Concurrent Disorders: Personality Disorder

Personality disorders are very common in those seeking help with addictive behaviours. Antisocial Personality Disorder, Borderline Personality Disorder and Narcissistic Personality Disorder are the most frequently associated with substance abuse. For example, there are estimates that approximately 80 % of individuals with an Antisocial Personality Disorder and 60-70 % of individuals with Borderline Personality Disorder will end up abusing illegal substances, and/or display other forms of addictive behaviours.

Please Note: Hope successfully treats many clients with common mental health issues such as depression and anxiety, usually together with addiction. However Hope Rehab is not a substitute for a psychiatric unit and do not have a psychiatrist onsite. We know our program is ideal for clients suffering with many types of mental health issues. We work closely with the Doctors/Psychiatrists at the hospital opposite who provide all our detox and medication needs. All clients must undergo a formal psychological assessment with our team and need to be able to function safely in our community. The reason we are selective is to protect all clients from unnecessary disappointment and disruption. If you are in any doubt please double check with our admissions department.

The Dangers of Self-Medicating When Suffering With A Personality Disorder

People who are dealing with a personality disorder can be tempted to turn to alcohol or drugs in an attempt to soothe their inner discomfort. This act of self-medication can feel like it is working in the beginning, but it is actually making the situation worse. The person can then end up in a catch-22 situation where it is not possible to effectively treat the personality disorder because of the substance abuse, and it is not possible to effectively treat the substance abuse because of the personality disorder.

Hope Medication Policy

What are Personality Disorders?

Personality Disorders can be defined as enduring patterns of thinking and behaving that deviate significantly from standard cultural norms, and these patterns typically cause significant impairment in all areas of functioning. Individuals with personality disorders usually display strongly inflexible and rigid ways of thinking, perceiving and responding to the world around them. They also tend to be unable to adapt to changing contexts or circumstances, and they are very much resistant to change.

Personality disorders are associated with ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life.

– American Psychiatric Association (Personality_Disorders_Factsheet.pdf)

Are there different types of Personality Disorders?

In short, yes. The Diagnostic Statistical Manual (DSM-V) lists currently ten different types of personality disorder, and as mentioned above, three of those are most commonly associated with serious substance abuse problems:

  • Antisocial Personality Disorder: Individuals with this diagnosis display a profound and consistent disregard for societal rules or social norms, based on the belief that rules somehow don’t apply to them. Individuals with this personality disorder tend to be overrepresented in the criminal justice system, as they typically do not hesitate to violate the rights and property of others.

  • Borderline Personality Disorder (BPD): More commonly diagnosed in women, this disorder is characterized by pronounced difficulties regulating one’s emotions, a poor self-image and a tendency to instigate drama and crisis in interpersonal relationships and occupational settings alike. Individuals suffering from BPD may resort to self-harm, and they have a tendency to resort to suicidal ideation or suicidal gestures as a way of coping with distress.

  • Narcissistic Personality Disorder: Individuals with this disorder display a strong sense of grandiosity, a need for admiration. They tend to feel superior towards others and are likely to dominate interpersonal interactions.

All 10 Types of Personality Disorder

  • Paranoid

  • Schizoid – focus on the person’s inner life rather than the outside world

  • Schizotypal – behaviour similar to schizophrenia

  • Antisocial

  • Borderline personality – the name comes from the fact that the symptoms are on the border of other types of mental illness

  • Narcissistic

  • Dependent – the individual is over-reliant on other people to take care of him/her

  • Histrionic – no self-worth

  • Obsessive-Compulsive

  • Avoidant – needs to be liked and avoids social interaction where there is a risk of being disliked

It is possible to divide personality disorders into three clusters

  • Cluster A is characterised by unusual thinking and behaviour (1 to 3 in the above list).

  • Cluster B personality disorders involve strong emotions and unpredictable thinking/behaviour (4 to 7).

  • Cluster C personality disorders are associated with behaviour driven by intense fear and anxiety (8 to 10). 

The exact symptoms a person experiences depends on the type of personality disorder, but they can include:

  • Unstable Relationships

  • Distorted Thinking

  • Impulsivity

  • Emotional Instability – Extreme Emotions

  • Fear of Abandonment

  • Unstable Self-Image

  • A Feeling of Emptiness

  • Self-Harm

  • Compulsive Behaviour

Why are Personality Disorders so Difficult to Treat in Rehab Settings?

Individuals with comorbid personality and substance use disorders pose significant conundrums to addictions rehab centers as they:

  • Show persistent impulse control problems, coupled with an inability to delay gratification and a tendency to react strongly and quickly with frustration and irritability. This is a significant contributor to impulsive substance use behaviours, as well as difficult and unhelpful social interactions that often require careful and consistent management in a treatment setting.

  • Display significant impairment in their ability to feel and express empathy for others, and often, in fact, blame others for what goes wrong in their lives. Consequently, individuals with personality disorders are often not interested in changing themselves, and may only seek treatment when more or less forced to by loved ones or authorities. This, in turn, makes it difficult to a) work therapeutically towards a change of maladaptive behaviours, and b) fully integrate such individuals in group therapy and/or community-oriented treatment programs.

  • Have difficulties establishing and maintaining mutually respectful meaningful relationships, including with a therapist or recovery coach. This may prove a significant hurdle in establishing a therapeutic alliance, and thus, in turn, make it difficult to work towards change.

  • Tend to feel rules either apply to others or are there to be broken. As such, individuals with personality disorders may frequently try covertly to cut corners, or overtly question rehab guidelines and staff. Unfortunately, these behaviours sometimes translate into early discharge from treatment facilities.

  • Display rigid and inflexible thinking and looking at the world, which makes it difficult to learn and incorporate new ideas, concepts and viewpoints. In short, personality disorders are resistant to change, and change typically requires long-term treatment. This poses a particular conundrum to addictions rehab treatments, as the length of typical rehab is between 30-90 days (=short term) only.

  • More likely to show higher rates of suicidal ideation and behaviour, suffer from additional mental health difficulties such as depression, and display much greater psychosocial impairment compared to others seeking treatment.
    Not surprisingly, this complexity translates into a need for more specialized and longer term treatment, and treatment requires highly skilled staff. Individuals with comorbid substance abuse and personality disorders may manage to stay abstinent during short-term treatment, but they are unlikely to change their maladaptive and engrained way of being in the world in this time frame. This, together with the fact that such individuals tend to not engage in after care programming unfortunately makes for a higher risk of relapse following short-term treatment completion.

What Treatment does Hope Rehab Center Offer for Personality Disordered Clients?

It is important to remember that personality difficulties exist on a continuum, ranging from adaptive/useful ways of being in the world on one end of the continuum, to maladaptive/unhelpful ways of being in the world on the other end of the continuum. Most of us, substance dependent or not, display at least some behaviours on the maladaptive and unhelpful end of the spectrum when we are in distress, and when things are not going well for us.

While we do not offer specialized long-term treatment for specific personality disorders at Hope Rehab Center, we carefully assess in which life areas and to what degree individuals struggle. Based on this assessment, our skilled team members tailor individual therapy sessions to address these specific needs and challenges and to improve overall functioning. Furthermore, Hope Rehab Center offers proven interventions to address addictive behaviours, anxiety and depression, all of which typically accompany personality problems and when treated improve day to day functioning.

Our team has a good track record of helping clients who have been diagnosed with a personality disorder. We provide individualised care to ensure that you have access to the resources you need to transform your life. You will be warmly welcomed into our therapeutic community, and you will be entering an environment where amazing transformations happen on an almost daily basis.

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