Skodol A E, Oldham J M, Gallaher P E
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, USA.
Am J Psychiatry. 1999 May;156(5):733-8. doi: 10.1176/ajp.156.5.733.
The purpose of this study was to determine the extent of comorbid substance use disorders in patients referred for treatment of personality disorders.
Two hundred inpatients and outpatients were assessed by semistructured interviews for substance use and personality disorders. Univariate odds ratios were calculated for groups of substance use disorders and each DSM-III-R axis II disorder; comorbidity among axis II disorders was controlled in multivariate models predicting current or lifetime substance use disorder groups. The impact of personality disorder on chronicity and overall impairment associated with substance use disorders was evaluated.
Close to 60% of subjects with substance use disorders had personality disorders. Borderline personality disorder was significantly associated with current substance use disorders, excluding alcohol and cannabis, and with lifetime alcohol, stimulant, and other substance use disorders, excluding cannabis. Antisocial personality disorder was associated with lifetime substance use disorders other than alcohol, cannabis, and stimulants. These relationships remained significant after controlling for the presence of all other personality disorders. There was no evidence that personality disorders increased the chronicity of substance use disorders, but comorbid personality disorders were associated with greater global impairment.
Borderline personality disorder may be associated with a wide variety of substance use disorders, especially among patients seeking treatment for personality problems.
本研究旨在确定转介接受人格障碍治疗的患者中合并物质使用障碍的程度。
通过半结构化访谈对200名住院患者和门诊患者进行物质使用和人格障碍评估。计算物质使用障碍组与每种《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）轴II障碍的单变量优势比；在预测当前或终生物质使用障碍组的多变量模型中，控制轴II障碍之间的共病情况。评估人格障碍对与物质使用障碍相关的慢性病程和整体损害的影响。
近60%患有物质使用障碍的受试者有人格障碍。边缘型人格障碍与当前物质使用障碍（不包括酒精和大麻）以及终生酒精、兴奋剂和其他物质使用障碍（不包括大麻）显著相关。反社会人格障碍与除酒精、大麻和兴奋剂之外的终生物质使用障碍相关。在控制所有其他人格障碍的存在后，这些关系仍然显著。没有证据表明人格障碍会增加物质使用障碍的慢性病程，但共患人格障碍与更大的整体损害相关。
边缘型人格障碍可能与多种物质使用障碍相关，尤其是在寻求人格问题治疗的患者中。
