For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., (Gunderson JG. Borderline personality disorder: A clinical guide. Washington, D.C.: American Psychiatric Press, 2001; Leichsenring et al., Lancet 377:74-84, 2011; Paris J. Borderline personality disorder: A multidimensional approach. American Psychiatric Pub, 1994; Trull et al., Clin Psychol Rev 20:235-53, 2000)). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence (Trull et al., Clin Psychol Rev 20:235-53, 2000). Here, we provide an updated review of the literature on the co-occurrence between borderline personality disorder (BPD) and substance use disorders (SUDs) from 70 studies published from 2000 to 2017, and we compare the co-occurrence of these disorders to that documented by a previous review of 36 studies over 15 years ago (Trull et al., Clin Psychol Rev 20:235-53, 2000).

Utilizing personality science within clinical assessment and intervention can aid in treatment planning. General personality constructs also are related to clinically relevant areas of dysfunction. However, personality continues to be underutilized in clinical settings. This article reviews current literature pertaining to the clinical applications of personality with a focus on dimensional models such as the Five‐Factor Model. With the advent of a dimensional personality model in DSM‐5, the clinical use of traits is an important topic of exploration. This review discusses the clinical significance of personality and personality pathology in various aspects of living (i.e., functioning, physical health, mental health), clinical applications and utility within clinical and treatment settings, and future research directions, as well as suggestions for further utilization of personality traits.

Despite the emphasis on evidence‐based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM‐5 Section 2. This is perhaps not surprising given the complex heterogeneity and co‐morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.

Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing. Personality disorders are associated with myriad serious outcomes, have a high degree of co-occurrence with substance use disorders, including AUD, and incur significant health care costs. This literature review focuses on co-occurring AUD and personality disorders characterized by impulsivity and affective dysregulation, specifically antisocial personality disorders and borderline personality disorders. Prevalence rates, potential explanations and causal models of co-occurrence, prognoses, and the status of existing treatment research are summarized. Several important future research considerations are relevant to these complex, co-occurring conditions. Research assessing mechanisms responsible for co-occurring AUD and antisocial personality disorder or borderline personality disorder will further delineate the underlying developmental processes and improve understanding of onset and courses. In addition, increased focus on the efficacy and effectiveness of treatments targeting underlying traits or common factors in these disorders will inform future prevention and treatment efforts, as interventions targeting these co-occurring conditions have relatively little empirical support.

Background Understanding the comorbidity of alcohol use disorder (AUD) and other psychiatric diagnoses has been a long‐standing interest of researchers and mental health professionals. Comorbidity is often examined via the diagnostic co‐occurrence of discrete, categorical diagnoses, which is incongruent with increasingly supported dimensional approaches of psychiatric classification and diagnosis, and for AUD more specifically. The present study examined associations between DSM‐5 AUD and psychiatric symptoms of other DSM‐IV and DSM‐5 disorders categorically, and dimensionally organized according to the Hierarchical Taxonomy of Psychopathology (HiTOP) spectra (e.g., Internalizing, Disinhibited Externalizing). Methods The comorbidity of AUD with other psychological disorders was examined in 2 independent nationally representative samples of past‐year drinkers via an initial examination in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 2 and replicated in NESARC‐III. Results Analyses focusing on psychopathology symptom counts organized by spectra demonstrated that greater AUD severity was associated with a higher number of symptoms across HiTOP spectra. Traditional categorical analyses also demonstrated increasing prevalence as a monotonic function of DSM‐5 AUD severity gradients. Conclusions This study indicates that AUD and other psychiatric disorder comorbidity implies increased presence of multiple forms of psychopathology with a corresponding increased number of symptoms across hierarchical spectra. Greater AUD severity increases the likelihood of other psychopathology and, when present, “more severe” presentations. That is, on average, a given disorder (e.g., depression) is more severe when copresenting with an AUD, and increases in severity along with the AUD.