PERSONALITY-DISORDERS IN SUBSTANCE-ABUSERS - RELATION TO SUBSTANCE USE

Previous studies have documented high but variable rates of DSM person ality disorders (axis TT) in clinical samples of substance abusers. Di stinguishing between personality disorder symptoms that are independen t versus substance-related CSR) is a particular challenge for diagnosi ng comorbid axis II disorders in substance abusers. DSM-IV guidelines currently recommend excluding axis II symptoms that are accounted for by an axis I disorder, including a substance use disorder. Ln this stu dy, axis II diagnoses were made on a heterogenous clinical sample of 3 70 patients entering treatment for substance use disorders. Axis II di agnoses were made according to DSM-III-R criteria using the Structured Clinical Interview for DSM-III-R (SCID-IT), which was modified to det ermine, on an item-by-item basis, whether symptoms were attributed to subjects' substance use disorders or independent of these disorders. T he majority (57.0%) of substance use disorder patients met criteria fo r at least one comorbid axis II disorder, with cluster B (45.7%) being particularly prominent, especially antisocial personality disorder (A SP) (27.0%) and borderline personality disorder (BPD) (18.4%). Notably , inclusion of SR symptoms led to a substantial number of newly diagno sed cases, especially for ASP (19.2%) and BPD (11.4%). Including SR sy mptoms improved the reliability of ASP and did not change the reliabil ity of BPD diagnoses. Generally, patients with SR and independent pers onality disorders had a similar clinical profile.