Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review

Abstract

Comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice. Borderline PD and antisocial PD are particularly found to be associated with SUDs. Our review suggests that the overall prevalence of PD ranges from 10% to 14.8% in the normal population and from 34.8% to 73.0% in patients treated for addictions. Even though the types of PD seen in patients with drug and alcohol use disorder are similar, the prevalence of any PD is higher among patients with drug use disorder than alcohol use disorder. The higher comorbidity between these two conditions has been explained by a primary personality pathology followed by a secondary development of a SUD. The comorbidity with PD positively correlates with the severity of the SUD. Comorbid PD among patients with SUDs is a predictor of poor prognosis in terms of poorer treatment response and outcome. Psychotherapy is the mainstay of treatment in comorbid condition with dialectical behavioral therapy, dynamic deconstructive psychotherapy, and dual-focused schema therapy having the most evidence base. Pharmacotherapy is primarily indicated for the acute crisis management or for the treatment of other comorbid conditions such as psychosis and depression. However, the evidence is insufficient as of now to suggest one treatment over the other. Further research is required to identify more efficacious treatment approaches for this comorbidity.

Discovery of Association Rules Patterns and Prevalence of Comorbidities in Adult Patients Hospitalized with Mental and Behavioral Disorders

“…Disorders of adult personality and behavior (F60-F69), unlike other individual mental and behavioral disorders, showed meaningful association rules only with accompanying mental disorders, not physical disorders, and it was more meaningful in the order of bidirectional path between mental and behavioral disorders due to psychoactive substance use (F10-F19) and behavioral syndromes associated with physiological disturbances and physical factors (F50-F59) and between mood (affective) disorders (F30-F39) and disorders of adult personality and behavior (F60-F69). This is related to the fact that character disorder is accompanied by depressive disorder, bipolar, and related disorders, substance use disorder, eating disorder, and other types of character disorder, or patients with these disorders are often accompanied by character disorder [41]. Personality disorders in Korea are more common in outpatient treatment than in the inpatient setting, and furthermore, there are many cases without treatment, so the results of this study on inpatients are limited.…”

Standard set of patient-reported outcomes for personality disorder

“…They are available in multiple formats, easily integrated into diverse data collection tools, are computer adaptive and can be used free of charge. A very important issue in mental health standard sets is comorbidity of PDs with other mental health disorders, such as substance use disorders [28], attention-deficit hyperactivity disorder [29] and schizophrenia [30]. Therefore, harmonization of measures across the mental health standard set, as well as among other standard sets that include the same domains, is an important issue, which was taken into account in the process of the selection of measures.…”

Pathway to care in co-occurring disorder and substance use disorder: an exploratory, cross-sectional study from India

“…Yet, this may affect the comparability of the two groups. We did not include personality disorders in the entire study sample as the prevalence among those with substance use disorder ranges between 34.8 and 73% (Parmar and Kaloiya, 2018). Given the high prevalence and low treatment seeking for personality disorders, we did not include them in the COD group.…”