Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA.
J Abnorm Psychol. 2011 Aug;120(3):656-69. doi: 10.1037/a0023539.
Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.
临床和基于人群的样本表明，物质使用障碍（SUDs）和轴 II 人格障碍（PDs）之间存在高度共病。然而，轴 II 障碍经常相互共病，并且现有研究通常未能区分 SUD/PD 共病在特定类型的 PD 和特定类型的 SUD 方面是普遍的还是特定的。我们试图确定表面上特定的物质依赖-轴 II 诊断（例如，酒精使用依赖和边缘型人格障碍）是否反映了更普遍或一般的人格病理学，或者共病是否特定于个体 PD。对来自美国家庭的 34653 名成年人的全国酒精和相关条件流行病学调查的第 1 波和第 2 波进行了面对面访谈数据的分析。我们使用层次因子模型来统计分离一般和特定的人格障碍维度，同时测试特定 PD-物质依赖关系。结果表明，物质依赖-轴 II 共病的特征是普遍（普遍）的病理和 B 群 PD 病理，而不仅仅是与一般 PD 因素的关系。此外，这些 PD 因素与物质依赖诊断之间的关系似乎在很大程度上解释了年轻参与者而不是年长参与者中物质依赖诊断之间的共病。我们的研究结果表明，如果不考虑一般 PD 因素，即我们认为反映人际功能障碍的因素，可能会导致对某些 PD 和 SUD 共病性质的潜在错误描述。
