Personality Disorders and Substance Use Disorders

1. Personality Disordersand Substance Use Disorders “What’s the connection?”

2. What is a Personality Disorder? • According to the American Psychiatric Association (APA), a personality disorder exists when an individual’s “personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress.”

3. What causes Personality Disorders? • There are various theories, but the leading ones hold that normal, healthy childhood development gets interrupted in some significant manner; • One type of scenario in which this occurs is that of abuse or neglect – including severe emotional, physical, or sexual abuse. • One perspective is that a personality disorder is like a “badge of courage” because it indicates that someone has survived much hurt.

4. Reframing the “problem” of Personality Disorders • One way to understand personality disorders is that the person coped in the best way they knew how, in response to difficult circumstances, and at that past time (typically during childhood), it helped them to survive. (i.e., ADAPTIVE)

5. Reframing the “problem” of Personality Disorders • However, those old coping mechanisms tend not to work very well in adulthood, and have become ineffective, or MALADAPTIVE.

6. What are the different types of personality disorders? • Cluster A • Paranoid Personality Disorder • Schizoid Personality Disorder • Schizotypal Personality Disorder • Cluster B • Antisocial Personality Disorder • Borderline Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder • Cluster C • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

7. Common Characteristics of Personality Disorders • Pattern of problematic relationships • Tendency to blame difficulties on others, or on “bad luck” • A lack of personal responsibility • Impaired ability to learn from previous experience

8. Personality Disorders and Addiction • Pattern of problematic relationships • In active addiction, a person’s primary relationship is with their substance of choice – all other relationships come second to that one.

9. Personality Disorders and Addiction • Tendency to blame difficulties on others, or on “bad luck” • Working through the symptom of “denial,” or working from a state of “precontemplation” to an “action” stage of change is one key to recovery success

10. Personality Disorders and Addiction • A lack of personal responsibility • Owning personal responsibility for actively participating in one’s own recovery is another key to recovery success (12-Step inventories & amends-making)

11. Personality Disorders and Addiction • Impaired ability to learn from previous experience • “Doing the same thing over and over again, and expecting a different result” description of addictive “insanity”

12. “Cluster B” Personality Disorders • Antisocial Personality Disorder • Borderline Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder

13. Antisocial Personality Disorder (3% males, 1% females) • “A pattern of disregard for, and violation of, the rights of others” • Over 30% prevalence in substance abuse treatment settings; most common with male alcoholics, “mean drunks”

14. Antisocial Personality Disorder – 3 or more traits • Failure to conform to social norms re: lawful behavior as in repeatedly performing acts that are grounds for arrest • Deceitfulness, as in repeated lying, using aliases, or conning others • Impulsivity or failure to plan ahead

15. Antisocial Personality Disorder – 3 or more traits • Irritability and aggressiveness, as in repeated assaults or fighting • Reckless disregard for safety of self or others • Consistent irresponsibility, as in repeated failure to maintain employment, or to honor $ obligations • Lack of remorse re: mistreating others

16. Borderline Personality Disorder (2%) • “a pattern of instability in interpersonal relationships, self-image” • 30-60% of persons diagnosed with personality disorders end up with this diagnosis

17. Borderline Personality Disorder – 5 or more traits • Frantic efforts to avoid abandonment • Pattern of unstable/intense relationships • Unstable self-image, sense of self • Impulsivity that is potentially self-harmful • Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior

18. Borderline Personality Disorder – 5 or more traits • Emotional instability, over-reactivity • Chronic feelings of emptiness • Inappropriate, intense anger or anger control problems • Transient, stress-related paranoid ideation or severe dissociative symptoms

19. Histrionic Personality Disorder (2-3%) • “a pattern of excessive emotionality and attention seeking”

20. Narcissistic Personality Disorder (<1%) • “a pattern of grandiosity, need for admiration, and lack of empathy”

21. Goods News / “Bad” News • Unlike many other disorders that are chronic or ongoing, personality disorders are resolvable / “curable” • The process of resolving a personality disorder usually involves hard work over an extended period of time

22. Dialectical Behavior Therapy treatment leads to changes in . . . • Ways of thinking • Ways of managing emotions • Ways of relating to others • Ways of dealing with distress

23. Thinking Emotions Dealing with others Dealing with discomfort Stinkin’ thinkin’ Emotional binging (ex. self-pity) can precede substance binging Conflict / avoidance, resentments Alternatives to using to manage distress Dual Recovery domains

24. “Cluster A” Personality Disorders • Paranoid Personality Disorder • Schizoid Personality Disorder • Schizotypal Personality Disorder

25. Paranoid Personality Disorder (2.5%) • “a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent”

26. Schizoid Personality Disorder (<1%) • “a pattern of detachment from social relationships, and a restricted range of emotional expression”

27. Schizotypal Personality Disorder (3%) • “a pattern of acute discomfort in close relationships, as well as cognitive or perceptual distortions, and eccentricities of behavior”

28. “Cluster C” Personality Disorders • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

29. Avoidant Personality Disorder (<1%) • “a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation”

30. Dependent Personality Disorder (?%) • “a pattern of submissive and clinging behavior related to an excessive need to be taken care of”

31. Obsessive-Compulsive Personality Disorder (1%) • “a pattern of preoccupation with orderliness, perfectionism, and control”