Association of personality disorders with Type A and Type B alcoholics

ORIGINAL PAPER

Abstract

Personality disorders frequently occur as comorbid disorder in alcohol–dependent subjects. Antisocial personality was described as an important characteristic in Cloninger's Type 2 and Babor's Type B subjects. The impact of other personality disorders on these alcoholism typologies, their pathogenesis and prognosis is, however, still unclear. The present study investigated the prevalence of personality disorders in 237 (194 males) detoxified alcohol–dependent patients after subtyping this sample according to Babor's Type A/B following the criteria suggested by Schuckit et al. (1995). Personality disorders were assessed with the SCID–II (DSM–IV). In all, 160 patients (68 %) could be classified as Type A, and 77 (32 %) as Type B.Type B subjects were younger, had an earlier onset,more alcohol intake and a more severe course of alcohol dependence. Type B patients had significantly more often any cluster A and B personality disorder, and significantly specifically more often a borderline, antisocial and avoidant personality disorder. There were no statistical differences concerning the other personality disorders. In summary, the Type A/B dichotomy using the criteria of Schuckit et al. (1995) was replicated successfully. Differences concerning cluster B personality disorder prevalence of Type B subjects demonstrated that these subjects are significantly more often affected from borderline and antisocial personality disorder. The impact of other personality disorders does not play a substantial role in subtyping alcoholics.

Key words

personality disorder alcohol typology 

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References

  1. 1.
    Andreoli A, Gressot G, Aapro N, Tricot L, Gognalons MY (1989) Personality disorders as a predictor of outcome. J Personality Dis 3:307–320Google Scholar
  2. 2.
    Anthenelli RM, Smith TL, Irwin MR, Schuckit MA (1994) A comparative study of criteria for subgrouping alcoholics: The primary/ secondary diagnostic scheme versus variations of the type 1/type 2 criteria. Am J Psychiatry 151:1468–1474Google Scholar
  3. 3.
    American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, ed 3, revised. Washington, American Psychiatric Press, 1987Google Scholar
  4. 4.
    Babor TF, Hofman M, DelBoca FK, Hesselbrock VM, Meyer RE, Dolinsky CS, Rounsaville BJ (1992) Types of alcoholics: I. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Arch Gen Psychiatry 49:599–608PubMedGoogle Scholar
  5. 5.
    Babor TF, Webb C, Burleson JA, Kaminer Y (2002) Subtypes for classifying adolescents with marijuana use disorders: construct validity and clinical implications. Addiction 97(Suppl 1):58–69PubMedGoogle Scholar
  6. 6.
    Bahlmann M, Preuss UW, Soyka M (2002) Chronological relationship between antisocial personality disorder and alcohol dependence. Eur Addict Res 8:195–200CrossRefPubMedGoogle Scholar
  7. 7.
    Ball SA (1996) Type A and B alcoholism: applicability across subpopulations and treatment settings. Alcohol Health Res World 20:30–35Google Scholar
  8. 8.
    Ball SA (2004) Splitting lumps: Type B or not Type B; that is the question: A comment on Windle and Scheidt. Addiction 99: 1608–1611Google Scholar
  9. 9.
    Bottlender M, Bottlender R, Scharfenberg CD, Soyka M (2003) Efficacy of outpatient treatment for alcoholism – Impact of personality disorders on course of treatment. Psychother Psych Med 53:1–6Google Scholar
  10. 10.
    Bucholz K, Cadoret R, Cloninger C, Dinwiddie S, Hesselbrock V, Nurnberger J, Reich T, Schmidt I, Schuckit M (1994) A new, semistructured psychiatric interview for use in genetic linkage studies. A report on the reliability of the SSAGA. J Stud Alcohol 55:149–158PubMedGoogle Scholar
  11. 11.
    Cadoret RJ, Troughton E, Widmer RB (1984) Clinical differences between antisocial and primary alcoholics. Compr Psychiatry 25:1–8CrossRefPubMedGoogle Scholar
  12. 12.
    Cloninger CR, Bohman M, Sigvardson S (1981) Inheritance of alcohol abuse. Arch Gen Psychiatry 38:861–868PubMedGoogle Scholar
  13. 13.
    Cottler LB, Compton WM, Ridenour TA, Ben Abdallah A, Gallagher T (1998) Reliability of self–reported antisocial personality disorder symptoms among substance abusers. Drug Alcohol Depend 49:189–199PubMedGoogle Scholar
  14. 14.
    Driessen M, Veltrup C, Wetterling T, John U, Dilling H (1998) Axis I and Axis II comorbidity in alcohol dependence and the two types of alcoholism. Alcohol Clin Exp Res 22(1):77–86PubMedGoogle Scholar
  15. 15.
    Dundon W, Lynch KG, Pettinati HM, Lipkin C (2004) Treatment outcomes in type A and B alcohol dependence 6 months after serotonergic pharmacotherapy. Alcohol Clin Exp Res 28(7):1065–1073PubMedGoogle Scholar
  16. 16.
    Epstein EE, Labouvie E, McCrady BS, Jensen NK, Hayaki J (2002) A multi–site study of alcohol subtypes: classification and overlap of unidimensional and multi–dimensional typologies. Addiction 97:1041–1053CrossRefPubMedGoogle Scholar
  17. 17.
    Hallman J, von Knorring L, Oreland L (1996) Personality disorders according to DSM–III–R and thrombocyte monoamine oxidase activity in type 1 and type 2 alcoholics. J Stud Alcohol 75:155–161Google Scholar
  18. 18.
    Hesselbrock MN, Hesselbrock VM, Workman–Daniels KL (1986) Effect of major depression and antisocial personality on alcoholism: Course and motivational patterns. J Stud Alcohol 47:207–212PubMedGoogle Scholar
  19. 19.
    Hesselbrock M, Easton C, Bucholz KK, Schuckit M, Hesselbrock V (1999) A validity study of the SSAGA–a comparison with the SCAN. Addiction 94(9):1361–1370CrossRefPubMedGoogle Scholar
  20. 20.
    Hudziak JJ, Boffeli TJ, Kriesman JJ, Battaglia MM, Stanger C, Guze SB (1996) Clinical study of the relation of borderline personality disorder to Briquet's syndrome (Hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorder. Am J Psychiatry 153:1598–1606PubMedGoogle Scholar
  21. 21.
    Kosten TA, Kosten TR, Rounsaville BJ (1989) Personality disorders in opiate addicts show prognostic specificity. J Subst Abuse Treatment 6:163–168 Google Scholar
  22. 22.
    Kranzler HR, Burleson JA, Brown J, Babor TF (1996) Fluoxetine treatment seems to reduce the beneficial effects of cognitive–behavioral therapy in type B alcoholics. Alcohol Clin Exp Res 20(9):1534–1541PubMedGoogle Scholar
  23. 23.
    Marinangeli MG, Butti G, Scinto A, Di Cicco L, Petruzzi C, Daneluzzo E, Rossi (2000) Patterns of comorbidity among DSMIII– R personality disorders. Psychopathology 33:69–74CrossRefPubMedGoogle Scholar
  24. 24.
    Nace EP, Davis CW, Gaspari JP (1991) Axis II comorbidity in substance abusers. Am J Psychiatry 148(1):118–120PubMedGoogle Scholar
  25. 25.
    Nurnberg HG, Rifkin A, Doddi S (1993) A systematic assessment of the comorbidity of DSM–III–R personality disorders in alcoholic outpatients. Compr Psychiatry 34(6):447–454CrossRefPubMedGoogle Scholar
  26. 26.
    Raimo EB, Daeppen JB, Smith TL, Danko GP, Schuckit MA (1999) Clinical characteristics of alcoholism in alcohol–dependent subjects with and without a history of alcohol treatment. Alcohol Clin Exp Res 23(10):1605–1613PubMedGoogle Scholar
  27. 27.
    Reich JH, Vasile RG (1993) Effect of personality disorders on the treatment outcome of Axis I conditions: An update. J Nerv Ment Dis 181:475–484PubMedGoogle Scholar
  28. 28.
    Schuckit MA (1985) The clinical implications of primary diagnostic groups among alcoholics. Arch Gen Psychiatry 42:1043–1049PubMedGoogle Scholar
  29. 29.
    Schuckit MA, Tipp JE, Smith TL, Shapiro E, Hesselbrock VM, Bucholz KK, Reich T, Nurnberger JL (1995) An evaluation of type A and type B alcoholics. Addiction 90:1189–1203PubMedGoogle Scholar
  30. 30.
    Strand JG, Benjamin LS (1997) Resistence to change in individuals with personality disorders. Curr Opin Psychiatry 10:132–135CrossRefGoogle Scholar
  31. 31.
    Tadic A, Dahmen N, Szegedi A, Rujescu D, Giegling I, Koller G, Anghelescu I, Fehr Ch, Klawe Ch, Preuss UW, Sander T, Toliat MR, Singer P, Bondy B, Soyka M (2005) Polymorphisms in the NMDA subunit 2B are not associated with alcohol dependence and alcohol withdrawal–induced seizures and delirium tremens. Eur Arch Psychiatry Clin Neurosci 255(2):129–135CrossRefPubMedGoogle Scholar
  32. 32.
    Verheul R, van den Brink W, Hartgers C (1995) Prevalence of personality disorders among alcoholics and drug addicts: An overview. Eur Addict Res 1:166–177Google Scholar
  33. 33.
    Verheul R, van den Brink W, Hartgers C (1998) Personality disorders predict relapse in alcoholic patients. Addictive Behav 23:869–882CrossRefGoogle Scholar
  34. 34.
    Von Knorring AL, Bohman M, von Knorring L, Oreland L (1985) Platelet MAO activity as a biological marker in subgroups of alcoholism. Acta Psychiatr Scand 72:51–58PubMedGoogle Scholar
  35. 35.
    Windle M, Scheidt DM (2004) Alcoholic subtypes: are two sufficient? Addiction 99(12):1508–1519CrossRefPubMedGoogle Scholar
  36. 36.
    Wittchen HU, Schramm E, Zaudig M, Spengler P, Rummler R, Mombour W (1994) Structured Clinical Interview for DSM–IV, German version 2. 0. Goettingen, Beltz–VerlagGoogle Scholar
  37. 37.
    Zimmerman M (1994) Diagnosing personality disorders. Arch Gen Psychiatry 51:225–245PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  1. 1.Department of PsychiatryLudwig–Maximilians–UniversityMuenchenGermany
  2. 2.Johanna–Odebrecht–StiftungGreifswaldGermany

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