Addictions and Personality Disorders

Strengths Based Biopsychosocial Approach

to Recovery from Addictions and Personality

DisordersDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC

Executive Director, AllCEUs

Recovery & Resilience International in partnership with AllCEUs.com Unlimited CE for $59 | Webinars $5 | Specialty Certificates $89


Objectives Define Personality Disorders Examine the similarities between the

behaviors of certain personality disorders and addictions

Identify ways to address these behaviors and thought patterns

Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose

Why I Care/How It Impacts Recovery When personality disorders are viewed as pervasive & perpetual, it

Provides an “excuse for relapse” Often derails treatment because patterns of behavior thought to be due

to the PD are essentially ignored Personality Disordered & Addictive Behavior often look the same Goals for recovery from both:

Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness)

Distress tolerance and the ability to self-soothe Hope and faith in self/future/others through addressing cognitive errors Development of self esteem to eliminate need for external validation Development of healthy, supportive relationships



Personality Disorders Represent a cluster of behaviors that is

pervasive beginning before the age of 15. Addictive behaviors also often begin before 15 Due to immature cognitive development, children

tend to be more egocentric, overgeneralize and think in terms of dichotomies

From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child


Personality Disorders Treatment

Since these behaviors formed the foundation for further development patients must

Understand their function in the pastIdentify how these behaviors and beliefs are faulty

in the presentDevelop alternative skillsBe empowered to interface with the world with the

strengths, knowledge and tools of the adult


Addictions Represent one way to cope with distress Can begin early in life Have overlapping symptoms with personality

disorders, especially Cluster B


Addictions & Personality Disorders Cluster A (Paranoid, Schizoid, Schizotypal)

Characterized by social awkwardness and withdrawal

Often co-occur with addictions Cluster C (Obsessive-Compulsive; Dependent)

Characterized as anxious and fearful May co-occur with addiction

Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) Characterized by dramatic, emotional, erratic

behavior Behavioral patterns overlap with addiction


Addictions & Personality Disorders Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)

Characterized by Dramatic, emotional, erratic behaviorAll or Nothing thinkingHostility and AggressionHypersensitivityManipulativeLow Self-Esteem / Weak Self-Concept


Addictions & Personality Disorders Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)

Antisocial: Disregard for the rights of other peopleImpulsivityHostility and/or aggressionDeceit and manipulationSeem to lack empathy


Addictions & Personality Disorders Cluster B

HistrionicExcessive emotionality and attention seeking

May become enraged at perceived rejectionNeed to be the center of attentionInability to engage in authentic relationships but

uncomfortable being aloneImagine relationships to be more intimate in nature

than they actually areTend to be suggestible and easily influenced by

other people's suggestions and opinions.


Addictions & Personality Disorders Cluster B (Borderline, Narcissistic, Histrionic,

Antisocial) Borderline:

Low self-esteemFeel helpless, anxious and constantly fear abandonmentPerceptions of themselves and others may quickly

vacillate back and forthHypervigilantExtremely emotionally reactive with inability to de-

escalate Often have a history of neglect, abuse or a dismissive

style of parent-child attachment


Addictions & Personality Disorders Cluster B

NarcissisticPowerful sense of entitlementBelieve they deserve special treatment, and to

assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive.

Need to be powerful, and admiredLack of empathy for othersRelationships that are often superficial and devoid

of real intimacy


Addictions vs. Personality Disorders Take home message

Many behaviors characteristic of active addiction Overlap with personality disordersBegin in late childhood/early adolescenceAre pervasive

As people’s experiences and knowledge expanded, their coping skills and behaviors remained relatively primitive

Recovery from addiction requiresDevelopment of effective coping skillsAddressing cognitive distortions



Recovery from addiction requires addressing…Dramatic, emotional, erratic behavior

Distress Tolerance Mindfulness to identify and process the source of the

distress Coping skills

All or Nothing thinking Awareness and elimination of cognitive distortions (CBT)

Hostility and Aggression Understanding of the fight or flight response Development of anger awareness and management skills



Recovery from addiction requiresHypersensitivity esp. to rejection

Awareness of and addressing thinking errors Awareness and addressing abandonment issues Development of self-esteem

Manipulative Interpersonal skill development (boundary setting,

communication skills) Low Self-Esteem / Weak Self-Concept

Development of self-esteem and the ability to internally validate


Summary Most patients with addictions have traits associated with

personality disorders These traits can be loosely classified into

Thinking errors the perception of a threat Behavioral reactivity to escape or eliminate the threat

The first steps in the recovery process… Honesty with self and others (Mindfulness and Awareness) Hope & faith (Identifying cognitive distortions and thinking errors to

encourage and empower) Courage and discipline to remain constantly mindful, accept and

address thoughts and feelings, make conscious choices based on facts


Summary cont… A child growing up in an unstable, neglectful,

emotionally detached environment may develop PD traits to survive Addictions to numb the pain and escape from the lack

of control. Behaviors characteristic of addictions and

personality disorders Were learned and reinforced Will always be in the recesses of the toolbox Must be made less rewarding than alternative, healthy

behaviors

Addictions and Personality Disorders

Education

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