Personality disorders are disorders that affect a person’s behavior, mood, and ability to function in normal life. Having a personality disorder can disrupt a person’s relationships, their ability to keep a job, and other areas of life that are important to personal wellbeing and happiness.
Experiencing emotional or behavioral difficulties can make a person more susceptible to turning to drugs or alcohol for relief. In these instances, drinking alcohol can often become a way for people to self-medicate: to numb or avoid their unhappiness. Drinking can initially feel soothing, and become a crutch people lean upon just to get through the day.
Using alcohol to cope with pain or feelings of isolation from others is unsustainable. Alcohol abuse can increase the risk for suicide in people with personality disorders and lead to other serious health risks.
If you or someone you know with a personality disorder is struggling with alcoholism, understanding the different types of personality disorders and treatment options may be an important first step towards seeking help.
Types Of Personality Disorders
The fifth and most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes 10 distinct types of personality disorders (PDs). These are divided into three clusters: Cluster A, Cluster B, and Cluster C.
Each personality disorder is categorized into one of these clusters based on the most dominant personality traits and behaviors.
Cluster A (Eccentric Behaviors)
- Paranoid: Paranoid personality disorder is characterized by a pattern of being highly suspicious of others and their intentions. People with this disorder may have a hard time getting close to others, and may suspect others are out to get them or do them harm.
- Schizoid: People with this disorder are largely detached from others, prefer to be alone, and show little emotion. They typically do not have close relationships, don’t pay much attention to social norms, and may display inappropriate emotional reactions.
- Schizotypal: Unlike schizoid personality disorder, people with schizotypal PD may want to have social relationships, but are fearful of or uncomfortable getting close to others. They may have eccentric behaviors or speech patterns, obsessive and distorted thinking, and hold odd beliefs.
Cluster B (Dramatic and Emotional Behaviors)
- Antisocial: Antisocial personality disorder (ASPD) is one of the most common personality disorders to co-occur with alcohol dependence. This disorder occurs more often in men, and is characterized by feeling a lack of empathy and regard for others. People with ASPD may act without guilt, become aggressive, frequently lie and manipulate, and show disregard for the feelings or pain of others.
- Borderline: Borderline PD is characterized by a pattern of unstable moods, difficulty maintaining relationships, poor self-esteem, and high impulsivity. People who are borderline may fear abandonment, require a great amount of attention from those closest to them, and experience intense mood swings from feelings of emptiness to unexpected anger.
- Histrionic: People who are histrionic rely excessively on the approval of others, and may dramatize their emotions to seek more attention and increase feelings of self-worth. They may change their appearance often for attention, act on impulse, and engage in risky behaviors and self-exploitation for the sake of gaining approval from others.
- Narcissistic: People with narcissistic PD lack empathy for others and have an inflated sense of their own importance, entitlement, and self-worth. They are likely to take advantage of other people to fulfill their own desires, caring little for how it affects others.
Cluster C (Anxious or Fearful Behaviors)
- Avoidant: This disorder is characterized by a pattern of avoiding social interaction, extreme shyness, low self-esteem, and difficulty facing criticism from others. This can lead to extreme isolation and difficulty maintaining social and intimate relationships.
- Dependent: Characterized by an excessive dependence on others to the point where they have extreme difficulty making everyday decisions without external assistance or reassurance. People with this disorder may experience fear and helplessness when they are alone, and feel incapable of caring for themselves.
- Obsessive Compulsive: Not to be confused with obsessive-compulsive disorder (OCD), OCDP refers to a pattern of requiring perfection, control, and inflexible expectations. People with OCPD often work excessive hours, leave little time for social interaction, and become preoccupied with creating lists, schedules, and focus on detail. In excess, these behaviors can negatively impact someone’s ability to function normally in their everyday life.
How Often Do Personality Disorders And Alcoholism Co-Occur?
Personality disorders co-occur at high rates among people who seek treatment for alcohol abuse – more than double the rate found in the general population. According to a recent study published in the journal European Psychiatry, people with personality disorders are at five times the risk for an alcohol use disorder.
For explanation of this high rate, many experts point to the shared symptoms and personality characteristics commonly experienced by people with substance abuse and personality disorders. For instance, many people with personality disorders are impulsive. This can make them more likely to abuse substances such as alcohol or drugs.
According to previous study of co-occurring personality disorders and substance abuse:
- substance abuse is most common among people with a Cluster B personality disorder (particularly borderline and antisocial personality disorder)
- alcohol dependence is most common among people with a Cluster C personality disorder
- people with a personality disorder may experience more intense substance abuse symptoms
What Causes High Rates Of Alcoholism In People With Personality Disorders?
People with personality disorders are more likely to experience intense mood swings, are more likely to enter the criminal justice system, and can often have a history of trauma or abuse. These experiences are also common among people who abuse alcohol.
Alcoholism cannot cause a personality disorder, but it can cause many of the symptoms associated with them, such as edginess, hostile behavior, and paranoia. Although someone with a PD may experience these difficulties already, alcohol and can intensify these symptoms.
Alcohol may also be used by someone with a personality disorder to numb, dull, or excite the intensity of their emotional experiences. Alcohol abuse can become a way to experience short-term relief. It can also make begin to make symptoms worse, and can lead to alcohol dependence and addiction. This addiction then becomes more than just physical, but a psychological craving for alcohol that develops in the brain.
What Are The Risk Factors?
Having a personality disorder can increase the risk of someone developing substance abuse problems at some point in their life. Additional factors common in those with personality disorders may increase this risk.
Other risk factors for developing alcohol dependence include:
- lacking social support
- suicidal thoughts and previous suicide attempts
- difficulty managing emotions
- not receiving treatment for the personality disorder (e.g. counseling, medication)
- having other mental health problems (i.e. mood or anxiety disorder)
Treating Co-Occurring Personality Disorders And Addiction
Having a personality disorder can make recovering from alcoholism more difficult, but it doesn’t make it impossible. The most effective form of treatment for people with co-occurring alcohol and personality disorders is a dual-diagnosis program capable of treating both disorders at the same time.
At Vertava Health, our dual-diagnosis treatment programs offer several treatment services capable of addressing the unique needs of people healing from the effects of co-occurring disorders.
- dialectical behavior therapy (DBT)
- group therapy
- medication-assisted treatment
- family counseling
- expressive therapies
- aftercare support
Through a supportive alcohol treatment program, our dual-diagnosis programs serve to address all aspects of our patients’ experiences with alcohol abuse for continued healing and lasting recovery.
Reaching out for help can be difficult, but we encourage you not to wait. Let us help you or someone you care about find alcohol abuse and addiction treatment that meets your needs.
Contact us today to learn more about dual-diagnosis treatment programs for alcoholism and personality disorders.
American Psychiatric Association (APA) — What Are Personality Disorders?
National Drug Strategy (AU) — Personality disorders and substance use
U.S. National Library of Medicine: Indian Journal of Psychological Medicine — Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review