problems can be difficult. Although their beliefs and behaviors may seem abnormal to the outside world, those struggling with personality disorders believe they are acting normal. 

Individuals with personality disorders also have a very different view of the world than most people. As a result, they may struggle to participate in family functions, social gatherings, and work events. 

They may also blame others for their challenges, which causes issues in relationships with friends and family.

While the cause of personality disorders is still unknown, they can be triggered by genetics and childhood environmental factors. However, they often do not emerge till the teen or young adult years. 

Cluster A Personality Disorders

Cluster A personality disorders are described as odd and eccentric. The common features of this cluster are social awkwardness and withdrawal. Those struggling with cluster A personality disorders are known to have distorted thinking. 

Paranoid Personality Disorder

The main characteristics of paranoid personality disorder include intense distrust and suspicion of others. A person struggling with this disorder will interpret and distort experiences to validate their fears, even among friends and family. 

Individuals with paranoid personality disorder believe others are out to harm, take advantage of, or humiliate them. As a result, they withdraw and distance themselves from everyone. However, they may also attack others if they feel threatened. 

The distorted thinking of this disorder also causes pathological jealousy. People struggling with paranoid personality disorder hold grudges, do not confide in others and do not develop close relationships.

Schizoid Personality Disorder

Individuals with schizoid personality disorder display patterns of social detachment and lack a range of emotional expressions. They are often focused solely on their inner life and have little interest in the outside world. 

Often called “loners,” a person with a schizoid personality disorder has no desire for intimate or social relationships. As a result, they don’t care about social norms or the needs of others. 

Furthermore, their lack of emotion and failure to exchange gestures such as smiles or nods make them seem dull and unattentive. 

Schizotypal Personality Disorder

A schizoid personality disorder causes a pattern of interpersonal and social limitations. People who struggle with this mental disorder have eccentric speech, appearance, and behavior. Their unusual perceptions often result in odd beliefs, obsessive thoughts, and suspiciousness. 

Like schizoid personality disorder, people with schizotypal personality disorder avoid people and social interactions. However, it differs because those with schizotypal personality disorder have a genuine fear of meeting other people. 

Cluster B Personality Disorders

Individuals with cluster B personality disorders are often described as being dramatic and overly emotional. They also have unpredictable thoughts and behaviors. While cluster B personality disorders are the least common disorders, they are often the most difficult to treat. 

Antisocial Personality Disorder

One of the more well-known cluster B personality disorders, antisocial personality disorder, occurs more often in men than in women. People with this disorder show no empathy or regard for the feelings of others. They may also be aggressive and act without thinking while feeling no remorse for their actions. 

For this reason, people with antisocial personality disorder often have criminal records and have been in and out of jail. Furthermore, the symptoms of antisocial personality disorder typically appear in childhood and include:

  • Hurting or tormenting animals
  • Bullying or intimidating others
  • Setting fires
  • Theft 

People with antisocial personality disorder typically blame others for their wrongdoings. They also believe their “victims” deserve what happened. Because of the aggressive nature of this cluster B personality disorder, it takes a unique toll on society.

Borderline Personality Disorder

People struggling with a borderline personality disorder may feel empty, abandoned, and struggle with their own identity. They may also have a history of short-lived relationships because of emotional instability, violent outbursts, and suicidal threats. 

People struggling with borderline personality disorder have intense and unstable moods. For example, once they are upset, they have a difficult time calming down. They also engage in impulsive behaviors such as substance use, binge eating, unsafe sex, and self-harm.

Furthermore, a borderline personality disorder is more common in women. And it is often the result of childhood sexual trauma. 

Histrionic Personality Disorder

Individuals with histrionic personality disorder are overly emotional attention seekers. They may be called “drama queens” because they can be dramatic when they are not the center of attention. 

People with this disorder are:

  • Flirtatious and seductive
  • Flamboyant and emotionally exaggerating
  • Lacking emotional expression
  • Flighty and fickle
  • Easily influenced by others opinions

Narcissistic Personality Disorder

A narcissistic personality disorder is characterized by a significant problem with self-worth and a strong sense of entitlement. For instance, people with narcissistic personality disorder believe they deserve special treatment because they are attractive, brilliant, and uniquely talented. Furthermore, they have no respect or regard for others because of this sense of entitlement.  

But, once a person with narcissistic personality disorder realizes they are not special, they can be highly devastated. This devastation can lead to intense anger and shame, which is often taken out on others. 

Additionally, narcissistic people can be manipulative to gain attention. They also lack empathy which leads to superficial relationships void of real feelings. 

Cluster C Personality Disorders

Individuals with cluster C personality disorders are extremely anxious and fearful. Depending on which of the cluster C personality disorders a person has, they may avoid people or cling to them. 

Avoidant Personality Disorder

A person with avoidant personality disorder believes they are socially awkward and people don’t want them around. As a result, they have a reasonable fear of rejection and embarrassment. Without absolute confidence that they will be accepted, people with an avoidant personality disorder will avoid meeting people. 

The symptoms of avoidant personality disorder include:

  • Isolates for fear of criticism, disapproval, or rejection
  • Is preoccupied with being criticized
  • Feels inadequate
  • Low self-esteem
  • Deep fear of embarrassment

Typically, an avoidant personality disorder is the result of abusive childhood criticism. Then later in life, it manifests as avoidance and anxiety. Because people with this disorder are hyper-aware of their issues, it makes them feel even more inferior.

Dependent Personality Disorder

A dependent personality disorder is characterized by the intense need to be cared for by others. This care includes a complete dependence on others to make all life’s decisions. Because people with dependent personalities feel inadequate, they often fear being abandoned.

Furthermore, people with dependent personality disorder idolize their caregivers and takes on no personal responsibilities. For this reason, they often gravitate toward those with a cluster B personality disorder because cluster B loves complete control. 

Obsessive-Compulsive Personality Disorder

An obsessive-compulsive personality disorder is an extreme obsession with perfectionism that interferes with normal daily functions. For instance, relationships often suffer due to the preoccupation with lists, details, and organization in their work.  

The anxiety over having no control over the world often leads to controlling others, a fear of taking risks and lacking patience for nuances. People struggling with obsessive-compulsive personality disorder come off as rigid and inflexible, especially with money.

Personality Disorders and Substance Use Disorder

Various research has found between 65 percent and 90 percent of people evaluated for substance use disorders also struggle with a personality disorder. People with cluster C personality disorders typically misuse alcohol. While those with cluster B personality disorders primarily misuse cocaine. 

Research also finds those with cluster B personality disorders misuse drugs and alcohol at higher rates than other personality disorders. This may be because people in this cluster are compulsive, which is a significant risk factor for substance misuse. 

According to Innovations in Clinical Neuroscience, up to 66 percent of those with borderline personality disorder are psychologically dependent on drugs and alcohol. While the National Institute on Alcohol Abuse and Alcoholism finds people with antisocial personality disorder, have higher rates of alcohol misuse and alcohol use disorder. 

Why do Personality Disorders and Substance Misuse Co-Occur?

People struggling with personality disorders misuse drugs and alcohol to ease the emotional toll of their disorder. For example, people whose personality disorders give them a lack of self-worth often drink to hide the emptiness they feel. Similarly, those with an avoidant personality disorder may misuse drugs or alcohol to hide their social awkwardness. 

Personality Disorder Treatment

Because beliefs and behaviors are so ingrained in those with personality disorders, it is challenging to treat these disorders. A person may even deny they have a problem. Borderline personality disorder, for example, can make a person aggressive toward their therapist. Simultaneously, they can be extremely needy. 

Treating personality disorders requires intense psychotherapy sessions. Dialectical Behavior Therapy (DBT) is the most effective therapy option for personality disorders. Because dialectical behavior therapy is a form of cognitive-behavioral therapy, it can help those with co-occurring personality disorders and substance abuse. 

Dual Diagnosis Treatment: Personality Disorders and Substance Use Disorder 

A dual diagnosis means a person struggles with substance use disorder and a mental health disorder. A dual diagnosis is common because almost 50 percent of people with a mental illness also struggle with substance misuse. 

With a dual diagnosis, both disorders need to be treated simultaneously. For treatment to be successful, a person must stop using drugs and alcohol. Behavioral therapies such as dialectical behavior therapy are effective in treating both personality disorders and substance abuse. 

However, therapy alone may not be enough to treat these co-occurring disorders. For this reason, treatment may also include:

  • Anti-anxiety medications such as Xanax or Ativan for anxiety
  • Antidepressants such as selective serotonin reuptake inhibitors to relieve social anxiety and emotional stress
  • Mood stabilizers such as Tegretol for mood swings and aggression
  • Antipsychotics like Risperdal and Zyprexa for hallucinations and delusions

While medications and therapy are effective treatments, comprehensive treatment of personality disorders and substance abuse can take years. 

Treating Personality Disorders and Substance Misuse at Sana Lake Behavioral Wellness

Are you or a family member struggling with a personality disorder and substance abuse? Are you struggling to get a family member to see they need help? At Sana Lake BWC, we offer intervention services and comprehensive treatment programs to help achieve Recovery for Life.

Call today and learn how you can live a life free of drugs and alcohol. 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241194/

https://medlineplus.gov/personalitydisorders.html

https://www.mentalhelp.net/personality-disorders/cluster-a/

https://pubs.niaaa.nih.gov/publications/arh25-1/5-11.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196330/