A systematic assessment of the comorbidity of DSM III R personality disorders in alcoholic outpatients

Albert Einstein College of Medicine, New York, New York, United States
Comprehensive Psychiatry (Impact Factor: 2.25). 11/1993; 34(6):447-54. DOI: 10.1016/0010-440X(93)90073-D
Source: PubMed


To our knowledge, this is the first study to examine the systematic comorbidity of DSM-III-R personality disorders (PDs) in a sample of alcoholic outpatients. The extent and direction of overlap can provide a measure of heterogeneity and descriptive validity. Fifty sober alcoholic outpatients enrolled in a treatment program were assessed by Structured Clinical Interview for DSM-III (SCID) instruments for the presence of axis I and axis II disorders; 80% had either a coexistent axis I or II disorder, with 66% having an axis I disorder, 64% an axis II disorder, and 50% both axis I and II disorders. There were 84 PD diagnoses among the 32 PD patients (2.6/patient), with multiple diagnoses in 20 (62%). The most prevalent PD diagnoses were paranoid (44%), antisocial (20%), avoidant (20%), passive-aggressive (18%), and borderline (16%). Overlap was extensive and not confined to any one of the three designated axis II clusters. Poorer outcome was associated with the presence of PD. Personality variables may offer a means of further characterizing the heterogeneity observed in axis I disorders. Further refinement of the current system of PD classification and investigation into alternate models is needed.

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    • "Outcome studies of samples of SUD patients have shown that the co-occurrence of PDs has a high negative predictive value for future abstinence in both AUD and DUD patients [1,4,49,50]. It has been hypothesized that this is related to the PD patients’ lower ability to form treatment alliances [51] or their lower ability to cope with negative affects [52]. "
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    ABSTRACT: Background Assessment of comorbid personality disorders (PDs) in patients with substance use disorders (SUDs) is challenging due to symptom overlap, additional mental and physical disorders, and limitations of the assessment methods. Our in-depth study applied methods to overcome these difficulties. Method A complete catchment area sample of 61 consecutively admitted patients with SUDs, with no previous history of specialized treatment (addiction clinics, psychiatry) were studied, addressing PDs and associated clinical and demographic variables. The thorough assessments included the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Results Forty-six percent of the SUD patients had at least one PD (16% antisocial [males only]; 13% borderline; and 8% paranoid, avoidant, and obsessive-compulsive, respectively). Cluster C disorders were as prevalent as Cluster B disorders. SUD patients with PDs were younger at the onset of their first SUD and at admission; used more illicit drugs; had more anxiety disorders, particularly social phobia; had more severe depressive symptoms; were more distressed; and less often attended work or school. Conclusion The psychiatric comorbidity and symptom load of SUD patients with PDs differed from those of SUD patients without PDs, suggesting different treatment needs, and stressing the value of the assessment of PDs in SUD patients.
    Full-text · Article · Oct 2012 · BMC Psychiatry
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    • ". In particular, the samples of alcoholics studied by SCID-II show an high prevalence of antisocial, borderline, and paranoid PDs [10] [11] [12] [13] [14]. Gender differences in psychiatric disorders and alcohol abuse or dependence are well-known [15] [16] [17]. "
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    ABSTRACT: Alcohol abuse and dependence are frequently associated with psychiatric disorders and personality disorders (PDs) with differences among gender. However, only few studies investigated gender differences in PDs among alcoholics. The aim of this study was to investigate PDs in a sample of patients accessing inpatient alcohol detoxification treatment and to describe gender differences in prevalence and comorbidity of PDs. The study population consisted of 206 patients entering alcohol detoxification treatment in a specialized clinic in Italy. At enrollment, patients filled in the Millon Clinical Multiaxial Inventory-III for the assessment of PDs. The sample consisted of 150 males and 56 females. Twenty-five percent of males vs 12.5% of females had 1 PD; 16% vs 23%, 2 PDs; and 46% vs 48%, more than 3 PDs. A statistically significant higher proportion of females got high scores on avoidant (21.4% vs 9.3%), self-defeating (50.0% vs 24.0%), and borderline scales (42.9% vs 25.3%). Depressive, self-defeating, and borderline PDs were frequently associated both to other PDs and among each other, particularly among females. Borderline PD is confirmed to be more frequent among females than among males accessing alcohol detoxification treatment. More studies are needed to clarify prevalence and associations of PDs, prognosis, and gender differences in alcoholics patients.
    Full-text · Article · Aug 2011 · Comprehensive psychiatry
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    • "For example, Echeburúa et al. (2005) reported 2.5 times more personality disorders in alcoholics. In the literature, there is a strong incidence between alcoholism and borderline personality disorder (Morgenstern et al. 1997; Powell and Peveler 1996; Trull et al. 2000), antisocial disorder (Grant et al. 2004; Kessler et al. 1997; Morgenstern et al. 1997), paranoid disorder (Morgenstern et al. 1997; Nurnberg et al. 1993), avoidant disorder (Pettinati et al. 1999) and anxiety syndrome (Kessler et al. 1997; Kushner et al. 1990; Schneider et al. 2001). "
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    ABSTRACT: The objective of this study was to provide a psychological profile of parents who have been formally accused of child maltreatment. A clinical group of 16 parents accused of physical abuse and 22 parents accused of neglect were compared with 18 parents from a control group. The MCMI-III was administered individually for each parent. Both groups of maltreatment showed significant differences on different scales of the MCMI-III. No difference was seen between the parents of both groups of child maltreatment. Many parents of both child maltreatment groups reported at least one form of abuse during their childhood, suggesting that a childhood marked by abuse or neglect on the part of a parent could result in personality disorders and that these disorders may have something to do with the intergenerational transmission of abuse.
    Full-text · Article · Jan 2011 · Journal of Family Violence
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