Personality Disorders and Addiction Treatment for Women

A personality is the way a person thinks, feels, and behaves that makes them different from other people. Your personality is affected by:

  • Experiences
  • Environment (life situations, surroundings)
  • Inherited traits

What is a Personality Disorder?

Typically, a person’s personality stays the same throughout their life. A personality disorder is a long-term way of thinking, feeling, and behaving that veers off significantly from the expectations of society. This causes distress or problems with functioning and lasts over time.

Personality Disorders and substance abuse

This pattern of behavior usually begins in late teens or early adulthood. Personality disorders can last a long time without treatment. They affect at least two of these areas:

  • Way of thinking about yourself
  • Way of reacting emotionally
  • Way of relating to other people
  • Way of controlling your behavior

How Common Are Personality Disorders?

Among severe mental disorders, personality disorders are the most common. Often, they occur alongside mental illnesses like substance use disorders, mood disorders (depression or bipolar disorder), and anxiety disorders. About 10% to 13% of the world’s population have some form of personality disorder.

Gender and Personality Disorders

Some personality disorders are more common in women than in men. These are borderline personality disorder and histrionic personality disorder. However, antisocial personality disorder and obsessive-compulsive personality disorder are more common in men.

Personality Disorders and Substance Abuse

There have been a number of studies that suggest that the commonness of personality disorders is higher among those struggling with substance abuse as compared to the general population. This was found to be the case, especially for antisocial, borderline, avoidant, and paranoid personality disorders. 

Overall, the commonness of personality disorders ranges from 10% to 14.8% in the general population and from 34.8% to 73% for individuals being treated for substance abuse. In a recent study, personality disorders were found in a total of 46% of people with substance abuse. Furthermore, the two most common personality disorders among those people were antisocial personality disorder (ASPD) and borderline personality disorder (BPD).

What Causes Personality Disorders?

Unfortunately, personality disorders are some of the least understood and recognized mental disorders. Professionals believe that both genetics and environment play parts in the development of personality disorders. 

personality disorders and substance abuse

Some personality disorders appear to be linked to a family history of mental illness. People with antisocial personality disorder are more likely to have family members who also have personality disorders. Also, a family history of depression could be a risk factor for borderline personality disorder or obsessive-compulsive personality disorder.

Even though research on personality disorders has been limited, no studies have shown that a person is born with a personality disorder. Similar to other mental disorders, the tendency to develop a disorder is inherited, not the disorder itself. The disorder appears when something interferes with the development of a healthy personality. 

The 10 Types and Symptoms of Personality Disorders

There are 10 distinct types of personality disorders, which are broken down into three clusters.

Cluster A: Odd and Eccentric

Schizoid Personality Disorder

The person with this disorder is detached from social ties and displays little emotion. They typically:

  • Don’t seek close relationships
  • Prefer to be alone
  • Seem not to care about praise or criticism from others

Schizotypal Personality Disorder

This disorder displays a pattern of being very uncomfortable in close relationships, having distorted thinking, and bizarre behavior. A person with this disorder may:

  • Have odd beliefs
  • Engage in odd or peculiar behavior or speech
  • Have extreme social anxiety

Paranoid Personality Disorder

Being suspicious of others and seeing them as spiteful or mean are typical of this disorder. These people also may:

  • Assume people will harm or deceive them
  • Not confide in or become close to other people

Cluster B: Dramatic and Erratic

Histrionic Personality Disorder

This disorder displays a pattern of excess emotion and attention-seeking. Individuals with this disorder may:

  • Be uncomfortable when not the center of attention
  • Use physical appearance to get attention
  • Have emotions that shift rapidly or are over-exaggerated

Borderline Personality Disorder (BPD)

People with this disorder show a pattern of instability in personal relationships, intense emotions, poor self-image, and recklessness. This person may:

  • Go to extremes to avoid being abandoned
  • Have repeated suicide attempts
  • Demonstrate inappropriate intense anger
  • Have continuous feelings of emptiness

It’s common for people with BPD to also have a co-occurring substance use disorder. BPD is a complex and serious mental disorder, and it’s the only personality disorder that features suicide attempts or self-harming actions.  

A history of childhood trauma such as physical or sexual abuse, neglect, or an early loss of a parent is more common for those people with borderline personality disorder. As a result, many individuals with BPD developed BPD symptoms as a way to cope with childhood trauma. 

However, not all people with BPD are coping with a history of childhood trauma. That makes it essential to have a diagnosis made by experienced medical professionals.

Challenges to Treatment of Borderline Personality Disorder and Substance Abuse

A client with BPD and a co-occurring substance use disorder presents some particular challenges to treatment. BPD is difficult to treat, partly because of the far-reaching, destructive nature of personality disorders and partly because clients with BPD often do not stick to their treatment and often drop out. 

The impulsiveness, suicidal tendencies, and self-harm risks associated with BPD may all be made worse by the use of alcohol or drugs. Besides, the presence of BPD may contribute to the severity of substance use disorder symptoms, and the course of substance abuse treatment may be more complicated for people who also have BPD. The co-occurrence of two disorders like this is called a dual diagnosis and both need to be treated at the same time.

Narcissistic Personality Disorder

These individuals display a pattern of need to be admired and a lack of empathy for others. They may:

  • have an extravagant sense of self-importance
  • have a sense of entitlement
  • take advantage of others

Antisocial Personality Disorder

This is a pattern of not considering or even violating the rights of others. An individual with antisocial personality disorder usually: 

  • doesn’t observe the social norms,
  • may lie repeatedly or
  • deceives others,
  • may act impulsively, and
  • may lack empathy.

People who have these traits don’t become that way overnight. Instead, they progress into the disorder over time. A study in American Psychologist reported that the progress over time into ASPD begins with genetic susceptibility. This is because people who have antisocial behavior tend to have relatives with the same types of traits.

While these people grow and show these behaviors they are likely to be avoided by their peers and others around them. They also tend to fail in school. All of this can cause them to seek out peers. As a result, they may connect with people who use drugs or behave in deviant ways. Likewise, drug addiction tends to introduce antisocial behavior in some people.

People may seem that they’re immune to being affected by their peers, but if everyone else is behaving badly, antisocial acts become normal and the behaviors may grow even more extreme. And if this includes drug use, an individual may quickly go from substance use to substance use disorder in no time.

Treating ASPD and Substance Abuse

At the beginning of treatment, it is tempting to focus on the substance use disorder because that is probably the issue that is causing the most pain at the time. However, it’s important to realize that antisocial behavior lies beneath the substance use issue. Sometimes, that behavior is rooted in a form of mental illness which must also be treated. 

The individual needs to be evaluated by a medical professional through several mental health tests. At the end of testing, it might reveal that person has an antisocial personality disorder, schizophrenia, or even depression. With the proper diagnosis, a treatment program can be put together to include all of the individual’s issues.

Cluster C: Fearful and Anxious

Avoidant Personality Disorder

Avoidant personality disorder is a pattern of extreme shyness, feelings of deficiency, and extreme sensitivity to criticism. People with this disorder may:

  • Be unwilling to get involved with others unless they are sure of being liked
  • Be preoccupied with being criticized or rejected
  • View themselves as not being good enough
  • Socially incompetent

Dependent Personality Disorder

This disorder includes a pattern of needing to be taken care of and submissive and clingy behavior. These individuals may:

  • Have difficulty making decisions without reassurance
  • Feel uncomfortable or helpless when alone
  • Be unable to care for themselves

Obsessive-Compulsive Personality Disorder 

This isn’t to be confused with obsessive-compulsive disorder (OCD). This disorder features a pattern of preoccupation with orderliness, perfection, and control. These people may:

  • Be overly focused on schedules and details
  • Work excessively and not allow time for leisure or friends
  • Be firm in their morality and values

Women and Borderline Personality Disorder

The criteria for personality disorders were standardized in 1980. Since then, all versions of the Diagnostic and Statistical Manual of Mental Disorders have indicated that BPD is positively more common in women than men. In fact, women were about 75% of people diagnosed with BPD in the U.S. 

Still, it isn’t known whether women are actually more likely to develop the disorder or this is because of gender bias in the diagnosis of BPD. It’s possible that men with symptoms of BPD are more likely to be diagnosed with a different condition like post-traumatic stress disorder or major depressive disorder.

That being said, BPD affects mostly young women. People with BPD often have other mental health issues including:

  • Anxiety disorders
  • Eating disorders
  • Substance use disorders

Misdiagnosis as Bipolar Disorder

In a study from Brown University, more than 40% of those people with BPD had originally been misdiagnosed as having bipolar disorder. One explanation of this is that bipolar disorder is easier to treat with medication, so it is more commonly diagnosed so that symptoms can be managed quickly with a prescription.

A misdiagnosis can be a serious problem. There are no medications approved by the Food and Drug Administration (FDA) for treating BPD. In addition, bipolar disorder medications are often not effective in treating BPD. Sadly, misdiagnosed BPD patients may be exposed to dangerous side effects from inappropriate prescriptions.

Although bipolar disorder and borderline personality disorder share some similar symptoms, they are very different. Bipolar disorder can cause severe depression or mood swings but people can function normally between episodes. People with BPD might have a more chronic condition that can cause self-harming behavior or suicidal tendencies.

Treatment of Personality Disorders and Substance Abuse

Some types of psychotherapy (talk therapy) help treat personality disorders. During therapy sessions, an individual can get insight and knowledge about their disorder and what contributes to their symptoms. With their therapist, they can talk about thoughts, feelings, and behaviors. 

Psychotherapy helps them: 

  • understand the effects of their behavior on others and 
  • learn to manage and cope with symptoms
  • reduce behaviors causing problems with relationships

Commonly used types of psychotherapy include:

  • Dialectical behavior therapy
  • Cognitive behavioral therapy
  • Group therapy
  • Psychoeducation (teaching the individual and family members about the illness, treatment, and ways of coping)
  • Family therapy: Family members can be important in an individual’s recovery. They can work with the individual’s therapist on the best ways to help and support their family member. Having a family member with personality disorders and substance abuse disorder can be very stressful. In that case, members of the individual’s family may also benefit from talking with a therapist who can help them with coping with difficulties.

About 50% to 70% of psychiatric patients with BPD also have a substance use disorder, usually alcohol use or dependence but frequently combined with other drugs. Addictive disorders associated with BPD are often severe and frequent enough to justify a dual diagnosis and appropriate simultaneous treatment. 

Medications

As mentioned above, there are no medications that specifically treat personality disorders. However, medications such as antidepressants, anti-anxiety medication, or mood stabilizers may be helpful in treating some symptoms. 

Likewise, these medications can be used in easing withdrawal symptoms from substance use. More severe or long-lasting symptoms might call for a team approach involving a primary care doctor, a psychiatrist, a psychologist, a social worker, and family members.

Where Can You Get Dual Diagnosis Treatment?

You can get personalized, specialized treatment at New Directions for Women. We are a female-only facility with over 40 years of providing support for women, families, and children in addiction recovery. We offer levels of care from detox to outpatient and aftercare so you can enter at whatever level is best for you. 

New Directions is nationally known for serving women with children and pregnant women, we also serve more mature women helping them enjoy their family as a sober mother and grandmother. At New Directions, we understand that some women would have a difficult time recovering in a co-ed facility. That’s why we specialize in treating women. If you need help, or someone you care about needs help, please contact us now. We are here to answer your questions or just talk.

References:

www.psychiatry.org

www.behavioralhealthflorida.com

www.ncbi.nlm.nih.gov/pmc/articles

www.store.samhsa.gov

www.my.clevelandclinic.org

www.womenshealth.gov

www.verywellmind.com

www.psychiatrictimes.com

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