Comorbid Personality Disorders Diagnosis and Treatment

Sometimes, people struggle with more than one mental health condition at the same time. When this happens with personality disorders, it’s called “comorbid personality disorders.” Simply put, this means that a person meets the criteria for two or more personality disorders at once. It is possible for someone with Avoidant Personality Disorder (AVPD) to also show traits of Borderline Personality Disorder (BPD) or Obsessive-Compulsive Personality Disorder (OCPD).

Comorbidity is a challenge in mental health because it makes diagnosis and treatment more complex. And different disorders can overlap, leading to a mix of symptoms that are hard to untangle.

Understanding comorbid disorders is key to effective treatments, as mental health professionals need to see the full picture to create a plan that addresses all the challenges a person faces. Without proper understanding, treatment only focuses on one condition, leaving others unaddressed. Recognizing and treating a comorbid personality disorder helps those who suffer from it gain better control over their mental health.

What are Personality Disorders?

Personality disorders are common mental health conditions that affect how people think, feel, and behave. They often start in childhood or early adulthood, causing problems in relationships, work, and daily life. Unlike mood disorders that come and go, personality disorders are long-lasting, shaping how someone sees themselves and others.

People with a personality disorder might have trouble understanding how their thoughts and actions affect others, struggling with emotions, self-esteem, or boundaries that make it hard for them to connect with people or handle stressful situations. It is also possible for one person to have more than one personality disorder.

There are three main clusters of personality disorders:

Cluster A

Personality disorders that fall into cluster A are defined by odd or eccentric behaviors that make the person stand out, often affecting their relationships with others. People in this cluster may seem detached or have difficulty expressing emotions.

This includes:

• Paranoid Personality Disorder: An extreme distrust and suspicion of others.
• Schizoid Personality Disorder: Preference for being alone with limited emotional expression.
• Schizotypal Personality Disorder: Unusual thoughts, behaviors, and difficulty forming relationships with others.

Cluster B

Cluster B personality disorders are defined by dramatic, emotional, or erratic behaviors with unstable moods, a strong need for attention and approval, and a complete lack of empathy for others.

These include:

• Borderline Personality Disorder: Intense emotions, fear of abandonment, and unstable relationships.
• Narcissistic Personality Disorder: Grandiose sense of self, a need for admiration, and lack of empathy.
• Histrionic Personality Disorder: Attention-seeking and exaggerated emotions.
• Antisocial Personality Disorder: Complete disregard for others’ rights, impulsivity, and a lack of remorse.

Cluster C

People in this cluster tend to be excessively dependent on others, marked by an intense fear of rejection and often struggling with rigid routines and perfectionism. They generally display anxious or avoidant behaviors.

Personality disorders in this cluster include:

• Avoidant Personality Disorder: Extreme fear of rejection and feelings of inadequacy.
• Dependent Personality Disorder: Rely heavily on others for decision-making and emotional support.
• Obsessive-Compulsive Personality Disorder: Perfectionists are rigid and need excessive control.

Putting personality disorders into categories helps professionals understand and also treat personality disorders. However, people often show traits from multiple clusters – a personality disorder overlap – that makes each case unique.

Personality disorders aren’t about being difficult or stubborn – they are genuine mental health conditions that develop from a mix of genetic factors, early life experiences, and the environment in which the person exists. Recognizing each condition is important because it opens the route to effective treatments.

How Common Are Comorbid Personality Disorders?

It is actually common for people to have more than one personality disorder at the same time. Research shows that many people diagnosed with one personality disorder also meet the criteria for at least one more. This overlap happens because so many of the personality disorders share similar traits, like difficulties in forming relationships, intense emotions, or distorted thinking patterns.

Someone with Avoidant Personality Disorder, a disorder from cluster C, could, for example, also show traits of Dependent Personality Disorder. They will often feel inadequate and fear rejection while also becoming overly dependent on certain people to feel secure.

There are a few reasons why these personality disorders occur together. Genetics plays a big role as some personality traits are passed down in families, while trauma, neglect, and abuse shape how different personality disorders develop.

So many of these personality disorders affect similar areas of life, like emotions and relationships, making it easier for the symptoms to bleed into one another and become a comorbid personality disorder.

Recognizing comorbid personality disorders is important because it affects how mental health professionals diagnose and treat these conditions. Addressing only one disorder could mean missing the challenges the person is suffering, and understanding how common these overlaps are helps therapists and mental health professionals create better treatment plans tailored to the person’s needs^[1].

Common Comorbid Combinations

Can you have more than one personality disorder? Yes, it is a possibility. Certain personality disorders often appear together because they have traits and patterns that overlap. When someone has more than one personality disorder at a time, it creates unique challenges that affect their relationships, emotions, and behaviors.

Here are a few of the more common comorbid combinations:

Avoidant Personality Disorder (AVPD) and Dependent Personality Disorder (DPD)

These personality disorders both involve feelings of insecurity but in different ways. AVPD makes people want to withdraw because they’re afraid of being rejected. DPD, on the other hand, makes people overly reliant on others for support and decision-making. This combination of AVPD and DPD creates a back-and-forth where someone fears getting close to others but also feels they can’t function without that closeness.

Borderline Personality Disorder (BPD) and Histrionic Personality Disorder (HPD)

This combination is a challenge, and both involve intense feelings and relationship challenges in distinct ways. People with BPD have a fear of being abandoned, while those with HPD seek out attention from others. Together, they lead to unpredictable outbursts and trouble maintaining stable relationships with others. These outbursts could turn violent^[2].

Antisocial Personality Disorder (ASPD) and Narcissistic Personality Disorder (NPD)

These are two personality disorders that can occur together. People with this combination don’t care about others’ feelings (APSD) while also believing that they are superior and crave admiration (NPD). This results in manipulative or harmful behaviors that damage personal and professional relationships.

When personality disorders overlap, the symptoms can become even more severe and make life very difficult. Understanding the various clinical presentations is key for mental health professionals to create better treatment plans and address the unique ways these personality disorders interact and impact someone’s life.

Risk Factors for Comorbid Personality Disorders

There are a few factors that increase the risk of developing comorbid personality disorders. And, like personality disorders, they often overlap. Here are the most common risk factors that make it more likely for someone to show traits of more than one personality disorder:

Biological Factors/Genetics

Certain personality traits, like impulsivity or sensitivity to stress, can run in families, increasing the likelihood of developing multiple disorders. Genetics and brain function play a big role in affecting how someone processes emotions and interacts with others.

Psychological Factors

These typically stem from childhood experiences like neglect, trauma, abuse, or inconsistent parenting/parental presence. Psychological factors disrupt emotional development, leading to bad coping mechanisms. For example, a person who grew up feeling neglected might develop Avoidant Personality Disorder, while the same experiences could lead to the traits that define Borderline Personality Disorder in someone else.

Environmental Factors

Stressful life events, like bullying, abuse, and unstable relationships, all play a significant role in the development of personality disorders and worsen symptoms or trigger additional personality traits. Unrealistic expectations or stigma that come from societal and cultural pressures, too, can play a large role in complicating someone’s mental well-being.

When these factors combine, they create a more complex mix of behaviors and feelings, making it more likely for someone to meet the criteria for more than one personality disorder. Understanding the risk factors helps mental health professionals address the unique needs and traits of someone with comorbid personality disorders.

The Challenges of Diagnosing Comorbid Personality Disorders

Diagnosing multiple or comorbid personality disorders can be tricky, as symptoms of different personality disorders often overlap. Many of the conditions we have discussed share similar traits, like difficulties with relationships, self-image, or managing emotions.

Someone with comorbid BPD might show impulsive behaviors that could also be part of ASPD. This overlap makes it increasingly difficult for mental health professionals to determine whether one disorder is present, both disorders, or neither. They have to carefully examine the full picture to understand what’s going on.

Another challenge is that a person’s symptoms can change depending on their mood or environment. Someone might appear withdrawn in one setting while being more dramatic and emotional in another. This inconsistency leads to confusion and misdiagnosis as mental health professionals focus only on the most obvious symptoms while missing any underlying issues.

When comorbid personality disorders are identified, treatment becomes a bit more complicated. Each disorder requires a different approach. Having multiple disorders also makes treatment progress slower. Addressing one concern might magnify new challenges from another disorder that needs extra time and care.

A personalized treatment plan that addresses all the conditions or personality disorders someone is facing is the only possible solution to prevent violent outbursts that could result in fatality^[3].

Treatment for Comorbid Personality Disorders

Treating multiple personality disorders can be challenging, but it’s definitely not impossible. The key is to create a personalized approach that addresses all the symptoms and traits a person is facing.

Here are a few of the more common treatment options for comorbid personality disorders:

Psychotherapy

Psychotherapy is often the foundation of any treatment for personality disorders. Different types of therapy can be helpful, depending on the disorders involved.

• Cognitive Behavioral Therapy (CBT): This is most commonly used to help people change their thought patterns and behaviors. It is also useful for managing anxiety, self-esteem issues, and impulsivity.
• Dialectical Behavior Therapy (DBT): This is a form of CBT that focuses more on regulating emotions, improving relationships, and developing useful coping skills. DBT is also the most effective therapy for BPD.
• Schema Therapy: This therapy helps people recognize and change deep-seated patterns that developed in childhood and contribute to multiple personality disorders.

Medications

Medication can be a great addition to psychotherapy to help manage and treat the symptoms of personality disorders like anxiety, depression, or mood instability. While there is no medication specifically designed to treat personality disorders, doctors may prescribe antidepressants to improve the mood and reduce anxiety, mood stabilizers to help with emotional regulation and antipsychotics for the more severe symptoms like paranoia and intense mood swings.
Because no two people are alike, treatment should be tailored to fit unique needs.

Final Thoughts

Comorbid personality disorders are possible, and in most cases, a person might have more than one personality disorder at the same time. From diagnosis to treatment, each case should be carefully evaluated to ensure that no traits are overlooked and that treatment will improve quality of life.