Running head: SUBSTANCE ABUSE AND OTHER COMORBIDITIES WITH PARANOID PD
SUBSTANCE ABUSE AND OTHER COMORBIDITIES WITH PARANOID PD
Substance Abuse and other Comorbidities associated with Paranoid Personality Disorder
CLP4444: Personality Disorders
July 8, 2020
Personality disorders are the enduring pattern of behavior and inner experiences that significantly deviate from norm and culture. These traits are inflexible and persistent with their onset before age 18 and early adulthood. These attributes are persistent and stable over time and cause significant impairment in individuals’ functioning. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5R), 10 PDs categorized into three clusters. Paranoid Personality Disorder falls in the category of cluster A. Paranoid PD is usually defined as “a pattern of pervasive distrust and suspiciousness of others’ intentions in social contexts are interpreted as malevolent” (American Psychiatric Association, 2013). There are varied contexts in which individuals feel and express paranoid features, and they may be subject to stress or mental illnesses.
Substance Abuse and other Comorbidities associated with Paranoid PD
In Paranoid PD, comorbidities are common. There is rarely a sole diagnosis for Paranoid PD. Commonly found comorbidities are PTSD, Schizophrenia, Anxiety Disorders, social anxiety or social phobia, and alcohol or substance use disorders (SUDs). The diagnostic evaluation of Paranoid PD is critical to providing a comprehensive treatment plan; hence, it is essential to consider comorbid factors such as other personality pathologies and substance use, including alcohol consumption, or drug abuse. In clinical practice, comorbidity of substance use and personality disorders (PDs) is very common. Comorbid PD among patients with SUDs predicts poor prognosis in terms of treatment response and results. According to (Parmer & Gaurishanker, 2018), Paranoid personality disorder and drug use frequently co-occur. People with paranoid personality disorder often start taking substances to get respite from their pain and distress. Alcohol and drugs with a calming effect work as sedatives, and an individual’s anger fade away that they experience over a suspected deception or betrayal. But these effects prove temporary and short-term, followed by more intense feelings of distress and agony. These substances sometimes also act as a buffer.
Prevalence of Paranoid PD
The epidemiology of PD is relatively less researched compared to the other mental disorders, and empirical studies regarding paranoid PD are even more limited. There is a need to understand the underlying mental processes with reference to management principles. It can help mental health professionals to diagnose and develop managing plans for this complex and debilitating condition. According to (Triebwasser, Chemerinski, Roussos, & Siever, 2013), data analysis indicates that a high frequency of PPD revealed a fairly high frequency of PPD. The data from 914 medication-free, non-hospitalized individuals, show that more than one fourth fulfilled the criteria of PPD.
Comorbidity of SUDs among Paranoid PD
According to (Trull, Jahng, Tomko, Wood, & Sher, 2010), SUDs are most common in patients with personality disorders, and the risk of comorbid alcohol use is increased five times more, whereas the risk of drug use is as high as 12 times. The most common comorbid personality disorders are antisocial and borderline personality disorders, with prevalence rates around 15 percent. Cluster A personality disorders usually depict distorted thought patterns, and maladaptive behavior, and paranoid PD is the most common. The statistics reports from 4.5 percent to 10 percent of patients receiving drug or alcohol addiction treatment have a comorbidity of paranoid personality disorder. According to The National Epidemiological Survey on Alcohol and Related Disorders, Paranoid PD stands at number three in the list of personality disorders among people with alcohol use (Blanco et al., 2013).
(Langas, Malt, & Opjordsmoen, 2012) studied challenges related to symptoms of personality disorder and comorbidity of SUDs due to overlap symptoms. The study was conducted on 61 inpatients with SUDs, with no history of treatments. They were thoroughly assessed through Structured Clinical Interview for DSM-IV Axis II Personality Disorders and the Psychiatric Research Interview for Substance and Mental Disorders. The results indicate that 46% of the SUD patient had at least one PD. Cluster C and cluster B disorders were prevalent. Further study reports SUD patients with personality disorders were young adults at the start of their first use of drugs and admission.
The use of Cannabis and Paranoid PD.
Cannabis use is commonly seen in adolescence, and it tends to stay longer. According to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), Personality disorders (PDs) are associated with substance use, including cannabis. The NESARC also found that increased CU is linked with a greater frequency of schizotypal PD. Individual differences also appear to be linked with higher SUDs. In one study, (Gillespie et al., 2018) studied if the combination of PDs trait results predicts cannabis use (CU) among young adults. The researchers also investigated the size and significance of environmental and genetic risks in PD traits linked with CU and paranoid personality disorder. The study findings highlight that genetic risk factors in developing CU are stronger with Borderline personality characteristics.
The co-occurrence of the use of Marijuana and other Stimulants with Paranoid PD. Marijuana aggravates paranoid thoughts and further intensifies Marijuana-induced Paranoia. It can pose a serious threat to people suffering from paranoid PD. It can trigger manic episodes, and in some cases, violent behavior is also reported. The regular use of marijuana can lead to dissociative episodes frequently. People feel disconnected and detached from their feelings, thoughts, and physical sensations. To them, the world seems unreal. Long and continued use of marijuana can negatively affect overall thought patterns, and people may suffer from panic attacks and extreme anxiety.
(Langas, Malt, & Opjordsmoen, 2012). Similarly, high doses of raises risks of developing stimulant-induced psychosis. The symptoms here may resemble or overlap the symptoms of schizophrenia. It poses a complex situation in which an individual is irrational and can harm himself; it also leads to misdiagnosis of the disorder. According to (Akhgari, Etemadi-Aleagha, & Jokar, 2016), even when there is no extreme reaction after the use of stimulants, it generally worsens the symptoms of paranoia and anxiety. It makes the diagnosis of paranoid PD complicated.
Paranoid PD and Alcohol Consumption
The abnormal comorbidity of alcohol dependence with anxiety, substance abuse, and personality disorders was studied (Mellos, Liappas, & Paparrigopoulos, 2010). The analyzed the presence of these disorders with personality disorders as predisposing and contributing factors in the clinical settings, pathogenesis, and treatment results of alcohol dependence. The clinical and epidemiological findings support the prevalence of personality disorders in alcohol use, and dependence was recorded between 22-40% and 60-78%.
The literature determines mainly the antisocial and borderline personality disorders; whereas, the entire band of personality disorders can be linked to alcohol dependence, such as the avoidant, paranoid, and others. Multiple issues, including sampling technique, diagnostic criteria, or measurement techniques, may justify the wide range. Another study by (Ana et al., 2017) reports comorbidity between alcohol use disorder (AUD) and borderline personality disorder (BPD) is high and significant as alcohol use appears to worsen the symptoms of BPD. They also examined the effects of nelfamene on BPD symptoms. The drug not only improved the symptoms but also reducing alcohol use indirectly. The study evaluated the efficacy of an 8-week treatment in reducing alcohol consumption in people with BPD and comorbid alcohol use disorder. There was a significant reduction in alcohol consumption, self-injurious behavior, BPD symptomatology, and binge eating. The study supports nalmefene as an effective and safe drug to treat people with BPD with co-occurrence of AUD.
Substance Abuse and its impact on Paranoid Personality Disorder
The distorted thoughts led by unfounded suspicion is the hallmark symptom of paranoid PD. These people frequently doubt others of deception and betrayal. They read hostile and intimidating messages into neutral descriptions. They hold resentments and respond aggressively to perceived insults. They are obsessed and react impulsively over their fear and suspicions. It aggravates their condition, and they develop secondary depression and anxiety. Substance use helps them to get rid of psychological distress temporarily.
Other Comorbidities associated with Paranoid PD
Multiple studied examined the Anxiety Disorders (PTSD, Social Phobia) as a co-occurring disorder with Paranoid Personality Disorder. (Blanco, et al., 2013) reported that PTSD is one of the most frequently Anxiety Disorders in general practice, and it is often linked to personality disorders. Another research findings indicate that women who experience huge body-contact trauma are more prone to develop personality disorder, particularly Paranoid personality disorder.
Trust versus mistrust is a central dimension of human development, and some people are typically suspicious or mistrustful (McCrae & Costa, 2003). Erikson’s model of psychosocial stages of development offers and “elaborative and finely articulated theory” that provides a basic framework to understand various aspects of human personality. Paranoid personality disorder reflects a pervasive and persistent doubt and distrust of the intents of others (American Psychiatric Association, 2013). They are also hypertensive to criticism, and they tend to react aggressively to threats to their freedom. They hold grudges and persistently seek confirmation of their doubts. According to (Akhgari, Etemadi-Aleagha, & Jokar, 2016), people with paranoid PD are more prone to get attracted to powerful drugs such as cocaine, alcohol, and amphetamines. These drugs augment the need for control that is a significant part of this disorder. Individuals feel more powerful after using these drugs, and they seem to control the otherwise hostile and dangerous world. The use of illicit drugs, including amphetamines, cannabis, and cocaine, further increases paranoid thinking.
There is little literature available about Substance use and other comorbidities with Paranoid Personality Disorders. The reason can be people with paranoid personality disorder usually do not take help or look for treatment on their own. People do not realize it as a problem, and the nature of the disorder makes it difficult for people to believe that they are suffering from a mental health problem. They tend to mistrust others, and that makes it less likely to get professional help. Substance use complicates the situation by distorting the symptoms and making it tougher and more difficult to detect and treat. The use of different types of substances can make people with Paranoid PD feel dominant and controlling. Sometimes they also tend to react under the influence of these drugs.
Reference Akhgari, M., Etemadi-Aleagha, A., & Jokar, F. (2016). Street-level Heroine, an overview of its components and adulterant. Neuropathology of Drug Addictions and Substance Misuse, 867-877. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders – fifth edition. Washington, DC: American Psychiatric Association. Ana, M.-B., Barbara, P., Joaquim, S., Xero, G., Matilde, E., Miquel, G., . . . Pascual, J. C. (2017). Use of nalmefene in patients with comorbid borderline personality disorder and alcohol use disorder. International Clinical Psychopharmacology, 231-234. Blanco, C., Xu, Y., Brady, K., Pérez-Fuentes, G., Okuda, M., & Wang, S. (2013). Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: Results from the National Epidemiological Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 230-238. Gillespie, N. A., Aggen, S. H., Neale, M. C., Knudsen, G. P., Krueger, R. F., South, S. C., . . . Reichborn-Kjennerud, T. (2018). Associations Between Personality Disorders and Cannabis Use and Cannabis Use Disorder: A Population-Based Twin Study. Addiction, 1488-1498. Langas, A.-M., Malt, U. F., & Opjordsmoen, S. (2012). In-depth study of personality disorders in first-admission patients with substance use disorders. BMJ Psychiatry. McCrae, R. R., & Costa, P. T. (2003). Personality in Adulthood: A Five-factor Theory Perspective. New York: The Guilford Press. Mellos, E., Liappas, I., & Paparrigopoulos, T. (2010). Comorbidity of Personality Disorders with Alcohol Abuse. International Journal of Experimental and Clinical Pathophysiology and Drug Research, 761-769. Parmer, A., & Gaurishanker, K. (2018). Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review. Indian J Psychol Med, 517-527. Triebwasser, J., Chemerinski, E., Roussos, P., & Siever, L. J. (2013). Paranoid Personality Disorder. Journal of Personality Disorders, 797-805. Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality disorder diagnoses Gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord, 412-426.
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