Personality Disorders And Addiction: Dual Diagnosis

Medically Reviewed by Johnelle Smith, M.D on April 19, 2021

Over one-fifth of adults in the United States with a personality disorder have a substance use disorder (SUD). Co-occurring addiction and personality disorders can best be treated through an integrated dual diagnosis treatment program.

Dual Diagnosis Personality Disorders And Addiction

Personality disorders affect about nine percent of adults in the United States, according to the National Institute of Mental Health.

Co-occurring disorders, also known as dual disorders, are common in people with personality disorders. Over one-fifth are estimated to have a drug or alcohol use disorder.

Recovering from drug or alcohol addiction with a personality disorder is possible. These co-occurring disorders can best be treated through integrated dual diagnosis treatment.

What Are Personality Disorders?

Personality disorders are mental illnesses that are characterized by chronic patterns of inflexible and unsupportive thoughts and behaviors.

Personality disorders generally affect at least two of these areas:

  • how someone relates to others
  • how someone responds emotionally
  • how someone thinks about their self and others
  • how one is able to control their behaviors

What a personality looks like—and how often it co-occurs with addiction—can vary depending on the specific type. These disorders are grouped into three clusters, based on shared symptoms.

Cluster A Personality Disorders

Cluster A personality disorders are characterized by odd or eccentric thinking and behavior.

Personality disorders belonging to this cluster include:

  • paranoid personality disorder
  • schizoid personality disorder
  • schizotypal personality disorder

Cluster B Personality Disorders

Personality disorders in cluster B are marked by overly emotional, dramatic, and unpredictable thought patterns and behaviors.

Cluster B personality disorders include:

  • antisocial personality disorder
  • borderline personality disorder
  • narcissistic personality disorder
  • histrionic personality disorder

Cluster C Personality Disorders

Cluster C personality disorders are identified by excessively anxious or fearful thought patterns and behaviors.

Personality disorders within this cluster include:

  • obsessive-compulsive personality disorder (OCPD)
  • dependent personality disorder
  • avoidant personality disorder

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How Common Are Personality Disorders And Addiction?

According to data from the most recent National Comorbidity Replication Survey, about 22.6 percent of people with a personality disorder also have a substance use disorder.

Additional research shows that personality disorders affect anywhere from 34 percent to 73 percent of people treated for substance addiction.

Research suggests that personality disorders are more common among people with substance use disorders, compared to the general population.

Addiction And Antisocial Personality Disorder

Antisocial personality disorder (ASPD), sometimes referred to as sociopathy, is one of the most common personality disorders believed to co-occur with substance abuse and addiction.

People with this disorder are more likely to engage in high-risk behaviors, including heavy drinking, non-medical drug use, and sharing paraphernalia such as needles or syringes.

Learn more about co-occurring antisocial personality disorder and addiction

Addiction And Avoidant Personality Disorder

Avoidant personality disorder is characterized by long-term patterns of extreme shyness, fear of rejection, and feelings of inadequacy.

People with this disorder may use drugs or alcohol to cope with symptoms of their disorder, as a form of self-medication.

Learn more about co-occurring avoidant personality disorder and addiction

Addiction And Borderline Personality Disorder

Borderline personality disorder (BPD) is one of the most common personality disorders to co-occur with substance abuse and addiction, along with ASPD.

This personality disorder is marked by:

  • intense mood swings
  • extreme insecurity
  • fear of abandonment
  • unstable relationships
  • impulsivity

People with BPD may use drugs or alcohol to self-medicate, in the absence of supportive coping strategies. Drug or alcohol abuse can also be a form of self-injury among people with BPD.

Learn more about co-occurring borderline personality disorder and addiction

Addiction And Dissociative Identity Disorder

Dissociative identity disorder, formerly known as multiple personality disorder, is characterized by the existence of at least two distinct identities—also known as alters, or personality states.

This dissociative disorder is highly stigmatized. Left untreated, or without a strong support system, a person with DID may be more likely to turn to drugs or alcohol to cope.

Learn more about co-occurring dissociative identity disorder and addiction

Addiction And Histrionic Personality Disorder

People with histrionic personality disorder tend to be hyper-focused on being the center of attention, are overly dramatic, and can be easily influenced by others.

People with this disorder may be more susceptible to social pressures to drink or use drugs, and may use substances as a form of self-medication for feelings of anxiety or low self-worth.

Learn more about co-occurring histrionic personality disorder and addiction

Addiction And Narcissistic Personality Disorder

People with narcissistic personality disorder have an exaggerated sense of self-worth, show a lack of empathy for others, and have a need for excessive attention and admiration.

Co-occurring substance abuse is particularly common in people with grandiose traits of this disorder, such as an overinflated sense of superiority over others and entitlement.

Learn more about co-occurring narcissistic personality disorders and addiction

Addiction And Paranoid Personality Disorder

Paranoid personality disorder is marked by an extreme suspicion of others, an unjustified belief that others are out to get you, and angry or hostile reactions to perceived insults.

People with this disorder may abuse substances as a way to escape or manage their symptoms.

Learn more about co-occurring paranoid personality disorders and addiction

Addiction And Schizoid Personality Disorder

People with schizoid personality disorder generally prefer to be alone, show a limited emotional range, have low empathy for others, and have little interest in most activities.

People with this disorder may misuse drugs or alcohol in order to self-medicate symptoms of their disorder. Drugs and alcohol can either mask or enhance symptoms.

Learn more about co-occurring schizoid personality disorder and addiction

Addiction And Codependency

Codependency is a behavior that is often seen in people with dependent personality disorder, which is characterized by an excessive need for attention and an extreme reliance on others.

People who are codependent can be more prone to drug or alcohol misuse as a way to cope with feelings of inadequacy, anxiety, or rejection.

What Causes Personality Disorders?

Like with most mental illnesses, personality disorders are often traced to a variety of factors, including interpersonal, hereditary, and environmental factors.

Most personality disorders develop in adolescence or early adulthood. Genes and childhood experiences are considered primary influences in the development of personality disorders.

The cause of a personality disorder can vary depending on the type, although several are associated with past trauma and childhood neglect.

Can Drug Abuse Cause A Personality Disorder?

Drugs and alcohol can affect the brains in ways that can trigger common symptoms of personality disorders, such as paranoia, anxiety, and agitation.

Substance abuse does not cause a personality disorder, however. Going through detox and withdrawal may result in the dissipation of substance-induced symptoms with time.

Diagnosing Personality Disorders In People With Substance Use Disorders

If someone without a former diagnosis is showing signs of a personality disorder in a substance abuse treatment setting, a doctor may provide a diagnosis through a clinical assessment process.

Considerations for diagnosis may include:

  • age
  • medical history
  • history of substance abuse
  • history of personality disorder symptoms
  • family history of mental illness

Although it does occur, many doctors tend to not diagnose personality disorders in people under the age of 18, since their brains are still developing.

Treatment For Addiction And Personality Disorders

Personality disorders are typically treated with behavioral therapies, such as dialectical behavior therapy (DBT), and sometimes medication.

For co-occurring disorders, seeking out a dual diagnosis treatment program is highly recommended. This offers an integrated approach that can treat all disorders at once.

Dual diagnosis treatment programs may offer:

  • medically supervised detox
  • individual behavioral therapy
  • dual diagnosis group therapy
  • medication
  • holistic treatments

Through an initial assessment, a clinician can determine what type of treatment program and treatment services can best meet a person’s physical, emotional, and mental health needs.

Find Treatment For Co-Occurring Addiction And Personality Disorders

Recovery from addiction is possible. If you’re looking for treatment for yourself or a loved one with co-occurring substance abuse and a personality disorder, we may be able to help.

Call our helpline today to find a dual diagnosis treatment program that’s right for you.

This page does not provide medical advice. See more

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Medically Reviewed by
Johnelle Smith, M.D on April 19, 2021
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