Personality Disorders and Alcohol

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.