Personality Disorders and Alcohol

Personality disorders and alcohol use disorder often influence each other in ways that make treatment and diagnosis difficult.

A personality disorder is an unchanging and enduring pattern of thoughts and behaviors that can cause difficulties in several areas of a person’s life. All personality disorders involve distorted patterns of thinking, inappropriate emotional responses, poor impulse control and social challenges.

Alcoholism and personality disorders commonly co-occur. People with alcohol use disorder may abuse alcohol as a means of coping with their intense emotions. When present simultaneously, alcoholism and personality disorders can be difficult to treat. However, recovery is possible with treatment that comprehensively addresses both conditions.

Effects of Alcohol on Personality Disorders

Research has found that the occurrence of personality disorders in those diagnosed with alcohol disorders rangesfrom as low as 22–40 percent to as high as 58–78 percent. Alcohol use cannot prompt the development of a personality disorder, but it can impact the progression by worsening a personality disorder’s symptoms and effects.

Some symptoms that worsen include:

• Increased impulsivity and risk-taking behaviors
• Erratic and poor decision-making
• Amplified mood swings
• Impaired emotional regulation
• More self-destructive actions
• Additional instability in relationships

Alcohol-induced personality disorders occur when alcohol triggers symptoms and signs of a personality disorder during intoxication or withdrawal. These signs may last for weeks but tend to disappear after a period of abstinence. Misdiagnosis becomes increasingly problematic in these cases, as attention is usually placed on personality disorder symptoms rather than alcohol dependence.

Borderline Personality Disorder and Alcohol

Borderline personality disorder (BPD) is a condition where individuals portray intense and inappropriate reactions, display high levels of impulsivity and have difficulty maintaining stability in their relationships. Individuals with BPD tend to have an intense fear of abandonment, experience powerful feelings of anxiety and depression and engage in risky and self-destructive behaviors.

Borderline personality disorder and alcohol abuse frequently co-occur, often because some individuals with BPD use alcohol to cope with and reduce the intensity of their symptoms, including:

• Powerful and erratic emotions
• Distorted self-perception
• Overpowering fear
• Anger and rage
• Depression
• Emotional emptiness

There may also be a genetic linkage with borderline personality disorder and drinking, as the two conditions share many mutual genetic pathways.

Antisocial Personality Disorder and Alcohol

There is a strong association between antisocial personality disorder and alcoholism. Antisocial personality disorder is characterized by a lack of regard for laws and authority. People who have antisocial personality disorder engage in dangerous behaviors, lack guilt and display low impulse control. These qualities make a person prone to addictive behaviors, with alcoholism being the one most common.

Alcohol addiction and antisocial personality disorder often prove to be a dangerous combination, as people with both of these conditions often display aggressive and destructive behaviors, including violence, sexual assault, child abuse and homicidal behaviors. Antisocial symptoms such as impulsivity, deceit and poor decision making also tend to worsen with alcohol use.

Studies show that an individual diagnosed with antisocial personality disorder is 21 times more likely to develop alcohol dependence. People with antisocial personality disorder tend to be young when they start alcohol use, use alcohol for extended amounts of time and form addiction-related problems quickly.

Narcissistic Personality Disorder and Alcohol

Narcissistic personality disorder occurs when an individual has an extravagant and overblown view of themselves and their importance. Narcissistic personality disorder and alcohol abuse share several similarities. Both conditions involve denial, as a narcissist believes that they are perfect, while denial allows addiction to develop. Narcissistic personality disorder and alcohol use disorder are both characterized by a lack of self-reflection, a sense of entitlement and an unwillingness to accept responsibility.

Nearly 22 percent of people with a narcissistic personality diagnosis also meet the diagnostic criteria for an alcohol use disorder. Some people with narcissistic personality disorder may use alcohol to cope with negative emotions and feelings. Alcohol use can heighten a narcissist’s feelings of entitlement and showiness while reducing empathy for others.

Can Personality Disorders Lead to Alcohol Abuse

Alcoholism and personality disorders co-occur frequently. However, the onset of a personality disorder usually occurs before alcohol dependence develops. Dysfunction in areas of the brain during childhood that controls emotional responsiveness may increase a child’s risk of developing a personality disorder and later trigger the development of alcohol dependence.

Individuals with personality disorders often have difficulty with emotional regulation and become increasingly susceptible to feelings of distress regarding personal, social and occupational difficulties. As individuals struggle with the symptoms of their personality disorder, alcohol can provide an emotional escape from feelings of low self-worth, isolation and emotional confusion. Similarly, alcohol may be used to help enhance positive emotions and overall feelings of well-being. Common personality disorder traits including impulsivity, emotional instability and negative affect may also account for high rates of alcohol abuse disorders.

Co-Occurring Alcohol Abuse and Personality Disorders Treatment

Personality disorder treatment can be challenging because many of the symptoms of these conditions can make it hard for a person to recognize that treatment is needed in the first place. Alcohol abuse serves to make these barriers more problematic, as it can increase the severity of symptoms or make it more difficult to detect and treat personality disorders.

Because of the complex way both of these conditions interact, alcohol abuse treatment must be conducted simultaneously with personality disorder treatment for treatment to be successful.

Treatment for a co-occurring alcoholism and personality disorder can result in positive outcomes if both conditions are addressed simultaneously. If you or someone that you know is struggling with alcohol dependence and a personality disorder, we can help.  Licensed professionals at The Recovery Village Drug and Alcohol Rehabcan assist you in choosing an effective treatment protocol for your alcohol use and personality disorder. Reach out today for more information.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Tracy Smith, LPC, NCC, ACS

Tracy Smith is a Licensed Professional Counselor, a Nationally Certified Counselor, an Approved Clinical Supervisor, and a mental health freelance and ghostwriter. Read more