Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
Curr Opin Psychiatry. 2020 Jan;33(1):51-56. doi: 10.1097/YCO.0000000000000558.
Personality disorders, mental disorders marked by long-term deviations from societal expectations that cause distress, and substance use and related disorders (SUDs), mental disorders marked by engaging with substances or behaviors that activate the brain's reward system to the point that normal activities are neglected, are common debilitating conditions. Personality disorders and SUDs are highly comorbid, potentially resistant to treatment, and their presence increases all-cause mortality, particularly when found together.
The present review highlights the most notable findings on prevalence, comorbidity, biological and behavioral pathways between the disorders, impact on incarcerated people and treatment for the disorders.
Personality disorders and SUDs are relatively common, highly comorbid, and increase the risk of all-cause mortality: particularly in those who have both conditions. Possible shared pathways between personality disorders and SUDs include emotional dysregulation, shared genes, and certain neurotransmitters. Personality disorders and SUDs are common in people who have been incarcerated, and this morbidity and comorbidity has been found throughout the world. Finally, comorbidity between personality disorders and SUDs greatly complicates treatment, with emerging treatment modalities such as mentalization-based treatment, schema modes, and attentional training showing potential, but lacking strong evidence of efficacy.
人格障碍、以长期偏离社会期望为特征并导致痛苦的精神障碍、物质使用和相关障碍（SUD）、以参与激活大脑奖励系统的物质或行为为特征并导致正常活动被忽视的精神障碍，这些都是常见的使人衰弱的疾病。人格障碍和 SUD 高度共病，可能对治疗有抵抗力，它们的存在会增加全因死亡率，尤其是当它们同时存在时。
本综述强调了关于患病率、共病、障碍之间的生物和行为途径、对被监禁者的影响以及障碍治疗方面最显著的发现。
人格障碍和 SUD 较为常见，高度共病，并增加全因死亡率的风险：特别是在同时患有这两种疾病的人群中。人格障碍和 SUD 之间可能存在共同途径，包括情绪调节障碍、共同的基因和某些神经递质。在被监禁者中，人格障碍和 SUD 很常见，这种发病率和共病性在世界各地都有发现。最后，人格障碍和 SUD 之间的共病大大增加了治疗的复杂性，新出现的治疗方式，如基于心理化的治疗、模式模式和注意训练，显示出潜力，但缺乏疗效的有力证据。
