Mental Illness, Substance Use, Personality Disorder: The Triple Threat

If having a major mental illness is not enough, imagine the person with a major mental illness whom also has a substance use disorder and a personality disorder as well. They are those living with a triple threat to their existence, and are most assuredly living with psychological pain and suffering.

Most of you know what a mental illness is, and most particularly the three major mental illnesses: Schizophrenia (marked by hallucinations and/or delusionary thoughts), Bipolar Disorder (marked by mania and/or depression), and major depression.

For many years these disorders were treated primarily, without acknowledgement of a person using a chemical substance, such as ethyl alcohol or cannabis at the same time.

In the mid 1990’s this was about to change with the recognition of the “Dual Diagnosis;” the person with a mental illness and an alcohol or other drug diagnosis (although we are most aware that the term can be applied to a person with mental illness and an intellectual disability, etc. as well).

Over time the term “Dual Diagnosis” has changed to “Comorbidity” or “Co-occurring Disorder.” During that era treatment centers and clinics throughout the nation began assessing and treating the person with a Dual Diagnosis; generally providing medication for the mental illness, while at the same time detoxifying and providing needed treatment and counseling programs for the persons drug/alcohol problem; their chemical dependency…and this practice continues to this day.

Licensed Professional Counselors, and others working in the field of mental illness, have known about persons with a Personality Disorder for many years, in the clinics and treatment facilities of their employ. It was often noted that “there really is nothing you can do to treat their conditions,” that “we can only treat their mental illness and their addiction to chemical substances.” Just what is a personality disorder anyway?

A personality disorder is a result of traits of character developed over a lengthy period of time within an individual that usually present during adolescent years of the person.

The DSM-V, the guide to diagnosing mental disorders, substance use disorders, and personality disorders; defines a personality disorder as “An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture,” and is manifested in the ways of perceiving and interpreting self and other people, the affectivity of emotional response, in interpersonal functioning, and impulse control.

There are essentially seven types of personality disorders, such as the Antisocial Personality Disorder, Borderline Personality Disorder, etc. The development of a personality disorder becomes part and parcel of the individual’s complete life, and when added to having a mental illness and substance use disorder, the results could be (and often are) most disastrous.

The most common occurrence of personality disorder, as presented to my colleague previously mentioned, is the Antisocial Personality Disorder. According to the DSM, Antisocial Personality Disorder is a “Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years.”

It contains elements of failure to conform to social norms, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for safety of self or others, consistent irresponsibility, and lack of remorse. This person is most likely to have a Substance Use Disorder as well, and if they are diagnosed with a mental illness, then they are “Tri-Diagnosed”…having a “Co-morbidity” condition.

Recently there has been a tremendous up-swing in our nation of the number of persons diagnosed with a personality disorder, particularly with a diagnosis of Antisocial Personality Disorder.

In recent discussion with a long time colleague of mine, who works with persons with mental illness in a large Behavioral Health Clinic, we discussed the issues of persons with personality disorders, the increase of numbers of people with disorders, and the impact it has on treatment of their mental illness and substance use disorders.

I believe that one of the reasons that individuals with personality disorders has increased is due to the way our children are raised and their reactions to their environment. As example, individuals with an anti social personality development has manifested itself by the recent increase in school attacks and shootings, “deviation markedly from the expectations of the individual’s culture.”

Our youth of today are confronted almost all of the time with violence; the TV programs, the “virtual Reality” games of violence, violence in the movies, etc. For some of them, it becomes their worldly reality. This becomes a major problem among some of our youth, most particularly if their parents, teachers, and care-givers cast a “blind eye” on their interactions and behavior.

My colleague has noted the increase in clientele with a diagnosed Antisocial Personality Disorder, particularly over the past year…that’s in addition to the marked increase of individuals with mental illness and substance use disorders.

My colleague further relates that “it seems like almost all of my clients are now “tri-diagnosed”…it was difficult working with those with mental illness and substance use disorders…now with the increase in those additionally diagnosed with a personality disorder is has become much more difficult, stressful and taxing.”

The factual reasons for the increase are somewhat unclear at this time…is it due to the increase in our census, our population? Is it due to the more detailed assessment and evaluation of those presenting to our clinics? Or, is it indeed the result of the changing values and attitudes of our society in general?

In contemporary treatment venues, the “Tri-Diagnosed” individual is provided medication for their mental illness; abstinence education, counseling, and self-help group referral for their substance use disorder, and group/individual cognitive-behavioral counseling therapy which assists with all three diagnosis. Treatment efforts are not easy…it is most difficult, and requires a lot of training and effort for clinicians to do so.

Licensed Professional Counselors and other clinicians working in the fields of mental health and addictions are in perhaps one of the most difficult occupations on earth.

Subject to psychological and physical abuse, these brave “first responders” in the field of mental health, deserve to be recognized more for their service to our community, state, and nation. As we thank those who serve, or have served, in our military; we should thank mental health clinicians as well for their service.

Until Next Time, Stay Healthy My Friends!