A report published by the UK government estimates that anywhere between 70 and 86% of individuals accessing addiction support have experienced a mental health problem at some point in their lives. In clinical discourse, mood disorders are commonly associated with addiction. However, addiction is also prevalent among individuals with personality disorders. Studies suggest that personality disorders are more common among individuals dealing with drug addiction as opposed to alcoholism. But why is this particular dual diagnosis so common? What are personality disorders, and what is behind their frequent link with addiction?
What are personality disorders?
The DSM-5 defines personality disorders as the result of ‘an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture.’
It goes on to say that this deviation manifests in:
- Cognition
- Affectivity
- Interpersonal functioning
- Impulse control
Cognition refers to the specific way an individual thinks. Affectivity refers to someone’s ability to influence their emotions or feelings. Interpersonal functioning considers the types of relationships and connections an individual has with other people. Impulse control is a person’s ability to ignore, suppress or avoid specific urges.
A personality disorder diagnosis is typically considered when an individual experiences difficulties in two or more of the above categories. These difficulties are typically long-term and are not usually linked to specific instances in an individual’s life.
Types of personality disorder
Whilst we can establish key signs of a personality disorder, it is important to remember that each type of personality disorder has its own set of symptoms.
Three key categories divide up the different types of personality disorders.
These are:
- Suspicious personality disorders
- Emotional and impulsive personality disorders
- Anxious personality disorders
Suspicious Personality Disorders include:
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Emotional and Impulsive Personality Disorders include:
- Antisocial personality disorder (ASPD)
- Borderline personality disorder
- Narcissistic personality disorder
Anxious Personality Disorders include:
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder (OCPD)
If you have symptoms of several types, you may be diagnosed with a mixed personality disorder or personality disorder not otherwise specified (PD-NOS).
The statistics
- Around 1 in 20 people in the UK have a personality disorder
- An estimated 7.8% of individuals experience personality disorders worldwide
- The most commonly diagnosed personality disorder is borderline personality disorder (BPD)
- Personality disorders are prevalent across different ethnic groups
Personality disorder and addiction: Why are they linked?
Research suggests that the ‘comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice.’ But why is this the case?
Personality disorders can be characterised by difficulties in how an individual copes with thoughts, feelings, connections and general life events. This can mean people with a personality disorder diagnosis experience difficulties with the following:
- Connecting with others
- Maintaining relationships
- Managing emotions
- Distress tolerance
- Controlling impulses
- Restricting risky behaviour
All of these symptoms can lead to people feeling isolated, distant, unusual or even ‘wrong.’ When we struggle to engage with thoughts, feelings, people, and events in the same way as others around us, that can take its toll on us. It can lead to feelings of confusion, embarrassment, guilt, or shame. This means that engaging in dangerous behaviours can be a symptom of a personality disorder, but they can also be a means of seeking solace due to the difficulty of coping with it in the longer term.
Individuals with a personality disorder may find that when they feel under heightened stress or pressure, their symptoms begin to worsen. This can lead to a vicious cycle of symptoms increasing and becoming harder to control. In some instances, this can lead to engaging in maladaptive behaviours, such as:
- Self-harm
- Suicide attempts
- Heavy drinking
- Illicit drug use
- Abuse of prescription medication
- Gambling
- Compulsive spending
- Unsafe sex
- Binge eating
- Reckless driving
One study found that 46% of the participants dealing with a substance use disorder also had a diagnosis of a personality disorder. Some researchers suggest that addictions are developed as a result of a personality disorder, whilst others indicate that experiences of trauma can cause both personality disorders and addictions. These theories indicate that addiction is developed in individuals with a personality disorder due to:
- Reduced impulse control
- An increased need to reduce stress
- An increased response to dopamine stimulation following engagement with addictive behaviour
Do I have a personality disorder?
It is important to remember that personality disorders are frequently misdiagnosed. That is, some individuals with a personality disorder are diagnosed as having another condition (such as anxiety, depression, bipolar disorder, or autism). Other people are diagnosed with a personality disorder when they are dealing with one of the conditions previously listed. It can sometimes take years for an individual to receive a diagnosis of a personality disorder. The diagnosis can also be quite contentious, with both clinical and cultural perspectives on personality disorders carrying greatly. This means that it can be helpful to use terms that feel more comfortable for you. However, for some individuals, the terminology of a diagnosis is very important.
For that reason, it is not possible to provide a thorough screening for a personality disorder outside of a professional assessment. However, it is possible to provide some questions for you to consider in order to gauge if an assessment may be useful.
- Do you naturally find it difficult to trust others?
- Do you frequently lose touch with people or detach from relationships?
- Do you feel very anxious, even in familiar contexts?
- Do you frequently experience aggressiveness?
- Do you sometimes act in reckless ways that could result in harming yourself or others?
- Do you often feel lonely or empty?
- Do you find it difficult when you are not the centre of attention?
- Do you find it hard to regulate your emotions?
- Are you able to take praise and criticism from others?
- Do you frequently deal with the urge to harm yourself?
Treatment options
Personality disorders are typically treated in three key ways:
- Talking therapies
- Medication
- Support groups
Psychotherapies such as cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) are often utilised in the treatment of personality disorders. DBT is often implemented as this form of support focuses on building distress tolerance and reducing engagement and reliance on risky behaviours. Specific medications (such as antidepressants, sedatives or antipsychotics) can also be helpful in managing symptoms. As with other conditions, specific support communities for personality disorders can help alleviate feelings of loneliness and can catalyse connections in a meaningful way.
Addiction can also be treated in this three pronged approach: through therapy, medically assisted treatment and support groups. This makes this trio of treatments particularly lucrative for managing both symptoms of personality disorder and addiction concurrently.
Seek help today
If you are dealing with a dual diagnosis, speaking with professionals in the addiction and mental health fields can offer you a nuanced approach to treatment and recovery. By combatting the immediate risks associated with addiction and implementing new strategies to manage symptoms of personality disorder, we can develop a rehab plan that takes your needs into account.
Call our admissions line 24 hours a day to get help.