Is reported here a case of young patient with prevalent previous diagnosis of personality disorder, submitted to several neuropsychological tests and perfusion brain SPECT, in order to assess the relationship between substance abuse, the results of brain SPECT, done at the onset of symptoms of the psychiatric disorder, and an assessment of cognitive abilities. In particular, tests were used to assess cognitive flexibility, working memory, attention, short and long-term memory. This case shows the presence of a link between cognitive deficits, hypoperfusion in specific areas of the brain revealed by SPECT and the evolution of diagnosis from axis II to axis I, according to DSM IV-TR.