Cluster A Personality Disorders and Addiction – A personality disorder is a profoundly ingrained pattern of behavior that deviates widely from the standards of generally accepted behavior. Signs of this condition are usually apparent by adolescence, and cause chronic difficulties in interpersonal relationships and/or functioning in society.
The four core features of personality disorders include the following:
- Distorted thinking patterns
- Problematic emotional responses
- Dysregulated impulse control
- Interpersonal problems
These four features are present in all personality disorders. Before a diagnosis can be confirmed, a person must display significant and persistent difficulties in two or more of those four areas.
These four essential features combine in a variety of ways to form ten specific personality disorders as identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Each disorder lists criteria that reflect the perceptible attributes associated with that disorder.
To be diagnosed with a distinct personality disorder, an individual must meet the minimum number of criteria designated for that disorder. Also, to meet the diagnostic requirements of a psychiatric disorder, the symptoms must result in functional impairment or distress. This means the symptoms are reported as being distressing to the person with the disorder and make it difficult for him or her to function in society appropriately.
The Three Clusters
The ten different personality disorders are sorted into three clusters based on descriptive similarities in each cluster. These include the following:
- Cluster A (odd, eccentric)
- Cluster B (dramatic, emotional, and erratic)
- Cluster C (anxious, fearful)
Of note, a person can be diagnosed with more than one personality disorder. Research has found that there is a propensity for personality disorders that are grouped into the same cluster to co-occur. There is an alternative model in development that aims to reduce this overlap by using a dimensional approach versus a categorical one.
Cluster A Personality Disorders
Cluster A is referred to as the odd, eccentric cluster. It includes paranoid, schizoid, and schizotypal personality disorders. The common traits of personality disorders in this cluster are social ineptness and withdrawal, which are further characterized by distorted thought.
Paranoid Personality Disorder
The paranoid personality disorder (PPD) is hallmarked by an intense distrust and wariness or suspiciousness of others and their intentions. People with this disorder believe that others are out to hurt them, take advantage of them, or embarrass them in some way. They put tremendous effort into protecting themselves and maintaining a wide distance from others.
Individuals with PPD are also known to attack others by whom they feel endangered. They tend to hold grudges, are hostile, and their jealousy is pathological. Their misunderstandings of the environment include perceiving harmless, benevolent comments or behavior as malevolent. Due to these reasons, they do not usually confide in other people or allow themselves to develop intimate relationships.
Schizoid Personality Disorder
The schizoid personality disorder (SZPD) is a relatively rare condition marked by a consistent pattern of social detachment and limited emotional expression. For this reason, people with this disorder are often socially withdrawn and do not appear to seek out or feel enjoyment from participating in close relationships. Rather, individuals with this personality disorder type almost always choose solitary activities that require minimal human interaction, and they also appear to experience little pleasure in life.
Emotionally, individuals with SZPD present as distant, indifferent, and cold. They are often unaware of social nuances and cues which causes them to come across to others as socially awkward and superficial. Their limited range of emotions and failure to reciprocate gestures or expressions may make them appear as somewhat vapid or absent-minded.
Schizotypal Personality Disorder
People with schizotypal personality disorder (STPD) are characterized by a consistent pattern of social and interpersonal restrictions. They experience marked discomfort in social environments and a reduced capacity for intimate relationships. For these reasons, like other cluster A disorders, they tend to be socially withdrawn, reserved, and aloof.
Unlike individuals with SZPD, however, individuals with STPD also encounter perceptual and cognitive distortions and may engage in eccentric behavior. These altered perceptions may include seeing flashes of light others do not see or detecting strange shadows or objects in the corner of their eyes before realizing that nothing is there.
Individuals with schizotypal personality disorder tend to have odd ideas. For example, an individual with STPD may erroneously believe they can read other people’s minds, or that their own thoughts seem to have been “stolen” from their heads. These strange or superstitious notions and fantasies are incongruous with cultural standards.
Schizotypal personality disorder tends to be more prevalent in families in which another member has been diagnosed with schizophrenia, which is another, often more debilitating mental illness with the defining feature being psychosis. Indeed, there is some evidence that these two distinct disorders do share some genetic similarities.
Personality Disorders and Addiction
Substance abuse and addiction are diagnosed in approximately 50% of those who have a personality disorder. However, those who abuse prescription or illicit drugs are diagnosed with personality disorders more frequently than those who abuse alcohol. Antisocial, dependent, narcissistic, and borderline personality disorders are the most common co-occurring diagnoses given to both drug and alcohol abusers.
A personality disorder typically exists before the addiction. Once individuals find that drugs or alcohol provide an escape from the inner loneliness and emotional conflicts they feel, addiction can develop effortlessly.
Moreover, an addiction to drugs or alcohol indicates that individuals must start associating with those who accept or encourage their addiction, such as dealers, bartenders, and others who know where to get drugs. This action then usually exacerbates addiction as well as mental illness.
Treatment for Addiction and Cluster A Personality Disorders
When employed separately, treatment for both addiction and cluster A personality disorder typically involve the use of a combination of medications, psychotherapy, psychoeducation, and self-help groups. Dual diagnosis programs work by addressing both mental illness and drug addiction concurrently, instead of as two separate disorders. Medical detox—the process of eliminating substances from the user’s system—is usually the first step in dual diagnosis treatment.
Once their body is free of toxins, a clinical team can better evaluate the patient’s personality disorder symptoms and identify the most effective course of treatment. Antipsychotics, antidepressants, and mood-stabilizing medications are often prescribed to help relieve symptoms of Cluster A personality disorders. While using medication to control symptoms, dual diagnosis patients also participate in various therapies to address the factors that contribute to their disorders.
Cognitive-behavioral therapy (CBT) is among the most common types of therapy used to treat co-occurring personality disorders and addiction. CBT helps the patient learn how to identify specific behaviors or ways of thinking that contribute to their addiction and/or mental illness and teaches strategies for managing symptoms.
Another common form of therapy used in dual diagnosis treatment is family therapy. Many people suffering from Cluster A personality disorders are members of high-stress families. Family therapy can help mitigate the amount and intensity of stressors that can serve as triggers for both personality disorders and substance abuse.
Recovery from substance abuse and the management of mental illness are absolutely achievable. If you or a loved one is experiencing co-occurring disorders, please contact Harmony Recovery Center as soon as possible to discuss treatment options and find out how we help people free themselves from addiction!