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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Personality Disorders Often Come With Other Difficulties

Simone Hoermann, Ph.D. Updated: Jul 30th 2009

magnifying glass pointed at a green question markIn 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.

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.



Simone Hoermann, Ph.D.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. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

Reader Comments
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Malignant Narcissistic Husband - MARSTEP - Jan 4th 2010

Been married for 38 years to my childhood sweetheart.  We dated for 7 years and he treated me like a queen, thoughtful, compassionate, loving, the envy of my friends.  We married and he went to professional school and he became another person complete total anxiety we even talked how his personality had changed.  So I was determined to get him  the help he needed to turn back to his original personality.  We saw 15 different therapist and no one could understand what was going on.  He was completely controlling, never bought furniture, angry bursts which terrified me, felt I was "walking on eggshells", incredible stress, accusing me of doing things I didn't do but he often did, no rational to his threats to me and sex was like rape, no love or empathy, unable to touch him.  I was dumbfounded why we werent able to get help.   I was so desperate for health and almost died several times due to his lack of support.  My family and friends thought I was the crazy one because I cried all the time and they could not see him do any of the things I was saying. He did whatever he wanted.  We would discuss problems for couple hours then 2 days later he said he didnt even know we talked which I always thought was suscpicious because he wanted to do whatever he wanted.  Also he had a very poor self esteem. My health deterioted to be permanently disabled.  He never placed a hand on me.  It is a horrible situation to be in and no one could support me because he was so nice and supportive when everyone was around and made them think I was the crazy one!!!Everyone outside of my house loved him.  My family thinks I just needed to be more forgiving.  Losts all of my friends and family.  Felt deserted and he certainly was never there for me.  After many surgeries he never took care of me or had someone else take care of me because it was too expensive.  Lived like paupers yet he was a dentist.  Never let me know what was going on financially.   I was a complete basket and I was dealing with a chronic serious illness.  It took my doctors and the 16th therapist to convenience me that he was never going to get better.  He also was a chronic pathological liar.  But in Ca. I have to play his game of an "imaginary perfect life" or he will literally turn me out.  I am unable to get divorce due to severe metabolic health problems.  What can be done?  I feel so trapped!  No one can understand the emotional abuse and how severe it is to live with it.   

PD often comes w/ other difficulties. - Sue C - Aug 2nd 2009

Your article comes at a time when difficulty seems to be in swing again & not just for myself but also my late teenagers.  It is hard to talk with and get help for my late teen girls about issues I see as being all to familar in their happenings.  What I am running up against is:  1) they still know everything 2) it definately does not apply to them and 3) crazy mom really has nothing to say worth listening to.  Yes, what every other mom goes through but not with extreme problems rising such as- dramatic mood swings, anxiety, social phobia, anger, depression and bouts of highs since there childhood.

Its nice to talk about genetic markers and  environment.... but what about those who are living it?  Is there any solid advice for helping their loved ones managae it as it arises? Especially after 38 out of 43 years I am just getting the correct help I need. 

Thank you for your knowledge, Sue

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