Personality disorders and tobacco

By Hind Yousef
Clinical and Health Psychologist

Personality disorders can cause a variety of complex and challenging mental health conditions. These disorders can impact all aspects of an individual’s life, including their behaviour, feelings, and interaction between themselves and others.

Tobacco use is often one manifestation of these disorders and can have serious implications on the health and well being of an individual. Personality disorders and smoking are two separate entities that are strongly connected. According to research, individuals with a personality disorder are more likely to indulge in substance abuse, including smoking.

Borderline Personality Disorder

There are different types of personality disorders, all of which can lead to the use of tobacco. Borderline personality disorder (BPD), for instance, is characterised by intense and unstable relationships, mood instability, and a fear of abandonment. Individuals with BPD may use tobacco as a means of coping with their constant emotional instability. They may also use cigarettes to cope with their self-harm behaviours or addictions. Individuals with personality disorders are more likely to smoke than those without a personality disorder.

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is characterised by feelings of grandiosity, a lack of empathy, and an overwhelming sense of superiority. This disorder can lead individuals to engage in risky behaviour, including excessive smoking. Individuals with NPD may view their smoking habit as a way to demonstrate their superiority over others and establish their sense of individuality.

Dependent Personality

When a person has a pervasive fear of being alone or losing the support of others, then this person has a Dependent Personality Disorder. This person may use tobacco to cope with feelings of anxiety or to manage stress. The smoking habit can provide a temporary sense of comfort, calm and security.

Schizoid Personality Disorder

When a person exhibits a lack of interest in and appreciation of social relationships, then this person suffers from Schizoid Personality Disorder. An individual with this disorder may use tobacco to regulate emotional responses, escape from social stimuli, or as a means to create a sense of comfort or familiarity with one’s surroundings.

Obsessive-Compulsive Personality Disorder

Persons with Obsessive-Compulsive Personality Disorder (OCBD) are less likely to smoke compared to the general population, but they are prone to other addictions.

The Link

So basically, all of these disorders indicate that there is a strong link between specific types of personality disorders and substance abuse, including smoking. Smoking has negative health effects on individuals with a personality disorder. Those with personality disorders are already vulnerable to the negative effects of smoking, such as cancer, heart disease and organ damage.

Smoking has shown to worsen symptoms of some personality disorders, such as depression and anxiety. The long-term effects of smoking, such as addiction and health issues, can further enhance the risk of developing a personality disorder or exacerbating existing symptoms.

Treatment

The treatment of personality disorders in individuals who smoke can be complicated. Quitting smoking and treating personality disorders simultaneously can often be difficult for patients. Many patients find it easier to put an end to their personality disorder treatments to continue smoking because smoking provides them with immediate gratification.

When treating patients with personality disorders and smoking, I take into account the long-term risks of smoking cessation and make them known to my patients. A balanced treatment approach that aims to address both health problems is ideal and can prevent the long-term effects of smoking on patients.

Individuals with personality disorders who smoke might not see quitting smoking as a priority. Many experience anxiety, depression and other negative emotions, which smoking relieves them of. 

A dual approach

To help smokers quit and prevent a relapse of the addiction, I often employ cognitive-behavioural therapy (CBT) that targets smoking addiction, particularly in tandem with other treatments for the personality disorder. I may have to adjust the course of treatment when patients are unwilling or unable to stop smoking, to prevent adverse effects.

A tailored approach integrating CBT for smoking addiction and other treatments for personality disorders can promote improved outcomes for patients. It is crucial to identify smoking disorders in personality disorder patients to help them quit and addiction treatment to prevent additional health risks.

For those in need, the Ministry of Health in Jordan has three smoking cessation clinics at Primary Healthcare centres (one clinic in each region: middle, north and south). They offer counselling and pharmacotherapy free of charge to smokers who desire to quit. These are the only available public health care centres for treatment. At King Hussein Cancer Centre, there is another smoking cessation clinic that provides counselling and pharmacotherapy mainly to cancer patients, as well as smokers from the general population, or, a person may visit private psychiatric clinics for mental health and addiction.

In the end, early intervention and appropriate treatment are necessary to help individuals manage their personality disorders and break free from tobacco addiction. Smoking has negative health implications for individuals with personality disorders and quitting smoking can pose a challenge along with personality disorder treatments.

Tobacco use can manifest itself as a symptom of various personality disorders. Individuals with these disorders may use tobacco as a coping mechanism, to manage stress, or to fill a void in their lives. As a result, addressing the root cause of each individual’s smoking habit is crucial in treating these disorders effectively.

Reprinted with permission from Family Flavours magazine