Personality Disorder and Alcohol Use Disorder: An Overview

Abstract

Background: Clinically, personality disorder (PD) commonly coexists with alcohol use disorder (AUD), although within mainstream mental health services both of these mental disorders are routinely overlooked. Despite a rich literature examining the interactions between AUD and personality functioning, personality traits, and PD, there remains conflicting evidence as to the degree of association and impact of one on the other. Methods: A narrative review and a synthesis of the literature were done. Results: The lifetime prevalence of AUD approaches 50% in some PD populations. The rates of PD in AUD populations are less clear but likely similar. Personality influences outcomes in AUD regardless of whether a categorical personality diagnosis or dimensional trait domain approach is taken. There are, however, no good data to inform clinicians on the impact of AUD on the outcomes of PD. Understanding the extent of this impact is complicated by the multiple tools used for diagnosis (of both PD and AUD) and the statistical methods used. Overall, caution is required in interpreting the data due to the quality of the current literature; however, comorbidity between the two disorders is likely significant and the impact of PD on AUD outcomes is sufficient to require consideration. Conclusions: From a research perspective, better agreement on both diagnoses and outcomes is urgently needed to improve the overall quality of the evidence. Clinically, despite the limitations in the literature, it is unacceptable for PD services to ignore AUD and for AUD services not to screen for PD. Both are likely to have an impact on health and functioning and should be considered in routine reviews. A better conceptualization of the putative mechanisms of this interaction, as well as an understanding of the neurobiology and reasons for the impact on treatment outcomes, will help to move the field forward.

Predictors of Psychiatric Outpatient Adherence after an Emergency Room Visit for a Suicide Attempt

“…[24][25][26] These include disinhibition, impulsivity, poor judgment, and underlying personality disorder in patients with problematic alcohol drinking. [27][28][29][30][31][32] In addition, alcohol use is also associated with low treatment adherence, which is related to the fluctuating nature of the personality of alcohol-dependent patients. 33 This study also suggests that patients who were drunken during their SA had low outpatient adherence, and that these patients required further intervention.…”

Psychiatric comorbidities in alcohol use disorder

“…For example, personality traits of people with personality disorders have been linked to known social and environmental risk factors for alcohol use disorder, such as deficient socialisation, school performance, family functioning, and deviant peers. [74][75][76] Although the role and strength of these mediating factors is not well described in the context of causal analysis, the known predictive power of these factors in personality disorder and alcohol use disorder is indicative for this potential indirect causal pathway.…”

Galenic syndromes: combinations of mental state and personality disorders too closely entwined to be separated

“…This joins up substance misuse in all its forms with the personality characteristics of disinhibition, recklessness and irresponsibility. 4 The third is the Diogenes syndrome, sometimes wrongly applied to hoarding disorder quite inappropriately, as Diogenes lived a sparse existence. The true Diogenes syndrome combines one part of autism spectrum disorder, formerly called Asperger syndrome, with the personality profiles of detachment and anankastia (obsessive-compulsive features).…”