Personality pathology and alcohol dependence at midlife in a community sample.

Abstract

The present study examined the association between personality pathology (PP) and alcohol dependence (AD; both lifetime and in the past 12 months) among middle-aged to older adults incorporating three sources of assessment, specifically, diagnostic interviews as well as self- and informant reports. We collected data from a representative sample of community participants (N = 1,630; ages 54 – 65 years) and their informants (N = 1,462). Measures employed were the substance use disorder sections of the Mini-International Neuropsychiatric Interview Schedule for Mental Disorders, the Structured Interview for DSM-IV Personality (American Psychiatric Association, 2000, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev.; DSM–IV–TR SIDP) and the NEO-Personality Inventory–Revised (Costa, P. T., & McCrae, R. R., Revised NEO-Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) manual, 1992, Odessa, FL, Psychological Assessment Resources; self-report and informant versions). To complement the diagnostic interview for personality disorders (PDs), we utilized a PD-count technique derived from the five-factor model (FFM), which provided an index of PP liability. Factors representing lifetime and past-12 month AD were regressed on each of the 10 PP factors constructed from the SIDP interview, as well as self-report and informant FFM-count scores. Lifetime diagnosis of AD was positively associated with higher scores on several PP measures, including paranoid, schizotypal, antisocial, borderline, histrionic, and narcissistic PP. There was an inverse relation between lifetime AD and the factor score for obsessive– compulsive PP. With regard to AD in the past 12 months, antisocial, borderline, histrionic, and narcissistic PP factors were significantly associated with increased risk for AD, whereas the obsessive– compulsive and schizoid PP factors were associated with decreased risk for AD. The present data indicate that features of antisocial and borderline PP continue to exhibit a relatively strong association with risk for AD in later middle age.

Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview, Self, and Informant Reports

“…This is, of course, exactly the kind of evidence that is needed to establish the validity of these diagnostic constructs (Kendell 2002). Our findings up to the present time indicate that symptoms of borderline PD are important in predicting various kinds of problems, including those associated with physical health (Powers and Oltmanns 2012), other mental disorders (Agrawal et al 2013; Galione and Oltmanns 2013), marital relationships (Weinstein et al 2012), and the onset of stressful life events (Gleason et al 2012). This is perhaps somewhat surprising in light of the fact that relatively few people in the study showed enough symptoms of borderline PD to meet a full diagnosis for that disorder, suggesting that these effects must hold for people who exhibit sub-threshold levels of symptoms.…”

Predicting problematic alcohol use with the DSM–5 alternative model of personality pathology.

“…Alternatively, it may be that our sampling method missed individuals whose disinhibition at younger ages has now led to more severe AUDs. Regardless of the precise mechanisms, these findings point to the need for future studies to examine personality pathology and alcohol misuse within a developmental framework in order to understand patterns of stability and change in the association between alcohol misuse and personality dysfunction (Agrawal et al, 2013; Vergés, Jackson, Bucholz, Grant, Trull, Wood, & Sher, 2012). …”

The Enduring Impact of Maladaptive Personality Traits on Relationship Quality and Health in Later Life

“…It is important to note, again, that this increase in the likelihood of reporting alcohol dependence occurs at subclinical levels—few individuals in our sample would actually receive a diagnosis of antisocial, borderline, histrionic, or narcissistic PD. Conversely, obsessive‐compulsive and schizoid PD traits, characterized by intense controlling behaviors and social avoidance, respectively, were associated with a decreased risk for alcohol dependence (Agrawal, Narayanan, & Oltmanns, ).…”