Download Personality Disorders and Substance Use Disorders

Personality Disorders
and
Substance Use Disorders
“What’s the connection?”
1
What is a Personality
Disorder?

2
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.”
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.
3
Reframing the “problem” of
Personality Disorders

4
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)
Reframing the “problem” of
Personality Disorders

5
However, those
old coping
mechanisms
tend not to work
very well in
adulthood, and
have become
ineffective, or
MALADAPTIVE.
What are the different types
of personality disorders?

Cluster A




Cluster B





Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Cluster C


6
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
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
7
Personality Disorders and
Addiction

8
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.
Personality Disorders and
Addiction

9
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
Personality Disorders and
Addiction

10
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)
Personality Disorders and
Addiction

11
Impaired ability
to learn from
previous
experience

“Doing the
same thing over
and over again,
and expecting a
different result”
description of
addictive
“insanity”
“Cluster B”
Personality Disorders
 Antisocial
Personality Disorder
 Borderline
 Histrionic
Personality Disorder
Personality Disorder
 Narcissistic
12
Personality Disorder
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”
13
Antisocial Personality
Disorder – 3 or more traits
1.
Failure to conform to social norms re:
lawful behavior as in repeatedly
performing acts that are grounds for
arrest
2.
Deceitfulness, as in repeated lying, using
aliases, or conning others
3.
Impulsivity or failure to plan ahead
14
Antisocial Personality
Disorder – 3 or more traits
4.
Irritability and aggressiveness, as in
repeated assaults or fighting
5.
Reckless disregard for safety of self or
others
6.
Consistent irresponsibility, as in repeated
failure to maintain employment, or to
honor $ obligations
7.
Lack of remorse re: mistreating others
15
Borderline Personality
Disorder (2%)

“a pattern of
instability in
interpersonal
relationships, selfimage”

30-60% of persons
diagnosed with
personality
disorders end up
with this diagnosis
16
Borderline Personality
Disorder – 5 or more traits
1.
Frantic efforts to avoid abandonment
2.
Pattern of unstable/intense
relationships
3.
Unstable self-image, sense of self
4.
Impulsivity that is potentially selfharmful
5.
Recurrent suicidal behavior, gestures,
threats, or self-mutilating behavior
17
Borderline Personality
Disorder – 5 or more traits
6.
Emotional instability, over-reactivity
7.
Chronic feelings of emptiness
8.
Inappropriate, intense anger or anger
control problems
9.
Transient, stress-related paranoid
ideation or severe dissociative
symptoms
18
Histrionic Personality
Disorder (2-3%)

19
“a pattern of
excessive
emotionality
and attention
seeking”
Narcissistic Personality
Disorder (<1%)

20
“a pattern of
grandiosity,
need for
admiration,
and lack of
empathy”
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
21
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
22
Dual Recovery domains


Thinking
Emotions

Dealing with others


Dealing with
discomfort


23

Stinkin’ thinkin’
Emotional binging
(ex. self-pity) can
precede substance
binging
Conflict / avoidance,
resentments
Alternatives to using
to manage distress
“Cluster A”
Personality Disorders
 Paranoid
 Schizoid
Personality Disorder
Personality Disorder
 Schizotypal
Disorder
24
Personality
Paranoid Personality
Disorder (2.5%)

25
“a pattern of
distrust and
suspiciousness
such that
others’ motives
are interpreted
as malevolent”
Schizoid Personality
Disorder (<1%)

26
“a pattern of
detachment
from social
relationships,
and a restricted
range of
emotional
expression”
Schizotypal Personality
Disorder (3%)

27
“a pattern of acute
discomfort in close
relationships, as
well as cognitive or
perceptual
distortions, and
eccentricities of
behavior”
“Cluster C”
Personality Disorders
 Avoidant
Personality Disorder
 Dependent
Personality Disorder
 Obsessive-Compulsive
Personality Disorder
28
Avoidant Personality
Disorder (<1%)

29
“a pattern of
social inhibition,
feelings of
inadequacy,
and
hypersensitivity
to negative
evaluation”
Dependent Personality
Disorder (?%)

30
“a pattern of
submissive and
clinging
behavior
related to an
excessive need
to be taken
care of”
Obsessive-Compulsive
Personality Disorder (1%)

31
“a pattern of
preoccupation
with
orderliness,
perfectionism,
and control”