Personality Disorders Often Come With Other Difficulties

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Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression ...Read More

In the next few blogs, I would like to write about some of the other emotional difficulties and issues that frequently go along with personality disorders. I have already mentioned substance use a couple of times, but there are a host of problems that tend to occur together with personality disorders. Some of these other problems, or some co-occurring diagnoses, could be viewed as related to the expression of a personality disorder. Alternatively, one problem might be causing the other, or the two difficulties may have a same underlying cause.

For instance, eating disorders, such as anorexia nervosa, bulimia, or binge-eating tend to co-occur with personality disorders, and particularly frequently with Borderline Personality Disorders. Many of the Borderline patients I have worked with whose symptoms of BPD include difficulties in regulating intense emotions tell me that restricting their food intake, despite the fact that it can be so dangerous to their health, is a way of feeling more in control and therefore helps them deal with intense feelings. Another example would be for someone with BPD to go on an eating binge in order to deal with intense stress.


Anxiety disorders and personality disorders also frequently go together and may be tough to distinguish. For instance, avoidant personality disorder is characterized by fear of rejection and embarrassment, which can look very similar to social phobia where a person may be excessively anxious in everyday social situations. The two disorders co-occur so frequently and look so similar that some experts believe they are the same thing, whereas others believe that avoidant personality disorder and social phobia are distinctly different problems. A recent study conducted in Norway by Ted Reichborn-Kjennerud and colleagues points towards identical genetic risk factors for avoidant personality disorder and social phobia, though the environmental risk factors that contribute to developing either avoidant personality disorder or social phobia appear to be different and unique for each disorder.

Another common problem is that people with a mood disorder, such as a major depressive disorder, or a bipolar disorder, i.e. episodes of euphoric or irritable mood alternating with depressed mood, can often also be diagnosed with a personality disorder. In fact, some experts believe that Borderline Personality Disorder, because of the frequent and sometimes dramatic shifts in mood and affect, might be a form of a mood disorder, or specifically of bipolar disorder. Another example that would illustrate how hard it can be to differentiate personality disorders from other problems would be the type of grandiosity, that is, the belief of a person that they have special powers, talents, or abilities, found in people who are manic, can look quite similar to the grandiosity found in Narcissistic Personality Disorders.

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Many therapists find that people with personality disorders have problems in their interpersonal relationships, such as mistrust, difficulties with modulating anger, or avoidance of close relationships, that make it hard to builld and maintain a lasting treatment relationship. There is some reasearch that indicates that, because of these difficulties,  treatment of symptoms of depression, anxiety or or other emotional problems can be complicated when a person also has a personality disorder.

Over the next few weeks, I will be spending some more time on discussing the different co-occurring diagnoses and issues, and will look at some of the research out there and at implications for treatment. In the meantime, I welcome and invite your thoughts and comments.


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