This is the sixth article in our series on Dual Diagnosis.
Narcissistic personality disorder, Borderline PD, Antisocial PD, and Histrionic PD are part of “Cluster B” – one of the three “clusters” among the ten personality disorders. Cluster B personality disorders are characterized as dramatic and erratic. There is also Cluster A (Paranoid PD, Schizoid PD, and Schizotypal PD) that are odd, bizarre, and eccentric, and Cluster C (Avoidant, Dependent PD, Obsessive-compulsive PD), known as anxious and fearful.
Substance abuse prevails among people with personality disorders. Research shows that about 40% to 50% of patients suffering from substance abuse meet the criteria for Antisocial Personality Disorder and Borderline Personality Disorder. Also, almost 90% of people diagnosed with Antisocial Personality Disorder also have a co-occurring substance use disorder.
Narcissistic and antisocial personality disorders have much in common. They are a part of Cluster B and many times there is a similarity in symptoms. However, they are different disorders that very often co-occur with addiction.
1. Narcissistic Personality Disorder and Addiction
Narcissistic Personality Disorder (NPD) characterizes with an emphasized sense of self as well as a lack of empathy. According to Mayo Clinic, “Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others.”
However, behind the picture of high self-esteem stands a vulnerable person sensitive to minor criticism. There is an association between Narcissistic Personality Disorder and cocaine. A study showed that “substance abuse and dependence may reflect attempts on the part of men with NPD not only to reestablish or maintain grandiosity but also to defend against negative affect accompanying mild depression.” The results of the research show that men with NPD often self-medicate to maintain the sense of grandiosity, protect their fragile self-esteem, and overcome feelings of depression and worthlessness.
Symptoms of Narcissistic Personality Disorder
The American Psychiatric Association published a Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this manual, they explain the criteria for diagnosing mental conditions. Their criteria for narcissistic personality disorder includes a presence of at least 5 of the following traits:
- The person has an inflated sense of importance, expects to be viewed as superior.
- The person obsesses over unlimited success, intelligence, beauty, ideal love or power.
- They believe in a uniqueness and specialness they “possess” and refuse to associate with others who don’t.
- Need an excessive amount of attention and admiration.
- Take advantage of other people for personal gain.
- Failed empathy for others.
- Display envy or suspects others envy them.
- Has an arrogant attitude.
There is a difference between people with Narcissistic Personality Disorder and people that show some narcissistic traits. The difference is in displaying problematic and maladaptive behaviors from people with NPD. If your loved one often shows emotional coldness, is extremely sensitive to criticism, acts snobbish, patronizing, and jealous, they might suffer from NPD. Other characteristics include:
- Preoccupation with how other people regard them and act furiously when they don’t get the treatment they think they deserve.
- Are aware of the pain they cause to others.
- They are extremely sensitive to criticism.
- Disrespect others when discussing their personal feelings.
2. Antisocial Personality Disorder
Antisocial Personality Disorder (APD) characterizes with a pattern of indifference and violation of the rights of others. The symptoms of patients suffering from this disorder vary from mild to severe. Therefore, the more dangerous and harmful behaviors are considered sociopathic or psychopathic. However, there is a difference between these two terms that are still under debate. Namely, sociopathy is a condition when something is severely wrong with the patient’s conscience. While psychopathy is a complete lack of conscience. Patients suffering from these two conditions express their symptoms towards other people. Some mental health professionals refer to patients with these conditions as “stone cold” to the feelings of others.
It’s unknown what causes this disorder. However, genetic and environmental factors are likely to affect the occurrence of the disorder. Research shows that the percentage of antisocial personality disorder is higher in people that have antisocial biological parents. When it comes to environmental factors, the person is more likely to develop this disorder when their role models show antisocial tendencies.
The Connection Between Antisocial Personality Disorder and Addiction
People that suffer from this condition tend to shift slowly from one behavior to another and behave in a certain pattern. These traits begin slowly, and usually around childhood people start to avoid them. This eventually leads to a suffering of APD from a desire to seek people with whom they can relate. Like people that take drugs or alcohol or behave in ways similar to theirs. People suffering from Antisocial Personality Disorder may feel misunderstood and therefore form bonds with people that abuse substances. This can quickly result in their consuming drugs and alcohol.
A study conducted by researchers at The Academy of Management Journal found that peer influence is strongly correlated to antisocial behaviors. For example, spending time with antisocial co-workers can lead a well-behaved employee to behave in similar antisocial ways. Consequently, if there are peers that abuse drugs or show antisocial behavior, other people might accept that behavior and start using drugs as well.
If left untreated, people with this dual diagnosis behave much worse. The symptoms of APD become more severe, as the person becomes more impulsive, violent, and is ready to do things he or she has never done in the past. Often, this could lead to criminal behavior and further isolation.
Symptoms of Antisocial Personality Disorder
People with antisocial personality disorder may fool you with their charm. Behind that picture is a person that’s likely irritable, aggressive, and irresponsible. They use their manipulative “skills” to lure people into believing they are something that they’re not. So it’s hard separating what’s true about them and what’s not. They also complain to have somatic symptoms and may attempt suicide. You can notice some triggers if you’re close to a person suffering from this disorder such as:
- Lack of remorse
- Superficial charm
- Disregard of any social morals
- Violation of both physical and emotional rights of others
- Lack of stability in family and in professional life
- A childhood diagnosis of conduct disorder
- Exploitation of others to get what they want
- Harm animals
- Express their opinion without considering to hear the other person
- Very often lie to hide their true self
The number of people that suffer from this condition is higher in those serving a prison sentence and affects more males than females.
3. Treatment of NPD and APD
Antisocial personality disorder is not diagnosed on people under 18 except if there is a history of “antisocial behaviors” as a part of conduct disorder before the age of 15. The diagnosis must be confirmed in a psychological evaluation by a mental health professional. It’s very common for this condition to comorbid with other personality disorders as well as with addiction. Therefore, a proper diagnosis leads to proper treatment for dual diagnosis. When there is coexistence with addiction the treatment is complicated. Consequently, out of the ten personality disorders, antisocial personality disorder is one of the most difficult to treat.
Unfortunately, there isn’t a known effective treatment for this disorder. People with the disorder rarely seek help on their own. But it’s crucial for a person after diagnose to enter a dual-diagnosis treatment center that addresses the nature of the addiction and the personality disorder at the same time.
For a person to overcome such a condition they need to connect to other people and get a sense of their needs. It’s important for them to understand the way other people feel and need. So treatment should begin early as the symptoms usually manifest when the person gets older. However, the results of this disorder throughout their lives can have serious consequences on other people. Therefore, it’s important to recognize the symptoms and take proactive measures that will improve their mental health.
- Medication that prevents relapse and decreases cravings
- Group and individual counseling
- Aftercare treatment – 12-Step programs, sober living, outpatient treatment or some holistic approaches.
How to Differentiate These Two Personality Disorders
Narcissistic Personality Disorder and Antisocial Personality Disorder are similar, making it hard for people to recognize the differences. Therefore, here are some key differences:
- Narcissistic people lack sociopaths’ aggression. People with APD look for a thrill while doing illegal things. And they do it without remorse. Narcissistic people rarely get arrested for violence.
- Narcissists often get verbally abusive, while antisocial personalities get more physically abusive.
- Narcissistic personalities are very lonely while antisocial personalities need no-one.
- Narcissists get deeply affected by criticism while antisocial personalities are invulnerable to criticism.
For more information please call our Addiction Treatment Helpline at (844) 439-4765. This is a Free and completely confidential call. We are available 24/7. In many cases, your health insurance company will cover 100% of the treatment cost. So please call now.