In order to lead a satisfying, productive life, an individual’s personality must not clash too much with his or her social environment. People with personality disorders differ so radically in their thoughts, behaviors or interactions that it can negatively impact their lives in the following ways:
- They may have trouble socializing with others.
- They may have difficulty sustaining meaningful relationships.
- They may have trouble finding or holding jobs.
- They may be unable to function in stressful situations.
Personality disorders, or PDs, are defined by a chronic pattern of feelings or behaviors that are extremely difficult to change. Because they do not perceive things the way others do or react to the world in healthy ways, individuals with PDs have trouble fitting in with their society. As a result, they frequently live with co-occurring conditions like depression, anxiety, or substance use disorders. Self-injury, violent behavior, suicide attempts, and psychiatric hospitalization are common in this population. People with personality disorders are usually reluctant or unable to change — if they see the need to change at all. The co-occurrence of drug or alcohol abuse makes recovery all the more difficult. However, it is possible to recover from these hard-to-treat disorders with compassionate, integrated treatment.
Common Personality Disorders
According to epidemiological statistics published in the Journal of Clinical Psychiatry, close to 15 percent of American adults — nearly 40 million people — have a personality disorder.
Some of these individuals have two or more personality disorders, making diagnosis and treatment all the more complicated. The most common personality disorders in the population studied were as follows:
- Obsessive-compulsive: nearly 8 percent
- Paranoid: Over 4 percent
- Antisocial: Over 3.5 percent
- Schizoid: Close to 3 percent
- Avoidant: Just over 2 percent
- Histrionic: Close to 2 percent
- Dependent: Around 0.5 percent
Personality disorders are classified in three groups. Cluster A disorders are characterized by strange, idiosyncratic behavior and bizarre or suspicious ways of thinking. Cluster B disorders are distinguished by highly emotional, dramatic responses and erratic behavior. Cluster C disorders are marked by high levels of anxiety and fear.
Listed below are Cluster A disorders and their hallmark traits:
- Paranoid PD: Suspicious, distrustful, angry
- Schizotypal PD: Eccentric, bizarre, anxious
- Schizoid PD: Reclusive, isolated, emotionally flat
Cluster B disorders include:
- Antisocial PD: Hostile, dishonest, irresponsible, indifferent to others
- Borderline PD: Unstable, emotionally volatile, afraid of abandonment
- Histrionic PD: Dramatic, attention-seeking, emotionally shallow
- Narcissistic PD: Self-aggrandizing, arrogant, unconscious of others’ feelings
Cluster C disorders include:
- Avoidant PD: Timid, overly sensitive, afraid of confrontation
- Dependent PD: Needy, lacking in confidence, anxious for approval
- Obsessive-compulsive PD: Inflexible, demanding, compulsive about detail
Each disorder is characterized by a set of traits that make it very difficult for the individual to function in conventional society. For instance, people with paranoid personality disorders may be so obsessed with conspiracy theories that they can’t relate to others or form deep friendships. People with narcissistic or histrionic personality disorders are so self-involved or dramatic that they are unable to perceive the needs of others. Individuals with dependent personality disorder are incapable of leading independent lives because of their powerful need to rely on others. Some PDs — such as borderline personality disorder, schizoid personality disorder, and paranoid personality disorder — can be difficult to distinguish from psychotic disorders like schizophrenia. However, while people with personality disorders may experience breaks with reality, such as hearing voices or holding delusional beliefs, these symptoms are less severe and do not last as long.
The roots of personality disorders run deep into the psyche. The causes of the bizarre beliefs and rigid, inflexible behavioral patterns are hard to determine. PDs may arise from one or more of the following sources:
- Genetic factors. The traits associated with personality disorders, such as fear, anxiety or obsessive thinking, often run in families, indicating that they may be part of the individual’s genetic makeup.
- Psychological trauma. Many PDs are associated with extreme stress, verbal abuse, or physical abuse in childhood. Borderline PD, obsessive-compulsive PD and paranoid PD, for example, have been linked to psychological distress and lack of emotional validation at a vulnerable age. According to the American Psychological Association, a high percentage of individuals with borderline PD have a childhood history of sexual abuse.
- Above-average sensitivity to sensory stimuli. Certain types of PDs, such as avoidant and dependent PD, may be related to a high level of reactivity to light, as well as visual, auditory and tactile stimuli.
- Stressful environments. While stressful situations may not directly cause PDs, they can contribute to their development, especially if the stress occurs in childhood. Situations like a parent’s death, a divorce, an unwanted relocation, or episodes of bullying could lead to the evolution of a personality disorder.
Drugs and alcohol do not cause personality disorders, but substance abuse features prominently in several PDs. Individuals with borderline personality disorder, for example, have high rates of substance abuse. Dr. Robert O. Friedel, author of a well-known book on borderline personality disorder, states that approximately two-thirds of individuals with borderline PD abuse drugs, alcohol or both. According to the National Institute on Alcohol Abuse and Alcoholism, people with antisocial personality disorder — a PD characterized by aggression, lack of empathy for others, destructive behavior, and avoidance of meaningful relationships — have a higher rate of alcohol abuse and alcoholism than the general population. These individuals are more likely to behave violently when they are drinking and more likely to have personal, financial or legal problems related to their alcohol use. Substance abuse and personality disorders are linked in several ways. It is possible that the genetic factors that contribute to drug or alcohol addiction also encourage the development of personality disorders. It is also likely that the psychological trauma experienced by many individuals with PDs contributes to a higher rate of alcoholism and drug addiction. Substance abuse can temporarily relieve the emotional pain, anxiety and distress of personality disorders. People with avoidant personality disorder may drink or use drugs in order to escape their fears of social situations or to numb feelings of worthlessness and incompetence. Individuals with borderline personality disorder may abuse drugs or alcohol as a means of self-destruction. They may also get intoxicated to fill the profound sense of emptiness that they feel.
Personality disorders are notoriously difficult to treat. The habits, beliefs and behaviors that characterize these disorders are rigid and deeply engrained. Changing these patterns requires extensive psychotherapy with an experienced, compassionate therapist. Working with patients with borderline personality disorder, in particular, is extremely challenging. These patients can be extremely needy and demanding, as well as self-destructive and hostile to their therapists. Helping them heal requires unique, creative approaches to therapy.
Dialectical behavior therapy, or DBT, was developed by psychologist Marsha Linehan as a way to help suicidal, chronically self-destructive individuals create meaningful lives.
A study published in Behaviour Research and Therapy showed that DBT can successfully reduce symptoms of BPD, including depression, anxiety, stress and suicide attempts. Since its inception, this form of behavioral modification therapy has been applied to other psychiatric disorders and to substance abuse. DBT helps reduce the symptoms of personality disorders in the following ways:
- By teaching the individual how to accept intensely stressful or painful emotions
- By offering effective coping strategies to deal with these overwhelming feelings
- By teaching the individual how to live in the moment — a state known as “mindfulness” — instead of obsessing over the past or future
- By helping the patient accept who she is while encouraging her to make positive changes in her life
In addition to behavioral modification therapies like DBT, psychiatric medications may be prescribed to help relieve the anxiety, depression, and obsessive traits of personality disorders. Medications commonly prescribed for individuals with personality disorders include:
- Anti-anxiety medications. Anxiety-related PDs may be treated with medications that help relieve fear or panic, such as lorazepam (Ativan) or alprazolam (Xanax). Less addictive medications, like bupropion (Wellbutrin) or certain classes of antidepressants may be prescribed for patients with a history of substance abuse.
- Antidepressants. Antidepressants can help with symptoms like self-isolation, hopelessness, social anxiety and emotional stress. Drugs in the SSRI (selective serotonin reuptake inhibitor) family have been used successfully to treat the symptoms of personality disorders.
- Mood stabilizers. Individuals who experience extreme mood swings or aggressive as part of a personality disorder may be treated with mood-stabilizing drugs like lithium carbonate or carbamazapine (Tegretol).
- Antipsychotic drugs. Patients who experience hallucinations or delusional beliefs may benefit from antipsychotic drugs that help them maintain a connection to reality. Antipsychotic drugs include risperidone (Risperdal), olanzapine (Zyprexia) and quetiapine (Seroquel).
- Anti-addiction medications. Medications like methadone, disulfiram (Antabuse), naltrexone (ReVia) and buprenorphine (Suboxone) can help individuals with PDs and substance use disorders cope with drug or alcohol withdrawal and overcome cravings.
Recovering From Addiction and PDs
In order to recover successfully from drug or alcohol addiction, individuals with a personality disorder must also undergo intensive psychotherapy. In the past, substance abuse and personality disorders were treated as separate issues; today, mental health professionals and addiction specialists recognize the need to integrate treatment for both conditions. Dialectical behavior therapy has been applied to the treatment of both personality disorders and addictive disorders. In integrated dual diagnosis treatment programs, DBT is now viewed as one of the most effective approaches to helping people with PDs lead productive, drug-free lives. Treatment for co-occurring personality disorders and substance abuse is demanding and intensive. Rehab should take place in a facility dedicated to treating individuals with comorbid disorders. For many of these individuals, long-term residential treatment at a specialized facility is the most effective approach to recovery. Medication is an important part of the recovery process for patients with co-occurring disorders. In dual diagnosis treatment, psychiatric medication is not viewed as a threat to sobriety but as a critical tool for symptom management. Psychiatric drugs and anti-addiction medications can increase the patient’s chances of success when they are combined with a comprehensive recovery program. Futures of Palm Beach is a residential treatment facility located in a scenic, spa-like setting in Florida. We are committed to helping our dual diagnosis clients achieve optimal health through our holistic, individualized treatment plans. For more information about our dual diagnosis rehab services, call our admissions counselors at any time.