Personality Disorder

People may use, misuse, or abuse substances for a number of reasons. Some possible reasons are the influences of peers, family problems, and the availability of substances in the community. For certain people, personality problems are just as important as these social influences. This article provides information on personality traits and disorders that are often seen in substance abusers.

Personality traits are the stable ways people have of thinking, feeling, perceiving, and relating to others. The social environment does shape personality traits to some extent, but people are also born different in the degree to which they are sociable, emotional, agreeable, impulsive, active, and so on.

Research does not support the idea that a person can have an addictive personality. However, research does show that several traits are common among substance abusers. These traits are thought to be one group of risk factors for tobacco, alcohol, and drug use and abuse:

• sensation seeking, or wanting to try new experiences
• hostility or aggressiveness
• impulsiveness
• disinhibition (poor control over behavior)
• low self-esteem
• social conformity
• being very emotional or consistently having negative emotions

This does not mean that anyone who has these traits will abuse substances. In fact, some or all of these traits and behaviors may be a normal phase of adolescence. However, individuals who show these traits very early in childhood and then throughout life are at higher risk for substance abuse. This risk increases when the individual also has a family history of alcohol or drug abuse, when the individual's peer group is one that engages in troublesome or illegal behaviors, and when drugs are easily available.

When personality traits become extreme and inflexible, they can interfere with day-to-day functioning and cause distress for the individual or those closest to him or her. When the individual has several problematic personality traits for a number of years, has significant problems stemming from these traits, and behaves in ways

that are sharply different from the norms of his or her culture, the person may be given a psychiatric diagnosis of personality disorder. Often, a personality disorder may be less distressing to the person who has it than it is to others. As a result, people with personality disorders are not motivated to change or seek help unless their behavior causes social problems or they also have another psychiatric disorder that is causing them distress. People with both a substance use disorder and another form of mental illness, such as depression , have a dual diagnosis.

Personality disorders are the most common type of psychiatric disorder found in substance abusers. Based on many research studies, personality disorders are found in 50 to 75 percent of substance abusers. The current system for diagnosing personality disorders has sparked significant controversy in the field of mental health. With the current diagnostic system (DSM-IV Axis II), there are ten different personality disorders that can be diagnosed, each with its own grouping of traits. Among substance abusers, Antisocial, Borderline, Avoidant, Dependent, and Paranoid are the more common personality disorders. Histrionic, Narcissistic, Schizoid, Schizotypal, and Obsessive-Compulsive Personality Disorders are less frequent, but still more common among substance abusers than among people who are not substance abusers.

The personality traits that come to define a personality disorder are usually recognizable by adolescence. However, most teenagers will not be diagnosed with a personality disorder until they reach adulthood. By that time, a long-term personality pattern shows consistent evidence of interfering with work or family functioning. Until then, it can be hard to tell the difference between personality problems that are common or limited to adolescence and problems that will become chronic (long-term) characteristics of a personality disorder.

When a person has a personality disorder in addition to a sub- stance abuse problem, he or she has an increased risk for suicide, hospitalization, repeated treatments, and HIV infection due to risky drug use or sexual behaviors. Such an individual may act abusively toward others and have family, employment, and legal problems. The presence of personality problems combined with substance abuse almost always indicates a need for professional treatment of some sort in addition to community interventions provided by school, church, or self-help meetings. Personality disorders are difficult to treat and usually require several years of psychotherapy. Medications are sometimes helpful in controlling extreme moods or behaviors. In some cases personality disorder can improve over time as the person ages.

see also Diagnosis of Drug and Alcohol Abuse: An Overview; Risk Factors for Substance Abuse; Suicide and Substance Abuse.