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Related Experiment Videos

Personality disorders in substance abusers: relation to substance use

B J Rounsaville1, H R Kranzler, S Ball

  • 1Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA.

The Journal of Nervous and Mental Disease
|March 4, 1998
PubMed
Summary

Diagnosing personality disorders in substance abusers is complex. Including substance-related symptoms significantly increases the accuracy of diagnosing comorbid personality disorders, especially antisocial and borderline types.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Addiction Medicine

Background:

  • High rates of DSM personality disorders (Axis II) are noted in substance abuse clinical samples.
  • Distinguishing independent versus substance-related (SR) personality disorder symptoms is challenging for comorbid diagnoses.
  • DSM-IV guidelines recommend excluding Axis II symptoms attributable to Axis I disorders, including substance use disorders.

Purpose of the Study:

  • To determine the impact of including substance-related (SR) symptoms on diagnosing comorbid Axis II disorders in patients with substance use disorders.
  • To assess the diagnostic utility and reliability of including SR symptoms for specific personality disorders.

Main Methods:

  • Utilized DSM-III-R criteria and a modified Structured Clinical Interview for DSM-III-R (SCID-II) on 370 patients in substance use disorder treatment.

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  • Modified SCID-II to differentiate symptoms as substance-related or independent on an item-by-item basis.
  • Analyzed diagnostic rates and reliability for Axis II disorders, particularly antisocial personality disorder (ASP) and borderline personality disorder (BPD).

    • Main Results:

    • 57.0% of patients met criteria for at least one comorbid Axis II disorder; Cluster B disorders were most prevalent (45.7%).
    • Antisocial personality disorder (ASP) and borderline personality disorder (BPD) were particularly prominent (27.0% and 18.4%, respectively).
    • Including SR symptoms substantially increased new diagnoses for ASP (19.2%) and BPD (11.4%), improving ASP reliability without altering BPD reliability.

    Conclusions:

    • A majority of substance use disorder patients exhibit comorbid personality disorders.
    • Inclusion of substance-related symptoms is crucial for accurate diagnosis and improves diagnostic reliability for certain personality disorders like ASP.
    • Patients with SR and independent personality disorders generally share similar clinical profiles, supporting their integrated diagnosis.