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Personality Disorders and Alcohol

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As with any mental health disorder, it can be challenging to function in everyday life. People may have trouble balancing emotional regulation and lack the motivation to complete daily tasks such as going to work or maintaining personal hygiene skills. Conflicts often occur in relationships, and maintaining a job or feeling financially stable can be challenging. People with mental health disorders often seek out alcohol as a way to numb and avoid the struggles they are experiencing. 

Unfortunately, alcohol exacerbates negative symptoms and enhances the disturbances brought on by mental health disorders. Let’s learn more about Personality Disorders, the relationship between alcohol use and mental health, and how we can find adaptive ways to heal

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What Are Personality Disorders?

Personality Disorders are a group of mental health conditions that include enduring and unchanging patterns of behaviors such as rigid thinking, emotionally labile reactions, unpredictable or impulsive behavior, and disruptive relationships. 

Personality Disorders are not diagnosed until a person is at least 18 years of age. The reasoning is that one’s personality continues to change throughout childhood and adolescence.  It can be challenging to identify if a person may have a Personality Disorder. One way to determine it is by looking at how behavior deviates from cultural norms; the behavior causes distress and lasts over time (1). 

It is estimated that 9% of U.S. adults have at least 1 Personality Disorder (1). 

According to the DSM-5-TR, there are currently 10 different types of Personality Disorders; however, Borderline Personality Disorder, Antisocial Personality Disorder, and Narcissistic Personality Disorder are commonly associated with alcohol-use disorder. 

10 Types of Personality Disorders (1): 

  • Antisocial Personality Disorder.
  • Avoidant Personality Disorder.
  • Borderline Personality Disorder.
  • Dependent Personality Disorder.
  • Histrionic Personality Disorder.
  • Narcissistic Personality Disorder.
  • Obsessive-Compulsive Personality Disorder.
  • Paranoid Personality Disorder.
  • Schizoid Personality Disorder.
  • Schizotypal Personality Disorder. 

Effects of Alcohol on Personality Disorders

The prevalence of alcohol-use disorder and comorbidity with Personality Disorders ranges from 22-40% and is as high as 58-78% (2). 

The concern with alcohol use and Personality Disorder is that it can increase the negative symptoms associated with mental illness. 

Alcohol increases emotional instability, impulsivity, depressive symptoms, aggression, and risk-taking behavior. These factors, added to the challenges one may already have with a Personality Disorder, put the individual and others at significant risk of harm. 

Many researchers are currently examining the causation of alcohol use and Personality Disorders. The question is whether alcohol-use disorder leads to Personality Disorder or Personality Disorder leads to alcohol-use disorder. It is challenging to know causality as there is an intertwining of symptoms; they both occur during the same stage of late adolescence-early adulthood, and perhaps both disorders may have similar genetic predispositions. 

In addition, the symptoms associated with Personality Disorders have also been identified in individuals with alcohol-use disorder. The specific symptoms identified were impulsivity, neuroticism, and sensation-seeking traits (3). 

Many times an alcohol-use disorder may go undiagnosed because the focus is typically on the person’s mental health and the symptoms of Personality Disorder rather than the behavior associated with alcohol use. 

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Borderline Personality Disorder and Alcohol

Borderline Personality Disorder (BPD) is when a person exhibits emotionally volatile outbursts, may show impulsive behavior, engages in self-harm and suicidal ideation, and can have challenges with interpersonal skills. In addition to the emotional highs and lows, a person with BPD may show reckless or self-destructive behaviors. 

Recent reviews have indicated that for individuals who met diagnostic criteria for BPD, 46% to 49% also met diagnostic criteria for current alcohol-use disorder, and 59% met diagnostic criteria for lifetime alcohol-use disorder (4). 

Treatment

Due to the complexity of dual diagnosis, individualized treatment must focus on alcohol-use disorder (AUD) and Borderline Personality Disorder. 

Treatment Approaches for AUD & BPD: 

  • A thorough assessment of mental health and alcohol/substance use disorder.
  • Medical detoxification.
  • Evidence-based mental health therapies such as DBT and EMDR.
  • Holistic treatment focuses on physical, mental, emotional, spiritual, and social factors.

Antisocial Personality Disorder and Alcohol

Antisocial Personality Disorder (ASPD) is known for symptoms that show a complete disregard for other people. People with ASPD engage in aggression and violence, may engage in behaviors that break the law, and show no regard for the safety of themselves or others. 

The prevalence of alcohol-use disorder and people with ASPD was 68% (4). 

ASPD and alcohol use can be a dangerous combination. Due to the severity of symptoms, people who use alcohol are at higher risk of engaging in criminal acts such as physical acts of destruction, sexual assault, child abuse, and homicide.

Research indicates that a person with Antisocial Personality Disorder is 21 times more likely to develop alcohol dependence. 

Treatment 

Because of the inherent safety concerns of the individual with ASPD, treatment will need to be at a higher level of care, such as residential inpatient treatment. Like BPD, the focus of treatment should be on both alcohol use and Personality Disorder. 

Treatment Approaches for AUD & ASPD:

  • A thorough assessment of mental health and alcohol/substance use disorder.
  • Medical detoxification.
  • Residential inpatient treatment. 
  • Holistic treatment focuses on physical, mental, emotional, spiritual, and social factors.

Narcissistic Personality Disorder and Alcohol

Narcissistic Personality Disorder is a mental health disorder that primarily consists of the person having a highly inflated sense of self-importance. Symptoms include an excessive need for admiration, disregard for others’ feelings, instability when faced with criticism, and an overblown sense of entitlement. 

Alcohol may become problematic for a person with Narcissistic Personality Disorder because it may increase feelings of entitlement, hostility, and lack of empathy toward others. 

Treatment

The challenge with treatment is helping an individual recognize the need and importance of therapy. A person with Narcissistic Personality Disorder may have trouble admitting they need help and struggle trusting others to help during moments of vulnerability. 

Treatment Approaches for AUD & NPD: 

  • A thorough assessment of mental health and alcohol/substance use disorder.
  • Medical detoxification.
  • Evidence-based mental health therapies such as DBT and EMDR.
  • A focus on empathy and vulnerability in therapy
  • Holistic treatment focuses on physical, mental, emotional, spiritual, and social factors.

Can Personality Disorders Lead to Alcohol Abuse

As mentioned earlier, it is unclear whether Personality Disorders lead to alcohol abuse. It is believed that many people diagnosed with a personality disorder often have experienced complex trauma in childhood and adolescence. 

When trauma patterns emerge, maladaptive coping skills develop to cope with trauma. Examples of maladaptive coping skills include substance and alcohol abuse, emotional instability, poor interpersonal skills, and impulsive and self-sabotaging behaviors. 

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Co-Occurring Alcohol Abuse and Personality Disorders Treatment

The goal of healing is to address the person as a whole. Examples include completing a thorough evaluation of one’s history, mental health, substance use, childhood, and current/past relationships. Finally, taking a holistic approach to treating a person’s physical, mental, emotional, spiritual, and social well-being. 

Treatment for a dual diagnosis of alcohol-use disorder and personality disorder can result in positive outcomes if both conditions are treated simultaneously. If you or someone you know is struggling with alcohol dependence and a personality disorder, we can help. Licensed professionals at Guardian Recovery can assist you in choosing an effective treatment protocol for your alcohol use and mental health disorder. Reach out today for more information and for a free, no obligation health insurance benefit check.

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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

  1. https://psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
  2. https://pubmed.ncbi.nlm.nih.gov/20952746/
  3. https://arcr.niaaa.nih.gov/alcohol-use-disorder-and-co-occurring-mental-health-conditions/alcohol-use-disorder-and-antisocial-personality-disorder?_gl=1%2A1vajx3i%2A_ga%2AODg0Mjg3Mjg1LjE2NjA2OTE3NDM.%2A_ga_E2D8B2PVE9%2AMTY2NTEwMjI2Ni41LjAuMTY2NTEwMjI3MC4wLjAuMA..
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927749

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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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