William Shakespeare once famously wrote, “When sorrows come, they come not single spies, but in battalions.” Though the Bard might not have had the disease of addiction in mind when he penned these immortal words, they could not be more applicable.
This is particularly true when substance use disorder (SUD) is accompanied by a personality disorder (PD). Indeed, there is mounting evidence that substance addiction and personality disorders often go hand-in-hand. According to recent estimates, while roughly 10-14% of the general population has some form of personality disorder, that average skyrockets to more than 56% of those who have experienced addiction (1). What, exactly, is the link between SUD and PD, and what might this mean to one’s recovery?
Understanding Personality Disorders
Addiction research has long underscored the significant connection between substance abuse and related mental health disorders. Indeed, addiction is often accompanied by comorbidities such as depression, anxiety, and post-traumatic stress disorder (PTSD), creating a vicious cycle in which one feeds off of, sustains, and exacerbates the other. Persons experiencing a mood disorder often turn to substances to cope with worry, loneliness, fear, and sadness. These maladaptive coping mechanisms, though, only serve to increase the symptoms of the mood disorder, compelling sufferers to turn again to drugs or alcohol, often in greater quantities and with increasing frequency, to endeavor to find relief in the moment, regardless of the consequences to follow (2, 3, 4).
Though, in many ways, the nexus between personality disorders and substance abuse functions a lot like the connection between mood disorders and substance abuse, the relationship is not exactly the same. Mood disorders and personality disorders belong to separate categories of mental health disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the Bible of the psychiatric profession.
While mood disorders may develop later in life and can be triggered by external factors, such as trauma or adverse life events, personality disorders are often more persistent, intransigent, and potentially debilitating (4, 5). Like mood disorders, much remains unknown about the origins and progression of personality disorders, but their etiology appears to derive from a complex amalgamation of genetic, environmental, and experiential factors.
Perhaps the most significant distinction between mood disorders and personality disorders, though, is that while mood disorders pertain principally to emotions, personality disorders often have a far broader impact. They describe persistently maladaptive personality traits and behaviors, attributes that color how the individual sees the world, how they understand the actions and emotions of others, and, consequently, how they manage their interpersonal relationships (6, 7, 8).
Importantly, though personality disorders are generally characterized and diagnosed by cognitive and behavioral patterns while mood disorders are largely defined by affective or emotional states, there is, perhaps not surprisingly, a great deal of overlap between the two categories. A mounting body of research shows that those with personality disorder are also significantly more likely than the general population to experience mood disorders and vice versa (9, 10, 11).
The Relationship Between Personality Disorder and Addiction
Given the strong associations between mood disorders and addiction, it’s perhaps not surprising that personality disorders and SUD should also be profoundly interconnected (1, 12, 13, 14). This relationship may be explained in part by treatment failure for patients with co-occurring mood disorders and personality disorders. In other words, when comorbid PD is not recognized or addressed in patients with affective disorders, then treatment protocols are likely to fail. Symptoms of depression and anxiety will persist and, consequently, so too will relapse triggers.
However, the characteristic features of personality disorder themselves also contribute to addictive behaviors. For instance, those with PD have been found to experience significant difficulty in regulating their emotions, hopelessness, self-harm, low self-efficacy, poor interpersonal relationships, negative self-image, and impulsivity (7, 15, 16).
It is not difficult to understand how these attributes can easily galvanize both the development of substance addiction and the occurrence of relapse. After all, when you feel as if you have no control over your life, your feelings, or your behavior, it’s nearly impossible to hold yourself accountable or responsible for your sobriety. Likewise, when you feel hopeless, unsupported, and unloved, no matter how far from the truth that perception may be, then how can you possibly find the motivation to get sober, let alone stay that way?
Conquering the Many-Headed Monster
Managing a mental illness is never easy. And when you or someone you love is experiencing addiction, a comorbid personality disorder only amplifies the challenges. But that in no way means that all hope is lost. Indeed, recognizing comorbid factors can actually be a tremendous asset because it will give you a more accurate and comprehensive understanding of the many-headed beast you, your loved ones, and your recovery team must fight together (17).
While much must still be learned regarding the mechanisms, progression, and treatment of PD, great strides have already been made. This includes promising results in the combined use of psychotropic interventions and psychotherapy. Schema therapy (ST, dialectical behavior therapy (DBT), and mentalization-based therapy (MBT) are showing particular efficacy in managing personality disorders and, thus, can be a critical component of addiction recovery for those with comorbid substance use disorder and personality disorder (18, 19, 20).
How Bayshore Can Help
At Bayshore, our multidisciplinary team of addiction recovery specialists is committed to helping our clients enjoy the quality of life they want and deserve. We do this by treating the whole person and not simply the addiction.
We offer onsite mental health care provided by board-certified psychiatrists and behavioral health specialists trained in dual-diagnosis treatment. Bayshore is also accredited by the Joint Commission and certified by LegitScript, enabling our team members to offer customized treatment protocols combining psychotherapeutic approaches with pharmacological care as appropriate for the treatment of PD and/or SUD in our clients.
In addition, because we recognize the vital importance that a strong support network plays both in the management of PD and in maintaining sobriety, we provide an array of counseling and life coaching services. This may include onsite individual and family counseling as well as coordinating after-care support with qualified experts in your community.
If you or someone you love is struggling with addiction and you suspect a comorbid personality disorder, contact our caring team at Bayshore today. We can help you or your loved one find health, healing, and wholeness at last.