The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist — homelessness and personality disorders — the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89) was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR) was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II). Cluster B personality disorders (antisocial, borderline, and narcissistic) avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a condition that begins in childhood but can continue into adulthood, and may be the cause of many disadaptive behaviors, as in the case of homeless people, who often display a high incidence of personality disorders. The goal of this study is to analyze the comorbidity of ADHD with axis II disorders in a Spanish homeless population.ResultsThe outcomes show high comorbidity between these two kinds of disorders, and that the prevalence of axis II disorders is higher among people with ADHD than among the general population.ConclusionsFrom these results we can draw the conclusion that in homeless people ADHD in childhood continues into adulthood, when it is very often observed together with personality disorders. Finally, the implications of this study both for clinical practice and for future lines of research are discussed.

En este estudio se lleva a cabo una investigación sobre comorbilidad en los trastornos de personalidad en personas sin hogar. El objetivo del estudio era analizar si existe comorbilidad entre trastornos. Para ello, se lleva a cabo un estudio ex post facto, de carácter transversal, con una muestra de 91 pacientes, que cumplimentaron una entrevista semiestructurada y el MCMI II, en el transcurso de su tratamiento. Los resultados muestran como en un 40,66% de la muestra, coexisten 2 o más trastornos de personalidad a un tiempo, con una media de 2,06 TP por persona. Además, los trastornos de personalidad del grupo B: antisocial, límite, histriónico y narcisista, son los que un mayor índice de comorbilidad presentan. Por el contrario, trastornos de personalidad del grupo C: obsesivo-compulsivo, por evitación o por dependencia, a pesar de tener mayor presencia, apenas presentan comorbilidad con otros. Por último, se comentan la implicación que tiene este estudio en la práctica clínica y líneas futuras de investigación.

BackgroundHomeless people have high dropout rates when they participate in therapeutic processes. The causes of this failure are not always known. This study investigates whether dropping-out is mediated by personality disorders or whether psychosocial problems are more important.MethodEighty-nine homeless people in a socio-laboral integration process were assessed. An initial interview was used, and the MCMI II questionnaire was applied to investigate the presence of psychosocial disorders (DSM-IV-TR axis IV). This was designed as an ex post-facto prospective study.ResultsPersonality disorders were very frequent among the homeless people examined. Moreover, the high index of psychosocial problems (axis IV) in this population supported the proposal that axis IV disorders are influential in failure to complete therapy.ConclusionThe outcomes of the study show that the homeless people examined presented with more psychopathological symptoms, in both axis II and axis IV, than the general population. This supports the need to take into account the comorbidity between these two types of disorder among homeless people, in treatment and in the development of specific intervention programs. In conclusion, the need for more psychosocial treatments addressing the individual problems of homeless people is supported.