Personality Disorders And Addiction

The Link Between Personality Disorders And Addiction

According to the National Institute of Mental Health, almost 1 in 10 Americans have a personality disorder. Those with personality disorder have a heightened risk of developing a substance use disorder, as these conditions share common risk factors, including:

• Childhood trauma or adverse experiences
• A family history of mental health conditions, which may suggest a genetic link
• Environmental stressors and family dysfunction
• Neurobiological factors affecting impulse control and reward systems
• The role of emotional regulation, particularly how shame and anger are managed

The relationship between these disorders is often bidirectional. Individuals with personality disorders may turn to substances to self-medicate symptoms or emotional distress, while substance use can worsen personality disorder traits or present with some of the same symptoms, complicating diagnosis and treatment.

Types Of Personality Disorders

Personality disorders are categorized into three clusters. Each of these has distinct patterns of thinking, feeling, and behaving.

Cluster A (Odd or Eccentric):

• Paranoid Personality Disorder: Characterized by a pervasive distrust and suspicion of others
• Schizoid Personality Disorder: Marked by detachment from social relationships and limited emotional expression
• Schizotypal Personality Disorder: Features eccentric behavior, unusual thought patterns, and social anxiety

Cluster B (Dramatic, Emotional, or Erratic):

• Antisocial Personality Disorder: Persistent disregard for social norms and the rights of others
• Borderline Personality Disorder: Instability in relationships, self-image, and emotions, with impulsive behavior
• Histrionic Personality Disorder: Excessive emotionality and attention-seeking behavior
• Narcissistic Personality Disorder: Grandiosity, need for admiration, and lack of empathy

Cluster C (Anxious or Fearful):

• Avoidant Personality Disorder: Social inhibition, feelings of inadequacy, and hypersensitivity to criticism
• Dependent Personality Disorder: Excessive need to be taken care of, leading to submissive and clingy behavior
• Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness, perfectionism, and control

Cluster B disorders, particularly antisocial and borderline personality disorders, have the strongest association with substance use disorders. However, individuals with any personality disorder may be at increased risk for developing addiction.

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Signs Of Addiction In Someone With A Personality Disorder

Identifying addiction in someone with a personality disorder should not be difficult, even though symptoms may overlap. Practically speaking, the first goal is to have the person stop using drugs or alcohol. If that can be achieved, the personality disorder can be more clearly determined. Key warning signs for addiction include:

• Increased tolerance to substances
• Withdrawal symptoms after stopping the use of a substance
• Using a substance in larger amounts or for longer periods than intended
• Continued use of a substance despite negative consequences in relationships, work, or health
• Spending significant time obtaining, using, or recovering from substances
• Giving up important activities because of substance use
• Inability to fulfill obligations due to substance use
• Using substances in physically hazardous situations
• Unsuccessful attempts to cut down or control use

However, these symptoms may present differently depending on the specific personality disorder, as personality traits may be enhanced while using substances. For example:

• Individuals with borderline personality disorder might show more dramatic shifts in mood or increased self-harm when intoxicated or withdrawing.
• Those with antisocial personality disorder may engage in more risk-taking or illegal activities to obtain substances.
• People with avoidant personality disorder might use substances, specifically in social situations, to reduce anxiety.

Why Do People With Personality Disorders Abuse Drugs And Alcohol?

Several factors contribute to the high degree of overlap between personality disorders and addiction.

Self-Medication

Many individuals use substances to alleviate distressing symptoms of their personality disorder. Someone with borderline personality disorder might use opioids to manage emotional intensity, while a person with avoidant personality disorder might use alcohol to reduce social anxiety. Major players in this emotional roller-coaster are the feelings of shame, humiliation, and guilt.

Impulsivity

Certain personality disorders, particularly those in Cluster B, are characterized by impulsive behavior, which increases vulnerability to substance experimentation and risk-taking.

Shared Neurobiological Vulnerabilities

Brain systems involved in reward processing, impulse control, and emotional regulation are involved in both personality disorders and addiction.

History Of Trauma

Many individuals with personality disorders have experienced trauma, which is also a risk factor for substance use disorders.

Social And Environmental Factors

Relationship difficulties, employment problems, and social isolation—common among those with personality disorders—can contribute to substance use as a coping mechanism.

The shared nature of personality disorders and addiction stems from a complex interplay of self-soothing behaviors, impulsive tendencies, and shared neurological pathways, made worse by traumatic experiences and social challenges. This creates a cycle where substance use becomes an unhealthy response to underlying emotional distress, further complicating the management of both conditions.

Treating Personality Disorders And Addiction

Effective treatment for co-occurring personality disorders and addiction requires an integrated approach that addresses both conditions together. Treating one condition before the other is generally less effective because each condition can sabotage the other.

Components of successful integrated treatment include:

• Comprehensive assessment: Thorough evaluation to identify both conditions and understand how they interact with each individual.
• Medication management: While no specific medications are approved by the Food and Drug Administration to treat personality disorders, certain medications can help manage symptoms like impulsivity, mood instability, or anxiety. Addiction treatment medications may also be appropriate, depending on the substance involved.
• Psychotherapy: Evidence-based approaches show promise for co-occurring disorders. Dialectical behavior therapy (DBT) was originally developed for borderline personality disorder and helps individuals develop skills in emotion regulation.

Simultaneous treatment of personality disorders and addiction is crucial, as each fuels the other, requiring a unified strategy that combines assessment, medication, and tailored therapy to address the intertwined roots of both conditions.

Can A Personality Disorder Be “Cured”?

The term “cure” may not be the most appropriate way to think about personality disorders. Instead, it’s more accurate to consider management and improvement of symptoms and functioning. It is a long process of understanding the underlying thought processes and habits that cause the symptoms. However, with appropriate treatment:

• Many individuals experience a significant reduction in symptoms.
• Improvement in interpersonal relationships and social functioning is possible.
• Coping skills can be developed to manage challenging situations more effectively.
• Quality of life can substantially improve.

Long-term studies suggest that personality disorder symptoms often decrease in intensity over time, even without treatment, though the extent of improvement varies by disorder type. For example, impulsivity symptoms in borderline personality disorder tend to improve faster than issues with identity and relationships.

With treatment, many individuals with more than one condition can achieve:

• Recovery from substance use
• Better emotional control
• Improved relationships
• Improved ability to manage stress
• Greater life satisfaction

Rather than focusing on a “cure,” personality disorder treatment focuses on teaching coping mechanisms and fostering gradual improvements in daily functioning and emotional regulation.

How To Find A Rehab That Treats Co-Occurring Disorders

Finding treatment for personality disorders and addiction needs careful planning.

Consider this checklist:

• Look for specialized programs: Treatment centers that state that they offer integrated treatment for co-occurring disorders. These are often referred to as “dual diagnosis” programs. These programs should have staff trained in both addiction and personality disorders.
• Verify credentials: Ensure the facility is accredited and is staffed by licensed professionals with experience in treating dual diagnoses.
• Ask about specific therapies: Inquire whether they offer treatments such as DBT, CBT, or schema therapy that are effective for co-occurring personality disorders and addiction.
• Determine the level of care that is needed, as well as what is affordable and accessible: Options range from outpatient services to intensive outpatient programs, partial hospitalization, and residential treatment. The appropriate level depends on the severity of both conditions.
• Check insurance coverage: Review your insurance coverage by contacting your provider. Understand exactly what services are covered and for how long.
• Ask about aftercare: Effective treatment includes a plan for continuing care after the initial intensive phase, which is crucial for long-term recovery.

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Reach Out For Help

Living with more than one life-changing mental health condition can be challenging, but recovery is possible. By managing addiction and personality disorders simultaneously through integrated, evidence-based approaches, individuals can develop the skills needed to manage symptoms, maintain sobriety, and build more fulfilling lives.

If you or someone you love is struggling with these conditions, contact a treatment provider today to discuss your rehab-related questions and explore your treatment options.