Personality Disorder

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What Is a Personality Disorder?

By The Fix staff 01/21/15

Symptoms of Personality Disorders That Co-Exist With Addiction

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Personality Disorders

Characterized by persistent maladaptive cognitive, emotive and behavior patterns that deviate conspicuously from behavioral norms within a specific society, personality disorders develop early in childhood, are markedly inflexible, and typically cause extreme disability or distress in the person's life. In psychotherapy terms, those diagnosed with a personality disorder are suffering from ego-syntonic behavior patterns that are profoundly rooted in the person's ego integrity, which helps to explain why people with personality disorders often see nothing wrong or maladaptive about their behavior.

Because they lack effective coping skills, act impulsively and irrationally, tend to be self-centered and have severe deficits in empathy and futuristic thinking, people with personality disorders typically suffer severe depression and anxiety throughout their turbulent lives, which often leads to self-medicating these mental disorders with addictive substances.

Personality Disorders Types

The DSM-V lists 10 different personality disorders that are classified as "Cluster A" or "Cluster B" or "Cluster C" personality disorders. Cluster A includes personality disorders characterized by eccentric, paranoid and generally odd behavior and/or thinking. Paranoid, schizotypal and schizoid personality disorders fall under the Cluster A category and may be disabling enough to warrant placing the person affected in a structured environment, such as a group or halfway home.

Personality disorders listed as Cluster B disorders are more commonly diagnosed than Cluster A disorders and are typified by unpredictable, irrationally emotional and selfish behavior/thinking patterns. However, Cluster B — narcissistic, antisocial, histrionic and borderline personality disorders — are more difficult to treat and do not respond as well to medications as Cluster A disorders do. This is because the development of Cluster B disorders is primarily the result of environmental/social factors shaping the patient's childhood, while Cluster A personality disorders are thought to arise from the interplay of genetics and abnormal neurotransmitter levels in the brain.

Cluster C personality disorders are characterized by fear, anxiety, panic and rigidity. They include the obsessive-compulsive, dependent and avoidant disorders that, like Cluster A personality disorders, are thought to be the result of the interaction between genetics and brain chemistry.

Cluster A personality disorders share the following characteristics:

  • Uncomfortable in social situations/goes out of way to avoid them
  • Exhibits odd appearance (strange haircut, unkempt/mismatched clothes)
  • Has no friends other than acquaintances
  • Holds odd beliefs that have little to no basis in reality
  • Overly suspicious of strangers and even acquaintances
  • Hypersensitive, hostile and argumentative about their odd beliefs

Cluster B personality disorders share the following characteristics:

  • Persistent lying and violating the rights of others to get what they want
  • Lack of empathy for others
  • Recurring run-ins with law enforcement
  • Acting aggressively and belligerently for no reason
  • Lack of impulse control in regard to making rational decisions
  • Inability to take responsibility for the consequences of bad decisions and behaviors
  • Intensely afraid of being alone or abandoned, although their behavior constantly pushes people away

Cluster C personality disorders share the following characteristics:

  • Fearful, anxious thought patterns (Cluster C people may be erroneously diagnosed with generalized anxiety disorder early in treatment)
  • Overly sensitive to rejection, criticism or playful teasing
  • Low self-esteem (feelings of inferiority and inadequacy compared to others)
  • Avoid meeting new people, doing new things or taking small risks; fear of embarrassment, disapproval or ridicule may develop into agoraphobia if left untreated
  • Excessively dependent on others; exhibit helpless, "clingy" behavior, especially around boyfriends/girlfriends and close family members
  • Preoccupied with maintaining control, orderliness, rules and "being perfect"; this is especially noticeable in people with obsessive-compulsive personality disorder

Who Is at Risk for Developing a Personality Disorder?

The precise etiology of personality disorders has not been established, but it is generally accepted by mental health professionals that specific factors shaping an individual's childhood are strongly linked to personality disorders. These factors include but are not limited to:

  • Having family members with mental illnesses or personality disorders.
  • Being verbally, sexually and/or physically abused.
  • Failing to graduate high school.
  • Having lower economic/social status.
  • Living in an unstable, chaotic family environment.
  • Exhibiting conduct disorder behaviors as a child and adolescent.
  • Being neglected, bullied or subjected to trauma.

It is interesting to note that some personality disorders disproportionately affect one gender over the other. For example, nearly 90 percent of antisocial personality disorder diagnoses are given to men while 78 percent of borderline personality disorder cases happen to women. Overall, more women than men are diagnosed with a personality disorder at some point in their lives.

Personality Disorders and Addiction

Substance addiction is diagnosed in approximately 50 percent of those suffering from a personality disorder. However, drug abusers are diagnosed with personality disorders more often than alcoholics, with antisocial, narcissistic, dependent and borderline personality disorders being the most frequent type of comorbid diagnoses given to both alcohol and drug addicts.

A personality disorder usually exists before the addiction. Once individuals discover that drugs and/or alcohol provide a numbing escape from the loneliness, inner emotional conflicts and feelings of worthlessness they feel, addiction begins quite effortlessly. Moreover, an addiction to drugs or alcohol means that individuals must start associating with people who encourage their addiction, such as dealers, bartenders and people who know where to get drugs and drug paraphernalia, an action that worsens their addiction as well as their personality disorder.

The Addictive Personality

Sensation-seeking or risk-taking behaviors are Sensation seeking has been studied as having a strong relationship with addictive personalities.[7] This sensation seeking trait may be a result an overactive ">strongly correlated with addictive personalities. Psychologists think that this sensation-seeking character trait is the result of an aggressive "approach system" intrinsic to individuals who deliberately seek out and experience extreme external stimuli to offset their inability to feel internally aroused.

Possible signs and symptoms of an addictive personality are:

  • Impulsivity/lack of foreseeing consequences of questionable actions
  • Emotionally unstable and moody, yet unaware of their extreme moodiness
  • Valuing nonconformity over socially valued achievements
  • Feeling alienated from society/feeling depersonalized or disassociated from reality
  • Lacking adequate coping skills necessary to deal with daily stress
  • Seeing things in only "black and white" (a thinking disorder involving cognitive distortions and self-centered thinking patterns)
  • Claiming to have a variety of health problems, despite never seeing a doctor

Biopsychosocial Causes of the Addictive Personality

Genetics

Studies with twins have found that both twins, regardless of whether they were raised together or separately, have a 50 to 70 percent of developing an addiction if one twin develops an addiction. For example, if one twin becomes addicted to cocaine, the other twin has a high chance of developing an addiction to cocaine or another substance.

Brain Chemistry

Neurotransmitter imbalances involving dopamine, serotonin and norepinephrine are also thought to play an active role in the development of addictive personalities. In fact, the American Society of Addiction Medicine recently redefined addiction as a chronic brain disorder and not a behavioral issue. According to the ASAM's previous president, Dr. Michael Miller, "Addiction is not a moral, social or criminal problem. It is a brain problem that causes behavioral manifestations in other areas. This disease — addiction — is about the brain, not drugs."

Environmental Factors

Addictive personality genes inherited by a potential addict are thought to remain dormant until strong environmental stressors "trigger" the genes' ability to influence the person's behavior. Contemporaneous with the stress-diathesis model, which asserts that a "biological vulnerability can be instantiated by a stressful event," the gene-supported addictive personality may never emerge unless some kind of trauma (especially childhood physical, emotional or sexual abuse) essentially releases the detrimental effect of these genes.

Personality Disorder Tests and Diagnostic Criteria

The DSM-V states that the following criteria must be met before a psychiatrist can diagnose a personality disorder:

  • Significant impairments in self-identity and interpersonal functioning
  • Impairments in personality functioning and the individual's personality trait expressions that are relatively stable across time and consistent across situations
  • Impairments in personality functioning and the individual's personality trait expressions that are not better understood as normative for individual's development stage or sociocultural environment
  • Impairments in personality functioning and the individual's personality trait expressions that are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)

An example of a standardized test used to help diagnose a personality disorder is the Narcissistic Personality Inventory, a widely used determinant of narcissism in psychological research. Developed by Raskin & Terry in 1988, the NPI is a self-reporting question-and-answer survey that is given to people suspected of having a narcissistic personality. People who score in the higher percentiles of this "test" are more likely to value money and material things above all else, be obsessed with how they appear to others, cheat and swindle others to further their goals, and seize resources for themselves when few resources exist for others.

Another well-known psychological test designed to assess personality traits and the existence of personality disorders is the Minnesota Multiphasic Personality Inventory (MMPI), a protected tool that can only be administered by trained psychologists. It contains a variety of scales that measure personality traits involving the hypochondrias, depression, hysteria, paranoia, obsessive-compulsive tendencies (psychasthenia), and social introversion.

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