Finding Stability With Personality Disorder Treatment at Forward Motion Health

What Is a Personality Disorder?

A personality disorder is a long-standing pattern of thinking, feeling, and behaving that deviates markedly from what is culturally expected and causes distress or impairment in daily life.[1] 

One distinguishing feature of personality disorders is that they involve persistent and inflexible personality traits and behavior patterns that remain relatively stable over time, rather than occurring only during discrete episodes.[2] These patterns often become apparent in late adolescence to early adulthood and dictate how a person perceives and experiences relationships, self-image, emotions, and the world around them.

There are ten officially recognized personality disorders in the DSM-5, grouped into three clusters based on shared characteristics and symptoms.[3] 

• Cluster A: This cluster involves unusual or eccentric thinking, and includes paranoid, schizoid, and schizotypal personality disorders. 
• Cluster B: This cluster is characterized by dramatic, emotional, or erratic behavior, and includes antisocial, narcissistic, histrionic, and borderline personality disorders. 
• Cluster C: This cluster is characterized by anxious and fearful behavior, and includes avoidant, dependent, and obsessive-compulsive personality disorders. 

Borderline personality disorder (BPD) is the most common Cluster B condition we treat in the context of substance use, and it’s where much evidence-based therapy development has happened in recent decades. 

Whatever personality disorder someone is struggling with, it does not mean these traits cannot change. When given the right treatment using dialectical behavior therapy (DBT) and other evidence-based methods, many people will experience positive changes and some may see significant improvement.

What Causes Personality Disorders?

Personality disorders result from both genetic predisposition and environmental influences. The research indicates that:

• Genetics — There is a strong heritable component for several personality disorders, specifically borderline, antisocial, and schizotypal.[4]
• Childhood trauma and adversity — This includes physical or sexual abuse, neglect, inconsistent or unpredictable parenting, and chronic invalidation. Chronic invalidation is very strongly linked to the development of borderline personality disorder and other Cluster B conditions; childhood trauma and adversity also appears to contribute to the development of Cluster C disorders.[5]
• Attachment disruptions — Early relationships that did not provide adequate emotional security appear to contribute to ongoing relationship difficulties and negative attachment patterns.[6]
• Brain chemistry and function — There are observable differences in brain regions involved in emotion regulation, threat processing, and impulse control between people with certain personality disorders.[7]
• Temperament — Innate tendencies toward emotional sensitivity, impulsivity, or low reactivity can influence the interaction between environment and personality development resulting in a higher likelihood of developing a personality disorder.[8]

These conditions are not anyone’s fault. Personality disorders are a set of enduring patterns of thought and behavior influenced by genetics and past experiences, and these patterns can be changed with proper treatment.

Common Personality Disorders

Several personality disorders consistently present in treatment programs for substance use. Below are the most common:

• Borderline Personality Disorder (BPD): Characterized by intense fear of abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, emotional dysregulation, self-destructive behavior, feelings of emptiness, and suicidal and self-harming behaviors.
• Narcissistic Personality Disorder (NPD): Characterized by a grandiose sense of self-worth, need for admiration, lack of empathy, and difficulty accepting criticism or rejection.
• Antisocial Personality Disorder (ASPD): Characterized by disregard for others’ rights or legal boundaries, impulsivity, deception, and difficulty conforming to social norms
• Avoidant Personality Disorder: Chronic feelings of inadequacy, fear of rejection or criticism, social inhibition.
• Dependent Personality Disorder: Excessive need for care and nurturing, reluctance to make decisions without direction from someone else, fear of being alone.

Each requires a slightly different therapeutic approach, but several core principles apply across all of them — particularly the importance of skilled, evidence-based therapy and a clinical team trained in working with these conditions.

More About Borderline Personality Disorder

Because BPD is seen very frequently in addiction treatment settings, it deserves special focus. 

Some of the typical symptoms of BPD are:

• Intense fear of abandonment — An overreaction to any situation where they feel rejected, which leads to their typical relationship patterns.
• Unpredictable relationships — A back-and-forth pattern of idealization and devaluation of another person. Relationships tend to be extremely intense and emotionally turbulent.
• Identity problems — An unstable sense of self and unclear goals or self-image.
• Impulsiveness — excessive spending, substance use, sexual promiscuity, binge eating, reckless driving, in many aspects of life.
• Emotional dysregulation — Intense and rapidly shifting swings in emotions that last for hours.
• Self-harm and suicide attempts — Including cutting, burning, or recurring thoughts of self-harm or suicide.
• Chronic feelings of emptiness — A continuous feeling of internal emptiness
• Difficulty regulating anger — Intense, inappropriate anger or difficulty managing it
• Stress-induced paranoia or dissociation — Temporary periods of paranoia or detachment from reality during extreme emotional distress.

Each symptom is incredibly tiring for the person who experiences it and the people who care for them. Each is also highly responsive to evidence-based borderline personality disorder treatment, which may include psychotherapy, medication management, and sessions specifically to help develop coping skills that can be utilized after treatment ends.

Personality Disorders and Addiction

There is a high frequency of co-occurrence between personality disorders and substance use disorder. 

Studies indicate that at least 50% of clients entering addiction treatment programs qualify for at least one personality disorder, with BPD as the most common in this population.[9] 

There is strong interconnection between these two factors: the emotional extremes and impulsivity associated with BPD provide powerful motivation for people to engage in drug or alcohol use as a means of numbing their emotional pain, regulating their emotions, or escaping their internal distress. Narcissistic and antisocial presentations can lead to substance use, including a perceived sense of invincibility or risk-taking. In contrast, people with avoidant or dependent personalities tend to engage in substance use to alleviate their social anxiety or relationship difficulties.

Substance use worsens virtually all elements of personality disorder pathology — poor emotional regulation, increased impulsive behavior, and additional damage to relationships.[10] Treating either the substance use disorder or the personality disorder in isolation typically does not produce long-term recovery. The standard of care for patients presenting with both diagnoses is integrated dual diagnosis treatment, and clinicians trained in both areas are critical components of treatment teams.[11]

When to Get Help With a Personality Disorder

Consider seeking professional help if you or someone you know is experiencing:

• Long-standing patterns of intense or unstable relationships
• Significant emotional dysregulation or rapid shifts in mood
• Impulsive or self-destructive behaviors including substance use
• Self-harm, suicidal ideation, or recurring crisis patterns
• Chronic feelings of emptiness, identity confusion, or low self-esteem
• Substance use that has become linked to the above patterns

If you or a loved one is experiencing suicidal ideation or engaging in self-harm, contact the 988 Suicide and Crisis Lifeline or emergency services immediately.