The relationship between personality disorders and addiction has been the subject of numerous studies. Substance misuse can aggravate the symptoms of a personality disorder and those that have a personality disorder can be more likely to develop an addiction. In this post, we will look at how a personality disorder is defined and some of the issues related to being diagnosed in this way. It will also look at the co-occurrence of substance misuse and personality disorders.
What is a personality disorder?
There are different types of personality disorders. However, the general definition is a person who feels, behaves, thinks, or relates to others in a very different way from the average person. One of the most common types is borderline personality disorder in which a person may behave impulsively, have a disturbing way of thinking, and have difficulties in managing and controlling their emotions. Having a personality disorder can have a significant impact on a person’s relationships, handling of life situations, and controlling inappropriate behaviors and impulses.
There are a broad range of behaviors and experiences that can come under the remit of a personality disorder. This means that there may be many different people with a wide range of different experiences under the same diagnosis. Having a diagnosis of a personality disorder is helpful for some people who find that it can help to explain their difficulties to others, validate their experiences, and help them to access the right support. However, for others, including those with the diagnosis and professionals in the field, the diagnosis of a personality disorder doesn’t take into account personal circumstances. Others feel that the criteria for diagnosis is too wide ranging and that the existence of the diagnosis itself can be stigmatizing.
Given the conflicting views on the use of the term ‘personality disorder’, it is important to recognize each patient as an individual. It is also vital to ensure that their views and preferences in terms of how their experiences and difficulties are named and upheld.
Is there a relationship between personality disorder and addiction?
Higher levels of substance abuse and addiction are reported by those with a personality disorder. Moreover, substance abuse is often used as a coping mechanism for dealing with a range of challenging emotions and feelings. Research has continually found that substance use disorders and a personality disorder are frequently diagnosed in the same person.
One study summarizing existing research into the link between substance use disorders and borderline personality disorder found that, in the eight studies they looked at, the rate of substance use disorders in individuals with borderline personality disorder was 44.3 percent. The link between borderline personality disorder and substance use disorders was even greater when looking at the studies that solely looked at lifetime rates of substance usage (rather than just current usage). Looking at the average over these four studies resulted in a rate of 63.5 percent, indicating that two thirds of the participants experienced the co-occurrence of lifetime substance use disorders and borderline personality disorder.
There is also some evidence to suggest that this co-occurrence can be affected by gender. For example, several studies (Zanari et al, Zlotnick et al, Johnson et al) have found that substance use disorders were more common for men who have a borderline personality disorder than for women who have this condition.
How personality disorder traits can be a tool for recovery
The co-occurrence of these conditions is an important reality for those helping to support and treat those with an addiction. In understanding how these two conditions are linked, clinicians and therapists can help to develop an individualized treatment plan for patients on the road to recovery from addiction.
Removing the sense of shame
Taking the step to seek help for someone experiencing addiction is not easy. As such, patients often experience a sense of shame and stigma when disclosing their reliance on drugs or alcohol. This is compounded when someone is dealing with the dual diagnosis of having a personality disorder also.
As with all patients, laying a foundation of empathy from the outset that ensures a patient doesn’t feel labeled or judged by their condition is essential. As a clinician, having an understanding of the experiences a person with a personality disorder is likely to have come up against and how this might have triggered a dependence on drugs or alcohol is important. An emphatic approach that ensures any sense of shame or stigma is removed from the outset is a critical starting point.
Understanding the impact on relationships
Having a personality disorder can have a significant impact on creating and maintaining relationships with others. Indeed, an individual with this condition may have lived an isolated life for a long time. These feelings of isolation may also have contributed to a dependence on drugs or alcohol. As a clinician treating someone with an addiction and a personality disorder it is important to recognize how this might impact a patient’s response to treatment and the clinician themselves. It may be difficult to initially create an effective therapeutic relationship with an individual who has a personality disorder and it is important to be conscious of this as a professional. Maintaining a compassionate and empathetic approach throughout will lead to a greater likelihood of engagement from the patient.
Individually tailored treatment
A patient experiencing addiction and a personality disorder needs to have an integrated treatment plan that takes into account how these two diagnoses can intersect. An individualized approach is required that considers all of a patient’s needs and takes account of how their personality disorder might impact on their response to treatment also.
There is a need for further research into the co-occurrence of personality disorders and addiction, how these two diagnoses intersect, and how they can be most effectively treated. Personality disorder can be a helpful diagnosis to help clinicians understand how specific behaviors can impact on an individual’s experience of their addiction and response to treatment. However, it is important that the label of this diagnosis does not detract from exploring the unique experiences and background of each patient seeking recovery from addiction.