Living with a Personality Disorder in Recovery
We don’t hear about personality disorders, or PD, enough in society. The truth is, the incidence of a personality disorder in those who become addicted to substances is incredibly high.
Research shows that the prevalence of personality disorders within the population is around 10% to 14.8%. However, the prevalence of PD skyrockets to 34.8% to 73% for those struggling with addiction.
Read on to learn more about what personality disorders are and how they may be impacting your recovery journey right now. Discover what you can do to manage your symptoms and truly thrive.
What is a personality disorder?
A personality disorder is a mental health condition in which you have a long-standing pattern of thinking and behaving that’s unhealthy and impairs your functioning.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, there are 5 different general criteria for personality disorders, which are as follows:
General criteria for personality disorders
- Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.
- One or more pathological personality trait domains or trait facets.
- The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time. They are consistent across situations.
- The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or sociocultural environment.
- The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication)
Although those are the general criteria, each personality disorder falls into one of three “clusters.” Each cluster has it’s own subset of criteria. The three clusters and 10 personality disorders as outlined by the American Psychological Association are:
- Cluster A: All personality disorders in this group are marked by eccentric or odd thinking or behaviour. This includes Paranoid Personality Disorder, Schizoid Personality Disorder, and Schizotypal Personality Disorder.
- Cluster B: All personality disorders in this group are marked by unpredictable, dramatic, or overly “emotional” thinking or behaviour. This includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
- Cluster C: All personality disorders in this group are marked by anxious or fearful thinking or behaviour. This includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.
Now you know a bit more about what personality disorders are and what they may look like. However, what causes these disorders to develop in the first place?
What causes personality disorders to develop?
The theory is that personality disorders are caused by a combination of two primary factors: your genes and your environment.
Your genes may leave you predisposed to developing a personality disorder. Then, something may happen in your life that can trigger the personality disorder to manifest. Certain genes may be passed down to you from your parents or grandparent, also contributing to a personality disorder.
The environment you grew up in could also be an integral component of the development of a personality disorder. This not only means the neighborhood you lived in, but also the experiences you had. This also constitutes your family dynamic, and the relationships you had with other people.
Although these factors contribute to the development of personality disorders, there are some factors that can prompt someone to develop a substance use disorder as well.
Which personality disorders are commonly associated with substance use disorders?
Although there are 10 distinct personality disorders, there are several that appear to cooccur at a higher rate alongside substance use disorders.
One interesting note is that personality disorders appear to be more prevalent in those struggling with a drug use disorder rather than an alcohol use disorder.
The personality disorders that appear to be most prevalent among those struggling with substance use disorders are as follows:
- antisocial PD
- avoidant PD
- borderline PD
- paranoid PD
Research indicates that the two most common personality disorders associated with substance use disorders appear to be borderline and antisocial PD. Studies have also shown that a whopping 78% of people with bipolar disorder will develop a substance use disorder in their lifetime.
Conversely, substance use disorders also appear to be prevalent for those diagnosed with personality disorders, primarily borderline PD and antisocial PD.
What causes the correlation between personality disorders and substance use disorders?
With such staggering numbers and high rates of co-occurrence, what could be causing the connection between personality disorders and substance use disorders?
No one set cause has been uncovered through research. However, there are many hypotheses regarding why PD’s and substance use disorders are so interconnected.
One concept is that a primary personality disorder leads to a secondary substance use disorder. Conversely, another hypothesis is that the inherent trauma of being addicted to a substance can trigger changes in personality. These changes can prompt the onset of a personality disorder.
Another hypothesis suggests that biological traits associated with impulsivity and impulse control issues may lead to both personality disorders and substance use disorders.
Significant evidence seems to be pointing in the direction of a primary personality disorder leading to a substance use disorder. However, not all people struggling with an addiction also have a personality disorder, so this is important to keep in mind.
Much of the research suggests that specific personality traits, that are also found in those with personality disorders, may lead these individuals to seek drug and alcohol use for distinct reasons.
For instance, those who have low harm avoidance, impulsivity, and high antisociality are at increased risk of engaging in substance use. Additionally, those who struggle with anxiety, traits of neuroticism, and poor stress reactions may be more likely to engage in substance use. This is in an effort to relieve their negative emotional states.
What to look out for in recovery if you’ve been diagnosed with a personality disorder
Addiction recovery is difficult enough as it is. However, it can be even more challenging for those who struggle with personality disorders. Some of the issues that can come up in early recovery due to having a personality disorder are having a poor relationship with your counsellor or therapist and not attending treatment. It can be not having the desire to change your behaviours, and leaving treatment early.
People with personality disorders and co-occurring substance use disorders often…
- Have more intense struggles with dependence
- Are more likely to leave treatment early
- Are more likely to engage in the use of other drugs
- Have an increased risk for suicide
Additionally, research shows that there are differences between those who have alcohol use disorder and a personality disorder versus those who don’t have a personality disorder. Some of those differences are as follows:
- Earlier onset
- More severe symptoms
- Poorer social functioning
- Shorter periods of abstinence
- Higher incidents of relapse
If you’re living with a personality disorder and struggling with an addiction, this information isn’t meant to scare you. On the contrary, it’s meant to prepare you for what to look out for, and to empower you.
You’re always in charge of the outcome of your life. You can take the course of your future into your own hands by seeking the proper treatment. You can still fully thrive in recovery, whether you have a personality disorder or not.
How to manage personality disorder symptoms without relapsing
One of the most important things to know if you’ve been diagnosed with a personality disorder in addiction recovery is that treatment of your addiction does not equate to treatment of the personality disorder. Ending substance use and working through recovery does not mean symptoms of your personality disorder will inherently disappear or even shift.
Personality disorders require their own unique treatment with different interventions than those used in treating addiction. Because of this, it is imperative to seek treatment specifically for your personality disorder. Not doing so could put your sobriety at risk. It could undo all of the hard work you’ve done thus far.
The symptoms of your personality disorder could be making your sobriety journey significantly more difficult to navigate. Therefore, it will only benefit you to seek the treatment that will help all aspects of who you are.
Below are a few ways to manage symptoms of personality disorder while in recovery from addiction:
The most common form of treatment for personality disorders today is psychotherapy, or talk therapy. However, there are specific forms of talk therapy that appear to be more effective than others when it comes to managing symptoms of personality disorders. It should be noted that those engaging in these forms of therapy appear to benefit from at least 6-months of engagement.
Dialectical behavioural therapy (DBT)
Dialectical behavioural therapy, or DBT, is a common form of therapy used in treating personality disorders. This form of therapy is a type of cognitive behavioural therapy. It is primarily used in identifying and shifting thought and behavioural patterns. DBT is often used in treating suicidal ideations, patterns of self-harm, mood disorders, and other destructive behaviours. Some studies have shown that DBT has also been helpful in treating substance use disorders. So, this could be a great option for those with co-occurring disorders. Several studies have shown that those engaged in DBT for substance use and a personality disorder had higher treatment retention rates, significant reductions in substance use, reduction in psychopathology, and greater social adjustment.
Dual-focused schema therapy (DFST)
Dual-focused schema therapy, or DFST, is a newer form of therapy that uses an integrative approach, fusing together CBT, psychoanalysis, emotion-focused therapy, and attachment theory. Schema therapy helps you dig into your schemas, or the unhelpful thought patterns you’ve developed and integrated into your life. Dual-focused schema therapy in particular helps you focus on and develop relapse prevention skills while also working on uncovering and shifting the schemas that have been ingrained into your way of thinking.
Dynamic deconstructive psychotherapy (DDP)
Dynamic deconstructive therapy, or DDP, is an integrative form of treatment that lasts 12 months and is primarily used to treat borderline personality disorder, as well as substance use disorder, eating disorders, patterns of self-harm, and other behavioural disorders. This form of therapy works to help you heal your negative self-image and the unhelpful way your mind processes emotionally charged experiences. Research shows that DDP has been helpful in reducing symptoms of borderline personality disorder, substance misuse, self-harm, and depression. It’s also been shown to help improve functioning. DDP appears to be a promising form of treatment, as an astounding 90% of people who complete one full year of treatment experience clinically significant improvements.
There currently aren’t any medications that specifically treat personality disorders. However, there are some medications that may be used to manage the symptoms associated with certain personality disorders.
Antidepressants may be used in order to help manage symptoms of depression, instability, or anger. Mood stabilizers may be used to manage symptoms including mood swings, impulsivity, and aggression. Neuroleptics, or antipsychotic medications, can be used to manage symptoms related to psychosis. Anti-anxiety medications may be used to help treat symptoms related to anxiety.
That being said, if you’re in recovery from addiction, it’s important to be mindful when it comes to taking medications, even medications that are prescribed. Some medications have a high potential for abuse, such as certain mood stabilizers or anti-anxiety medications. Talk therapy and alternative forms of treatment should be explored when looking for long-term change while maintaining recovery.
A final word on living with personality disorders while in recovery from addiction
As previously mentioned, living with a personality disorder while in recovery can make your journey even more difficult. However, knowing you have a personality disorder can be to your benefit, as you can use this knowledge to seek the proper treatment.
Knowing you have a personality disorder can help you understand why you think the way you do or why you engage in some of the behaviours you engage in. It can help you understand your relationship patterns better. With this knowledge you can take the steps to work on shifting your thought patterns, and therefore your behaviour patterns, to truly thrive in recovery and in life.
Author - Thurga