Addiction and Personality Disorders

The Similarities Between Addictive Disorders and Personality Disorders

Addiction shares a lot of traits with numerous personality disorders, understanding some of these traits better could be very key to understanding what might keep you well and free from using or boozing.

Compassion needed

Before continuing it is important for me to state that personality disorders more than often stem from adverse childhood experiences that can be incredibly tragic. Personality disorders can be develop from inter-generational traumas (traumatic events in families that exist over 3 generations), childhood rape, assault, neglect and domestic abuse. There can also be organic personality disorders that can be caused by pathological disturbances in either genetic make-up or brain injury. Please approach this subject with an open mind. Some of the traits of personality disorder can be very self-centered and anti-social which in often why they are viewed in an unsympathetic way.

One analogy I like to share with many of those whom I work with, is that if you were to encounter someone drowning in a stream, you’d pull them out. Then if you were to see another person in the river, so you pull them out too, then another, then another…. eventually you’d have to start walking up stream to find out who’s pushing all these people in?

The Untreatable

There is a very sad aspect of mental health, especially the NHS in the UK, whereby treatment can be incredibly limited for those who have a mental health issues such as a personality disorder (unless under emergency conditions). Due to poorer outcomes and disruption in mental health units some NHS trusts no longer admit personality disorder cases.

Working with PD’s at Leeds Addiction Unit

In 2009, when I began my psychology of Addiction Studies at Leeds Addiction Unit, which was a part of Leeds University, I was introduced to some of their screening tools for mental health and addiction. They were some of the best in the country and giving a good indication for the care plan of the client/patient.

My course was largely made up of mental health workers and social workers, very few, in fact none were counselors. This degree was more for the building blocks of a clinical psychologist role, which I had my eyes on at the time.

Most of the others on the course were also from Leeds. They comprised of community mental health teams, drug services and psychiatric hospitals. During a break we began to talk about personality disorders and those whom we have encountered. It is important to state here that clinicians often talk about patients whom they have worked with but they never disclose specifics that could identify the person, we generally only talk in vague terms about the issues we’re facing or for some professional advice.

The others began to share how the new NHS policy was not to admit personality disorder patients. Dynamics such as splitting, anti-social behavior and narcissism were deemed to be having a very negative impact on the psych-ward communities. Instead the new policy moving forward was to see personality disorder clients in the community only and if there were any emergence situations the crisis team would be tasked to come and intervene on any self-harm, suicide or emergence delirium.

I wasn’t totally privy to the reasoning behind this decision making, I didn’t see all the facts and figures but I do know in 2009 the axe began to fall on a lot of mental health services in the UK. A lot of services were going into a crisis mode of saving because the looming Tory government, who generally remove these services from people, were casting a dark shadow over people’s mental-wellbeing.

In the UK the psychiatric services provided are often called the Cinderella services, not because someday a Prince will come or that it has a fairy godmother, but unfortunately it refers to first part of the story. That she is kept second best to everyone, mistreated and made to do all the work. Sadly only a couple of years ago even Leeds Addiction Unit, my school at Leeds, was shut due to the government pulling funding.

Well, before I digress any further. I found the attitude of some of my colleagues on the course a little shocking, they had a bit of jibing attitude to personality disorders. They were quite dismissive on how to treat PDs (personality disorders), one even commented that “you can’t treat someone with a personality disorder, you just have to wait for them to burn out.”

PD’s can be indeed very difficult to treat, patients often don’t continue with courses of therapy or medications. Anti-depressives often have very little effect on someone who has a personality disorder. CBT and Dialectic Behaviour Therapy can be very affective when dealing with personality disorders, however, a person really must have a lot of GRIT to continue with the therapy. (See article about using GRIT in CBT here: http://cbt-therapist.com/importance-grit/ )

Psychiatric Treatment Vs Rehab and Therapeutic Communities

In the UK, not too long ago, there were therapeutic communities (I believe there are still some but they’ve greatly reduced in number to almost non existent). These communities would use models of psychotherapy, such TA, CBT and gestalt therapy in an intensive therapeutic environment to help people make changes to their thinking and behaving.

The results for TC’s were very patchy, hence why most of them no longer exist. Certain therapies like gestalt, transactional analysis and person centered counseling don’t hold up well under in serious lab conditions for making long term changes in behaviour, thinking and mood for personality disorder patients.

The Psychiatric process in the UK for NHS is mostly about diagnosis and referral to treatment such as medication and therapy. Another factor in the UK is where you live, where I was from in Bromsgrove in the UK the psychiatric services were very weak, counselors were over-subscribed and you’d mostly like only be able to access psychiatric drugs from your GP.

Rehabs that work with personality disorders usually offer acute programs, ranging from 2 weeks to 6 months. However, a personality disorder is not an acute disorder, it is something that is long lasting and may remain with a person for most if not all their life – That is not to say it isn’t treatable. If it’s treated in an acute way then there must be some ongoing therapy, relapse prevention plan or aftercare support in order to achieve long term changes.

Similarities Between Addiction and Personality Disorders

It’s important to state that a lot of mental health disorders share similar traits with personality disorders, however one thing that makes it more unique is that treatment for addiction is very similar to treatment for personality disorders.

Alcoholics Anonymous was founded in 1935 by Bill W and Doctor Bob. One of the unique features of AA compared to a lot of other treatments for alcoholism of the time was that you continue to work on the characteristics that drove you to drink in the first place. In AA these are called “Character Defects” and “Shortcomings”. AA teaches people that they have list of traits that will come back unless they continue to work a program of recovery, it’s not just about refraining from drinking.

Over the years AA members have coined the term “dry drunk” and along with the term King Baby Syndrome – which is essentially an “Ego-maniac with vulnerability issues”, a narcissist.

Narcissism is a Cluster B Personality disorder, it is characterized by excessive self admiration, egocentricity and sense of grandiose. Although it can seem to some that a person is simply self-indulgent and sometimes even bad for want of a better word. Their personality may have been shaped by severe disruptions to a healthy development – such as, being the child of an alcoholic, growing up in poverty, neglect, bullying and being objectified in key developmental years.

Another example is Schizoid Personality disorder, schizoid personality is Cluster A personality disorder where by a person appears to be excessively shy and withdrawn, they find it hard to make eye contact and can have very pressured speech. Schizoid personality types can often suppress feelings of attachment, love and distain. Schizoids who bottle up emotions can sometimes act out very passive aggressively. Another trait of schizoid personality is substance abuse. Substance use disorder is very common in personality disorders, as they will find life very difficult to manage emotionally and the support is very weak for people who have a personality disorder.

People who have schizoid personality will often personify their substance of choice, they will sometimes give their choice substance a human name and often even refer to their drugs or drink as a friend.

Anti-social personality disorder is part of the Cluster B of personality disorders. Roughly around 90% of people who have an anti-social personality disorder will take drugs and drink on a regular basis. Anti-social personality disorder is also in lay-terms it’s what commonly referred to a being a psychopath by the general public.

Psychopaths

The term psychopath is not commonly used in the field of medicine anymore, there are more accurate ways of deeming disturbances in pathology of patients.

One key thing to understand is that most people whom we’d call psychopaths are not dangerous, people becoming dangerous actually make up a very small percentile of those with any pathological disturbances. The CEO or team leader of your company may very well be a psychopath. Although the typical image of a psychopath is some kind Norman Bates (Of the Psycho films) or Charles Manson character, the actual reality of anti-social behaviour personality disorder is someone who cannot think or consider other’s feelings or concerns.

In the business world this can be a helpful trait at times. For example someone might keep someone on who isn’t performing because they have a wife and kids because they don’t want to be responsible for their hardship. Someone with an anti-social personality disorder probably wouldn’t have that issue, they might manipulate the person into doing the wrong things, making their working situation impossible, or they might overtly directly cut the person down.

People with anti-social personality disorder generally have a very limited range of emotions, usually there is a complete lack of empathy.

Drug Addiction and Alcoholism

When a person is addicted to drugs they often display a lot of anti-social behaviors, when robotized by their addiction they are capable of incredibly narcissistic and anti-social deeds. Some people over the years have asked me “Am I a psychopath? I stole from my mother, I let everyone down, I lied all the time”…etc

The fact that anyone is able to ask themselves this question is a good starting point, when PDs are very active it is sometimes very hard for a person to see any of these traits active in themselves and they rarely question themself. Also if you are feeling guilt and remorse for things you’ve done then you’re probably not a psychopath….. yet.

So before we continue on this exploration of personality disorders sharing a lot of traits with addictive disorders, substance use disorder and alcohol use disorder let’s recap:

  • Personality disorders are difficult to treat because they are very robust and person needs the right motivation to treat them.
  • Addictive disorders share many traits of personality disorders and has been quite well documented over the last 80 years
  • Personality disorders often occur due to adverse childhood experiences
  • Addictive disorders often occur due to adverse childhood experiences

Personality Disorders are split up into 3 different clusters, A,B,C

  • Cluster A – Paranoid Personality (in state of anxiety and suspicion), Schizoid Personality (withdrawn, shy and emotionally shut down), Schizotypical (not to be confused with schizoid, but this personality type is focused on strange and magical thinking, those who possess this trait seem to be very extroverted in dress and have trouble fitting in)
  • Cluster B – Histrionic Personality (attention seeking, needing external affirmation and provocative), Borderline (manipulative, impulsive and self harming), Anti-social (emotionally shut down, lacks empathy, self interested), Narcissistic (self interested, grandiose, excessive self-admiration).
  • Cluster C – Avoidant (overly serious, withdrawn and fears criticism), Dependent (Clingy, indecisive, obsessive), Obsessive and Compulsive (very rigid, perfectionist and passive aggressive)

You may look at the different clusters above and feel that maybe you belong in one or more clusters, this is perfectly normal, we will all go in and out of these kinds of traits depending on what is happening for us both internally and externally. However, it’s when it becomes a constant problem, say for instance if it constantly reappears in your life or you feel crushed and suicidal over a facebook comment about how you appear to look. Then there might be a consideration.

Please do not use the above information to diagnose yourself, you should be careful about pigeon-holing yourself. “Labelling” yourself is after all a cognitive distortion. Always speak to a professional before making any assumptions about yourself.

I don’t believe I’ve met a single addict or alcoholic who hasn’t one or more of the traits listed in the three clusters. It’s not my position to diagnose people with personality disorders but it can be useful in careplanning and counseling to know where a person is.

In addiction treatment it is important to recognize that some of the pathology is to do with a biological effect from the drugs. For instance, one example of this is a heroin user who has run out of drugs or is going to run out of drugs. They will do almost anything to get that drug and avoid the withdrawal symptoms, which are: Immense sweating, sickness, diarrhea, shaking, cramps and pain all over the body. Symptoms are so dire a person would step over a loved one to get hold of something to kill off that feeling.

During my time in London working with a lot of chaotic street drug users , I did see on a few occasions someone wildly dart out of a hostel in an incredibly animated way, despite leg injuries or a usual slow demeanor. The call of the smack was just too great to leave ringing. I’ve also seen people jump over fences in treatment as fast lightning to get hold of something. This confirms how mind altering drugs can be when you’re on the hook, the brain becomes hard-wired to get hold of drugs.

There is little point of trying to diagnose someone with a personality disorder within the first 30 days of becoming drug and alcohol free.

If you are using drugs or alcohol regularly there may be quite a personality shift when you cease to use those drugs or booze. However, there may be a case for seriously working on your personality.

The onset of addiction can leave a person very out of touch with their emotions. A person can become very emotionally flat, or frozen. Drugs of addiction by their very nature work mostly on the reptilian brain, drawing chemical energy to the VTA. With reduction and withdrawal of drugs a person may become much less emotionally frozen.

One of the most difficult things about coping with a personality disorder is suffering through periods of emotional distress, anxiety, mood swings and behaviour that may isolate you from others.

-Written By Dylan Kerr 2019

Comment on what you think:

I’d like you to take time to comment on what you think about this idea of how addiction and personality disorder traits over-lap, do you think there is a real overlap? Is there something we’re not seeing in the addiction field? Are drugs and booze just the medication for a complex personality disorder?

1 Comment

  1. I’m sad there’s so much stigma around PDs. I’ve AVPD from complex trauma and sometimes feel it means my very personality and character is disordered. Despite there being therapies (eg, schema therapy) with good effectiveness for PDs, it can be hard to find a practitioner.

    Like

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