Personality Disorders

Individuals with personality disorders commonly suffer from a co-occurring substance use disorder. Finding an accredited rehab program that treats both disorders at the same time is the first step toward improved mental health and long-term recovery from addiction.

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A personality disorder is a mental health disorder that affects an individual’s perception of and response to the world. It results in a long-lasting pattern of unusual or dangerous behaviors that deviate from cultural norms.

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People with personality disorders exhibit high rates of addiction. A 2014 study published in the journal Co-occurring Addictive and Psychiatric Disorders stated that approximately every other patient diagnosed with a personality disorder is also diagnosed with addiction. Research shows that 50 to 70 percent of those with borderline personality disorder have a co-occurring substance use disorder.

Substance use disorder is especially prevalent among those with antisocial, narcissistic, dependent and borderline personality disorders.

The onset of personality disorders typically begins during adolescence or early adulthood. When personality disorder and addiction co-occur, the personality disorder is generally diagnosed first because people often use drugs or alcohol to treat the symptoms of their mental health condition. In some cases, the addiction is diagnosed before the personality disorder.

Over time, self-medicating to treat symptoms of a personality disorder can lead to addiction. Once an addiction develops and drug abuse worsens, the severity of an individual’s personality disorder can also increase.

Types of Personality Disorders

Mental health experts divide personality disorders into three groups of called clusters. Each cluster contains a group of disorders characterized by similar behaviors.

Cluster A

People with cluster A personality disorders display odd and eccentric behaviors.

Disorders include:
  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Cluster B

People with cluster B personality disorders display dramatic, erratic and emotional behaviors.

Disorders include:
  • Antisocial personality disorder
  • Borderline personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder

Cluster C

People with cluster C personality disorders display anxious and fearful behaviors.

Disorders include:
  • Avoidant personality disorder
  • Dependent personality disorder
  • Obsessive-compulsive personality disorder

Cluster B personality disorders are the most commonly diagnosed type. People with cluster B disorders, especially those with borderline personality disorder or antisocial personality disorder, also come into contact with law enforcement more often than those with cluster A and C disorders.

People can exhibit symptoms of multiple personality disorders at once. In fact, people commonly display symptoms of multiple personality disorders from the same cluster.

Some people display symptoms that meet the criteria for a personality disorder but do not fall under the criteria of any specific disorder. These people may have what is called an unspecified personality disorder or a personality disorder not otherwise specified.

Symptoms of Personality Disorders by Cluster

Knowing the symptoms of co-occurring personality disorders can help you or a loved one determine that an undiagnosed mental health disorder may be present.

Cluster A symptoms:
  • Widespread distrust of others
  • Hostile reactions to insults or perceived slights
  • Lack of interest in personal or social relationships
  • Failure to pick up on social cues
  • Peculiar thoughts, beliefs, dress or behavior
  • Lack of emotions or inappropriate emotional responses
Cluster B symptoms:
  • Habitual lying
  • Taking advantage of others
  • Repeated trouble with law enforcement
  • Aggressiveness
  • Acting belligerently
  • Inability to accept responsibility for actions
Cluster C symptoms:
  • Overly sensitive to rejection or criticism
  • Low self-esteem
  • Fear of embarrassment or disapproval
  • Excessive dependence on others
  • Desire to control people and situations
  • Extreme perfectionism that creates distress

People displaying symptoms that occur repeatedly and cause significant functional impairment or distress should visit a mental health expert for an evaluation prior to starting addiction treatment. Those with an undiagnosed or untreated personality disorder are much less likely to maintain sobriety after addiction treatment.

Treatment That Addresses Both Disorders Is Key to Recovery

Treating co-occurring personality and substance use disorders can be a complicated process. Making an accurate diagnosis is often difficult because of the complexity of the disorders and the relationship between them. Multiple symptoms of personality disorders overlap with those of drug addiction, and one disorder can remain undetected in some cases.

Research shows that 50 to 70 percent of those with borderline personality disorder have a co-occurring disorder.

Seeking help from a qualified treatment professional is the first step toward successful recovery. It is important to find doctors who have experience treating people with personality disorders and co-occurring addiction. Research shows that the most effective approach is to treat both disorders at the same time.

Treatment for people with both disorders may involve multiple specialists who work together as a team. Team members may include a primary care provider, a group or individual therapist, a psychiatrist and a substance abuse counselor.

Experts on the treatment team require special skills to effectively connect with people who have co-occurring mental health disorders. Addiction treatment dropout rates are high among people with personality disorders. Patients often end treatment because of a strained or failed relationship with their therapist.

Research on borderline personality disorder and addiction shows that dual diagnosis treatment programs can provide support and effective management that improves patient outcomes and motivates them to continue treatment.

People diagnosed with these disorders often resist treatment. They are far more likely to end treatment early than those without a personality disorder. The combination of appropriate treatment and therapy groups such as Alcoholics Anonymous and Narcotics Anonymous can help motivate people to stay in treatment.

Seeking help for a co-occurring disorder?We have programs designed specifically for you.

Treatment for Patients with Co-Occurring Personality and Substance Use Disorders

Studies suggest that the most promising treatment methods for co-occurring disorders include dialectical behavior therapy, cognitive behavioral therapy and a dynamic psychology approach.

Effective dual recovery treatment programs combine inpatient and outpatient addiction treatment with treatments and therapies that address the recovering individual’s personality disorder. Therapy educates patients about addiction and the problems that arise from self-medicating with drugs or alcohol.

Leading treatment facilities focus on building a strong relationship between therapists and patients, which provides patients with stability and trust in times of emotional distress.

Families of individuals facing addiction and a personality disorder can help by working with their loved one during treatment to help repair damaged relationships. Treatment professionals can help by providing an environment where the patient’s family and loved ones can learn the skills needed to improve relationships and provide continued support throughout recovery.

Preventing Relapse After Co-Occurring Disorder Treatment

The chance of relapse among people with co-occurring disorders is high. A relapse can cause individuals to fall back into harmful situations and patterns of behavior.

The risk of suicide among people with co-occurring personality and substance use disorders is also high. These individuals may view suicide or self-harm as an outlet to deal with difficult emotions.

Continuing treatment after initially achieving sobriety is incredibly important for avoiding these types of risks.

Group therapy, 12-step meetings and online support communities can greatly benefit people who need help continuing their recovery after completing treatment. Families can also turn to support groups such as Al-Anon for additional resources.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Trey Dyer
Content Writer,
Trey Dyer is a writer for and an advocate for substance abuse treatment. Trey is passionate about sharing his knowledge and tales about his own family’s struggle with drug addiction to help others overcome the challenges that face substance dependent individuals and their families. Trey has a degree in journalism from American University and has been writing professionally since 2011.

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