Personality Disorders and Addiction

Personality disorders are persistent patterns of behavior and coping that lead to chronic problems with maladjustment.

Psychological trauma in childhood and other problems with development are thought to contribute to the development of a personality disorder. There may also be genetic factors.

Personality disorders are resistant to change. They represent a lifelong constriction in the range of available coping strategies. People with personality disorders are unaware of problems with their behavior and tend to use projection and blaming in a defensive fashion in order to avoid introspection.

In this sense, people with addiction resemble those with personality disorders. There is considerable overlap in the incidence of addiction and personality disorders; the difference is that the distortions of personality caused by addiction will gradually improve with recovery. When addiction and a personality disorder are both present, adopting a lifestyle of recovery and continued growth can be very difficult.

Antisocial personality disorder is commonly complicated by addiction for several reasons. There may be a shared genetic vulnerability. Also, people with antisocial personality tend to have difficulty learning from painful experience and to take risks. Their ability to relate to other people is significantly impaired, and relationships are shallow and exploitive. People with the disorder often become involved in criminal or abusive behaviors.

The presence of antisocial personality disorder makes success in recovery unlikely. It should be noted that this situation does not constitute a dual diagnosis in the typical sense of the term. In fact, the modifications in addiction treatment that are made for people with dual diagnosis are the opposite of what a person with antisocial personality disorder needs in order to get better. Highly confrontational and structured programs such as the therapeutic community approach of the sixties or recent prison-based "boot camp" programs are more likely to be successful for a person with this disorder who is addicted.

People with paranoid, schizoid, or schizotypal personal ity disorders have traits that resemble symptoms of schizophrenia. They have difficulty with socialization and with self-esteem, and sometimes do poorly in traditional alcohol and drug treatment or unmodified 12-step programs. Dual diagnosis programming is often helpful for an addict with one of these personality disorders.

Narcissistic, dependent, histrionic, and compulsive personality disorders involve various neurotic traits which lead to impaired interpersonal functioning and difficulties with jobs and academic achievement, but often do not preclude successful treatment in traditional alcohol and drug programs.

Borderline personality disorder is a complex condition that resembles a number of other severe psychiatric disorders and is unique in its responsiveness to medication and therapy. It is characterized by instability in relationships, poor stress tolerance, repeated self-destructive behavior that includes suicide gestures and attempts, severe anxiety, periods of depression, and, often, brief episodes of psychosis. Eating disorders such as bulimia or compulsive overeating may be present. Substance abuse may occur in episodes or may lead to the development of addiction. It is thought that borderline personality disorder arises from a combination of genetic vulnerability to depression and early childhood trauma. A history of such trauma, especially sexual abuse, is common in people with this disorder.