Dual Diagnosis: Personality Disorders And Substance Abuse
When an individual suffers from a substance use disorder concurrently with a mental health disorder, this is called a dual diagnosis. Personality disorders encompass ten types of disorders, each of which require a specific treatment approach. A comprehensive treatment program should treat these, and any other co-occurring disorders, in order to maximize the impact of treatment and potential for sobriety and wellness.
Substance use disorders are quite commonly, and strongly, correlated to various mental health disorders. When this occurs, this is called a dual diagnosis, or a co-occurring disorder. Personality disorders affect 9.1% of the United State’s adult population, as reported by the National Institute of Mental Health. If an individual struggles with both a personality disorder and a substance use disorder, they require a comprehensive and individualized dual diagnosis treatment plan in order to fully address these concerns and create a more balanced and sober state.
What Are Personality Disorders?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),“A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”
At its core, a personality disorder drastically affects the manner by which an individual perceives themselves and those around them, in a capacity that severely impedes their ability to function within their life, altering the way they think, feel and behave.Within this disorder, individuals may:
- Have difficulties coping with stress.
- Be unable to handle day-to-day issues.
- Struggle within their work- or school-related responsibilities.
- Blame others for their hardships.
- Believe their thoughts, feelings and behaviors to be without fault.
Additionally, these individuals often experiencing intense hardships related to creating and maintaining relationships. Existing relationships are often tumultuous, fraught with tension and very tenuous in their standing.
What Are The Criteria?
According to DSM-5 criteria for personality disorders, a person must meet the following criteria, as sourced directly from the guidelines:
A. Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.
B. One or more pathological personality trait domains or trait facets.
The impairments in personality functioning and the individual’s personality trait expression are:
C. relatively stable across time and consistent across situations.
D. not better understood as normative for the individual’s developmental stage or socio-cultural environment.
E. not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
Understanding Each Type Of Personality Disorders
Each of the ten types is further broken down into one of three clusters as outlined by the DSM-5, based on specific behaviors and thought patterns manifested by the person. They are as follows, as explained by Mayo Clinic:
Cluster A Type Personality Disorders
This group is characterized by odd, bizarre and eccentric thoughts and behaviors.
Paranoid Personality Disorder
Individuals with this disorder adhere to the notion that those around them are trying to bring them harm, because of this, they live in a constant state of suspicion and mistrust of others, to the extent that they misconstrue other’s non-harmful or non-negative remarks to be offensive and react in an angry way.
Schizoid Personality Disorder
These individuals prefer isolation and do not desire intimacy, either emotional or physical. They do not desire social interaction and fail to pick up on typical social cues when in these situations. They often appear distant and without emotion.
Schizotypal Personality Disorder
An individual with this disorder is prone to “magical thinking,” believing that they can influence both people and scenarios by their mind, they also derive hidden meaning from everyday occurrences. They may hear voices, act in an odd manner, and experience anxiety in social situations.
Cluster B Type Personality Disorders
This group is characterized by dramatic, erratic, unpredictable or overly emotional thoughts and behaviors.
Antisocial Personality Disorder
These individuals do not intuit or place importance in other people’s emotional states and do not feel remorseful for negative or adverse behaviors. They may lie, act impulsively, become violent or aggressive, or act without thought of consequences in other ways.
Borderline Personality Disorder
An individual struggling with this disorder has a constant fear of being alone and frequently feels empty; however, they often have rocky or extreme relationships. Constant mood shifts, impulsive tendencies, risky behavior, suicidal tendencies, anger and paranoia may be all frequent within this disorder.
Histrionic Personality Disorder
Within this disorder, an individual may exhibit extreme shows of emotion or sexual enticement as a means to garner attention, while being excessively concerned with how they look. They strongly base their state of mind on those around them, believing these individuals to be more connected to them than they really are.
Narcissistic Personality Disorder
Marked by arrogance, a belief of supremacy, and an infatuation with power or personal fulfillment, these individuals put their own perception forefront, while negating other’s views or needs and believing these individuals to envy them.
Cluster C Type Personality Disorders
This group is characterized by anxious or fearful thoughts and behaviors.
Avoidant Personality Disorder
Prone to isolation, due to their sense of shyness, fear of making mistakes or being dismissed or teased, these people strive to avoid new people, while struggling in the relationships they already have. They are also highly fearful of criticism.
Dependent Personality Disorder
Moving quickly from one relationship to the next, when one ends, these individuals have the constant need to feel taken care of and feel fearful of fending for themselves. With a low sense of self-worth, these individuals are constantly seeking approval or direction from others, even in small, trivial decisions. Due to this, they may accept situations where they are treated poorly, exhibiting submissive behaviors.
Obsessive-Compulsive Personality Disorder
Highly inflexible and controlling, these individuals fret over small details, expending large amounts of time trying to create what they believe is the optimal outcome and become upset when a situation does not pan out the way they desire it to. They often push people away for lack of time or because they are trying to control them.
When considering the full list of criteria (which is not represented in entirety here), it is important to understand that a person may exhibit characteristics from more than one cluster. A professional diagnosis is essential towards fully understanding if, and how, a disorder exists, in order to fully inform, and create, the correct treatment method.
The Importance Of Dual Diagnosis Care
As evidenced, these disorders can cause very extreme and discordant thoughts and behaviors within an individual; on the inside, living within the spectrum of these mental illnesses, a person may grow to become very overwhelmed and despondent. Living untreated within these mental illnesses may cause other co-occurring disorders to surface as well, including depression and anxiety. As a person struggles to cope within the turbulent state of their mind and life, many may turn to substance abuse in an attempt to calm this inner storm. So begins a vicious cycle.
Drugs and alcohol begin to change a person, at the center of these changes lies a sobering truth—substance use and addiction change your brain’s very chemistry. As these changes progress, many mental illnesses actually begin to grow worse, as numerous symptoms are actually exacerbated by the abused substance. In order to counter this, a person may consume more of their drug of abuse, thus fueling this negative cycle. Because of this, it is critical that any person who struggles with a co-occurring disorder, including personality disorders, receive not only substance abuse treatment, but dual diagnosis care, so that both disorders are treated together. This ensures a person has the highest chance of sobriety and a sound recovery.
How Are These Disorders Treated?
Like substance abuse and addiction, personality disorders are treated by a variety of psychotherapies or “talk therapies,” and at times, certain medications. What is fortunate about this similar approach, is that in some instances one form of therapy may have the dual benefit of treating both simultaneously. Interestingly enough, a dynamic method of therapy that is often employed within substance abuse programs actually originated as a means to treat borderline personality disorder. Dialectical behavioral therapy has great applications in treating some personality disorders and substance abuse. Cognitive behavioral therapy has also shown promise. If this need is not met in a singular form, various other therapies or modalities will be employed until the proper approach is met.
To accompany these therapies, a person will engage in counseling on a one-on-one basis and also in a group setting. As relationships often struggle within the context of both disorders, family therapy and support may also be integrated into treatment, should an individual choose. This aids both them, and their loved ones, in learning more effective and positive interpersonal and coping skills. Lastly, relapse prevention will be stressed, as well as continued aftercare support.
Find Balance Today
If you’re faced with both a personality disorder and a substance use disorder, look no further. Turning Point can assist you in finding the proper dual diagnosis care to meet your unique needs, that way you can begin working towards a more balanced life, body and mind. Contact us today and set forth on the path towards sobriety.
National Institute of Mental Health — Any Personality Disorder
Medscape — Personality Disorders
Substance Abuse and Mental Health Services Administration — Prevention of Substance Abuse and Mental Illness
University of Buenos Aires — DSM-IV and DSM-V Criteria for the Personality Disorders
Psychology Today — The 10 Personality Disorders