Personality disorders are a medically unique subset of mental disorders.
According to the DSM-5, a personality disorder is an enduring and inflexible pattern of behavior which significantly harms the person with the disorder. Personality disorders are not the result of any type of pharmaceutical or chemical substance, nor are they the result of another medical condition.
Alcohol & Personality Disorders
According to clinical studies, the prevalence of personality disorders with alcoholism ranges from as low as 22-40% to as high as 58-78%. The studies have focused primarily on antisocial and borderline personality disorders, however, almost the whole spectrum of personality disorders can be encountered in alcohol dependence, such as the dependent, avoidant, paranoid and others.
Personality Disorders and Substance Abuse
In a study done in 2012 (In-depth study of personality disorders in first-admission patients with substance use disorders) they discovered 46% of the substance abuse (SUD) patients had at least one Personality Disorder (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively).
Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school.
Clusters Of Personality Disorders
In order to better assist doctors in providing diagnosis and treatment for their patients, the DSM-5 has grouped the 10 known personality disorders into 3 distinct types of personality clusters. These disorders, as grouped, are:
Odd or Eccentric Personality Disorders
- Schizoid personality disorder – Disinterest or detachment from social relationships and difficulty expressing emotions
- Schizotypal personality disorder – Characterized by beliefs in the unusual, sometimes even paranormal, sufferers of this disorder tend towards extreme eccentricity and have great difficulty engaging in social interactions
- Paranoid personality disorder – A deep and constant distrust and assigning of malignant motives to even the most benign actions
Dramatic, Emotional, or Erratic Personality Disorders
- Borderline personality disorder – People who routinely experience dramatic mood swings that lead to self destructive behavior
- Narcissistic personality disorder – Individuals that experience an acute need for admiration and attention, often coupled with a near complete lack of empathy for others
- Antisocial personality disorder – A complete disregard for the rights and feelings of others and often characterized by highly manipulative behavior
- Histrionic personality disorder – Similar to narcissistic personality disorder in need for attention, but characterized more by a willingness to do anything, even engage in reckless sexual behavior, to enjoy that attention, rather than obtaining attention at a cost to others
Anxious or Fearful Personality Disorders
- Obsessive compulsive personality disorder – An unbending conformity to rules and structures, usually created by the person suffering from the disorder, at the cost of normal relationships and comfortable living
- Dependent personality disorder – An abiding need to be nurtured or supported by other people
- Avoidant personality disorder – A complete fear of any type of negative evaluation or social rejection that results in avoidance of most social interactions
Diagnosing Personality Disorders
Personality disorders can be found in approximately 10% of the population, with a particularly high prevalence among the homeless, though the causal relationship is almost certainly that personality disorders often result in homelessness, not vice versa. While there is a strong genetic component that increases the likelihood of blood relatives having the same personality disorders, few other factors seem to consistently influence the existence of these disorders. The single exception is that six of the disorders are more likely in males while three of the disorders are more likely in females and one disorder is split evenly among the genders.
Medical professionals test for personality disorder using a combination of techniques. Psychiatric evaluation is usually the most effective testing. Both psychiatrists and traditional doctors will ask specific questions to evoke emotional and behavioral responses. By comparing those responses to the symptoms of a specific disorder, as detailed in the DSM-5, doctors are able to pinpoint specific personality disorders. In some cases physical examinations may also be helpful, especially in order to rule out substance abuse as a cause for observed symptoms. Usually such examinations are performed in a controlled setting like a doctor’s office, but when attempting to diagnose younger children, or in other special cases, a doctor may perform such tests “in the wild.”
Treatment For Personality Disorders
There are more unique treatment options for personality disorders than there are unique personality disorders. This variety of treatment options makes it difficult to discuss common treatments.
A few generalities do apply, though. First, less than half of personality disorders meaningfully respond to pharmaceutical treatment. Pharmaceuticals are often prescribed for co-morbid depression or anxiety, but usually do little for the underlying problem.
Second, most personality disorders are also highly resistant to traditional forms of psychiatric treatment or counseling (individual or group). Personality disorders are biological in nature and rarely can be resolved through simple discussion.
More often than not, treatment involves getting the patient to acknowledge their personality disorder and then training the patient to recognize symptoms, so as to minimize their impact on themself and others. This is somewhat akin to putting a band-aid on a wound when it really needs stitches, but it is one of the most effective options. This particular approach does not represent a single treatment option, however, but instead represents numerous specific approaches and philosophies of treatment throughout the field.
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