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Personality disorders are some of the most disorienting mental health conditions for individuals and their families. People often become complete strangers to their friends and family. They also turn to drugs or alcohol to cope with mental anguish. Knowing how to address personality disorders and addiction means understanding the two and what is the correlation between personality disorders and substance use.

What are Personality Disorders?


The most recent version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) defines personality disorders as when a person experiences significant impairments in themselves and interpersonal functioning and other personality traits that occur at the same time.

For a person to have a personality disorder, their symptoms must be stable and consistent over a period of time. Their symptoms must also be distinct from any natural changes in development or an effect of the environment or living situation. Finally, personality disorders cannot result from substance abuse such as opioids or a medical disorder.

What are the 10 Personality Disorders?

The DSM-5 states there are ten different personality disorder types. These ten personality disorders are categorized into Cluster A, B, and C.

  • Cluster A is known as the odd and eccentric cluster. Individuals struggling with paranoid personality disorder and schizoid personality disorder fit into this category.
  • Cluster B is the erratic and dramatic cluster, including antisocial and borderline personality disorders.
  • Cluster C disorders are anxiety and fear-based personality disorders such as avoidant and obsessive-compulsive personality disorders.

Cluster A Personality Disorders

Cluster A personality disorders involve thoughts and behaviors others find unusual or eccentric. These personality disorders often lead to social problems.

Paranoid Personality Disorder

People struggling with paranoid personality disorder have a pathological distrust of others. They don’t even trust their close friends and family members. Someone with a paranoid personality disorder is always suspicious of people’s motives and thinks everyone wants to hurt them.

Other traits of paranoid personality disorder include:

  • Difficulty trusting others
  • Unjustified suspicion others are being disloyal
  • Being reluctant to confide in others out of fear people will use the information against them
  • Perceives innocent remarks as insults or threats
  • Gets angry about perceived attacks
  • Tendency to hold a grudge
  • Unjustified fear that a spouse or partner is being unfaithful

Schizoid Personality Disorder

A schizoid personality disorder is an uncommon mental health disorder. This disorder causes people to avoid social activities and struggle to display emotions. To the outside world, people with schizoid personality disorder seem humorless or cold.

Other characteristics of schizoid personality disorder include:

  • Preferring to be alone
  • Not enjoying or wanting close friends
  • Feeling unable to experience joy from anything
  • Difficulty expressing emotions
  • Trouble reacting appropriately to emotional situations
  • Feeling little to no desire to have sexual relations

Schizotypal Personality Disorder

Individuals struggling with schizotypal personality disorder are typically described as having unusual personalities. They have incredibly high social anxiety, distrust most people, and usually have a few romantic partners.

People with a schizotypal personality disorder also display the following:

  • Use a particular speech style or have an unusual speaking pattern
  • Lack close friends
  • Dress in unusual ways
  • Believe they have special powers, such as the ability to use their thoughts to influence events
  • Experiences unusual sensations like hearing voices that aren’t there
  • Has unique beliefs, behaviors, or mannerisms
  • Is suspicious of people without reason
  • Has inappropriate reactions

Cluster B Personality Disorders

Cluster B personality disorders are a group of disorders that affect people’s behavior. People are more likely to be dramatic and erratic.

Antisocial Personality Disorder

One of the better-known Cluster B disorders, antisocial personality disorder, occurs more in men than women. It is known for how it causes people to be unempathetic or disregard people’s feelings.

People struggling with an antisocial personality disorder also:

  • Refrain from paying attention to social rules
  • Are often aggressive
  • Act without thinking
  • Do not feel guilty for their behaviors
  • Are inflexible with their actions
  • Often have criminal records and have been in and out of jail many times

Borderline Personality Disorder

Individuals with borderline personality disorder often struggle with a sense of identity. This leaves them feeling abandoned and empty. Their relationships are often very intense but short-lived because symptoms cause the following:

  • Emotional instability
  • Violent outbursts
  • Threats of suicide

Borderline comes from an old theory that the condition was “borderline” neurotic and psychotic disorders. However, modern research theorizes that borderline personality disorder results from childhood sexual abuse. This disorder is more common in women than in men.

Histrionic Personality Disorder

Individuals with histrionic personality disorder base their overall well-being on the approval and attention of others. People even resort to dramatizing or histrionics to boost their self-worth. From the outside, it seems like they are overly obsessed with appearance and inappropriately desire attention.

There are many impulses behind their actions. Unfortunately, their actions can put them at risk of being exploited or manipulated. People with histrionic personality disorder usually have superficial romantic and social relationships because they:

  • Are overly sensitive to criticism
  • Cannot healthily process rejection or failure

The more rejection they feel, the more histrionic they become.

Narcissistic Personality Disorder

People with narcissistic personality disorder have an exaggerated sense of self-importance. They believe they are entitled to other people’s admiration. They are typically not empathetic to others’ feelings.

Cluster C Personality Disorders

Cluster C personality disorders have symptoms of intense anxiety and fear.

Avoidant Personality Disorder

People struggling with avoidant personality disorder believe they are socially awkward and unwanted. This leads to a legitimate fear of rejection or embarrassment. They try hard not to meet new people unless they are confident of being accepted.

Individuals with avoidant personality disorder typically have the following:

  • Childhood history of abusive criticism, which manifests as anxiety and avoidance in adulthood
  • Difficulty engaging in social situations due to being hyperaware of their awkwardness

Because people with avoidant personality disorder have a great awareness of their nuances, they feel inferior, and the more inferior they feel, the more aware they become.

Dependent Personality Disorder

People with dependent personality disorder have a deep need to be cared for to the point of being utterly dependent on others for both daily and important decisions. They also have an unhealthy fear of abandonment. This fear is from perceiving themselves as inadequate.

People with this disorder do not have a personality or a sense of responsibility. Additionally, they idealize their partners as great sources of power and comfort. Their partners typically have a Cluster B personality disorder since those with Cluster B disorders crave the high regard given by people with Cluster C disorders.

Anankastic (Obsessive-Compulsive) Personality Disorder

People struggling with anankastic personality disorder have an excessive obsession with perfectionism, preventing them from functioning normally. They are preoccupied with lists, details, rules, order, and organization. They will also put work ahead of relationships and get rest which is detrimental to their health.

This disorder has underlying anxiety due to a believed lack of control over the world. As a result they:

  • Overcompensate with things they can control
  • Have a desperate need to control others
  • Are afraid to take risks or improvise
  • Lack of patience for fine details

This personality disorder and its symptoms put a strain on co-workers and loved ones because of the perceived “flaws.”

Why are There Clusters?

Psychology Today reiterates that the characteristics of personality disorders are more the product of observation than scientific study—people with a personality disorder rarely present with symptoms that fit into one cluster. More than likely, they have a mix of symptoms across different clusters.

For example, a person with a Cluster A personality disorder likely has symptoms of paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

What is the Correlation Between Personality Disorders and Substance Abuse?


Almost one in four people with personality disorders also have a substance use disorder. People struggling with both personality disorders and addiction are said to have co-occurring conditions. But what is the correlation between personality disorders and substance use?

Individuals who struggle with personality disorders often use drugs and alcohol to cope. This is called self-medicating and happens when:

  • Someone with an avoidant personality disorder may use alcohol to cope with feelings of being socially awkward
  • Individuals with a paranoid personality disorder often use drugs or alcohol to escape negative or scary thoughts
  • People with borderline personality disorder may turn to drugs or alcohol to improve their mood and feel better about themselves.

Self-medicating is a form of substance abuse, and if it continues can lead to addiction. It can also worsen the symptoms and severity of both personality disorders and addiction.

Co-occurring personality disorders and substance abuse affects the parts of the brain responsible for reward, impulse, and regulating emotions. People with personality disorders are already prone to erratic behaviors, emotional instability, and anxieties. When drugs and alcohol are added, their emotions and behaviors become even harder to manage.

Additionally, it is harder to get them into treatment which is more complex with co-occurring personality disorders and addiction.

How Do You Treat Personality Disorders?

It can be challenging to treat personality disorders because of the beliefs and erratic behaviors that are deeply ingrained in people. Sometimes they refuse even to consider that they have a disorder. For example, a person with borderline personality disorder can be aggressive and hostile toward their therapist and simultaneously be overly needy.

Treating personality disorders entails deep psychotherapy sessions to stop the pattern of  unhealthy thoughts, beliefs, and behaviors. A comprehensive treatment plan includes dialectical behavior therapy or DBT. DBT has connections to cognitive behavioral therapy (CBT), which helps treat co-occurring personality disorders and addiction.

How Do We Address Personality Disorders and Substance Abuse?

Dialectical behavior therapy teaches people how to accept the emotions that cause them distress. With the help of coping skills and mindfulness, people can learn to accept their disorder without looking for validation. DBT is also useful in treating co-occurring substance use disorders.

Medications can also help address the anxiety, depression, and obsessive behaviors of personality disorders and addiction.

Medications for treating personality disorders and substance abuse include:

  • Anti-anxiety medication – Xanax and Ativan
  • Anti-depressants – Selective serotonin reuptake inhibitors
  • Mood stabilizers – Tegretol
  • Antipsychotic medications – Risperdal and Zyprexa

A combination of medication and psychotherapy can help significantly with personality disorders and addiction. However, treatment involves a lot of work and should be ongoing.

Get Help Today at Casco Bay Recovery


Struggling with personality disorders and substance abuse can leave you feeling isolated and alone. But there is help available. At Casco Bay, we understand your unique needs and help you on your journey to recovery. Contact us today to find out more.