Personality Disorders in Substance Abusers: Relation to Substance Use

Abstract

Previous studies have documented high but variable rates of DSM personality disorders (axis II) in clinical samples of substance abusers. Distinguishing between personality disorder symptoms that are independent versus substance-related (SR) is a particular challenge for diagnosing comorbid axis II disorders in substance abusers. DSM-IV guidelines currently recommend excluding axis II symptoms that are accounted for by an axis I disorder, including a substance use disorder. In this study, axis II diagnoses were made on a heterogenous clinical sample of 370 patients entering treatment for substance use disorders. Axis II diagnoses were made according to DSM-III-R criteria using the Structured Clinical Interview for DSM-III-R (SCID-II), which was modified to determine, on an item-by-item basis, whether symptoms were attributed to subjects' substance use disorders or independent of these disorders. The majority (57.0%) of substance use disorder patients met criteria for at least one comorbid axis II disorder, with cluster B (45.7%) being particularly prominent, especially antisocial personality disorder (ASP) (27.0%) and borderline personality disorder (BPD) (18.4%). Notably, inclusion of SR symptoms led to a substantial number of newly diagnosed cases, especially for ASP (19.2%) and BPD (11.4%). Including SR symptoms improved the reliability of ASP and did not change the reliability of BPD diagnoses. Generally, patients with SR and independent personality disorders had a similar clinical profile.

The association between gambling pathology and personality disorders

“…The body of research on substance abuse/dependence and personality disorders underscores the associations among these disorders. Multiple studies have identified high rates of comorbidity between Cluster B and substance use disorder diagnoses in treatment and community samples (Casillas & Clark, 2002;Taylor, 2005), even when substance abuserelated personality disorder criteria are removed (Rounsaville et al, 1998). In examining the longitudinal development of PGD, Slutske and colleagues (2005) found that "the personality profile associated with problem gambling was strikingly similar to the profiles associated with alcohol, cannabis, and nicotine dependence".…”

“…Axis II disorders also display high levels of comorbidity with each other . Furthermore, theorists have identified a lack of diagnostic and conceptual clarity between substance abuse/dependence, PGD, and personality disorders (Blaszczynski et al, 1989;Rounsaville et al, 1998). These relationships complicate analysis of associations among these conditions.…”

Race and Sexually Transmitted Diseases in Women With and Without Borderline Personality Disorder

“…17 BPD is perhaps the most common Axis II disorder in women with SUD, with prevalence ranging from 10% to 65%. [17][18][19][20] In the largest and most stringent study on the comorbidity of BPD in psychiatric patients to date, 59% of women with BPD had at least one lifetime SUD, including alcohol abuse or dependence, and 41% had at least one lifetime diagnosis of drug abuse or dependence. 21 In addition, BPD appears to be associated with new onsets of SUD, even in BPD patients who are in stable remission.…”

Diretrizes da Associação Brasileira de Estudos do Álcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias

“…24 Abuso de uma ou mais substâncias foram relatados por 76% de pacientes com transtorno da personalidade borderline (TPB) e por 95% dos pacientes com transtorno da personalidade anti-social (TPAS), em adultos jovens internados em um serviço psiquiátrico de hospital geral.…”